Guest guest Posted November 7, 2011 Report Share Posted November 7, 2011 upadhya wrote: > > Hi, > > I have just been diagnosed with achalasia > Welcome to the club. > based on the barium swallow ( that showed a dilated oesophagus) and > the manometric results. I was hoping that somebody could look at the > interpretation and confirm that the diagnosis is accurate. > Well we can't diagnose but we are free to give our beliefs in a general way. > The patient had hihg resolution esophageal manometry performed on > 10/31. The Sandhill HRiM probe was placed down the nares. No > medication given and no difficulty seen. > > FINDINGS: > > 1) The LES: proximal LES was located at 40.6 cm, the distal LES was at > 45 cm, the total LES lenght was 4.4 cm.The LES pressure was at 23 mm, > normal between 10 and 45. The LES on residual pressure was l1.4, on > both the liquid and viscous swallow. This is elevated. Normal is less > than 8 mm. > > 2) Esophageal body; There is only 305 bolus transit with the liquid > swallow. Normal is greater than 80%. This was consistent with viscous > swallow. There was no complete bolus transit in viscous swallow. > Normal viscous swallow is greater that 70%. The mid-oesophageal > amplitude measured between 21 mm in the liquid which is normal. Normal > is between 30 and 180 mm Hg. In the viscous swallow, the > mid-oesophageal amplitude is 35 and 31 respectively. Again, normal is > between 30 and 180 mm Hg. The distal oesophageal pressure was 31 and > 37 for liquid and viscous. There was less than 20% peristaltic > contractions on liquid and viscous. There is 50% simultaneous > contractions with both liquid and viscous > > IMPRESSION: > There is gross abnormal oesophageal motility study with incomplete > bolus transit, 305 with liquids and 0% with solids.Esophageal > pressures were low to lower limits of normal. There was elevated LES > residual pressure. There was poor peristaltic contracstions and > simultaneous contractions. All these findings are consistent with > achalasia. > There seems to be some typos and half a sentence missing, but figuring what was likely being said, achalasia fits the findings. What it is saying is that the muscles that are suppose to move food down your esophagus (peristalsis) are not working right. They are sometimes weak and uncoordinated and only do what they are suppose to less than one fifth of the time. The Lower Esophageal Sphincter (LES), which is like a valve made of rings of muscles at the end of the esophagus, does not open as much as it should to let the food enter the stomach. Because of the problems, not as much of a swallow makes it into your stomach as it should. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 8, 2011 Report Share Posted November 8, 2011 Thanks notan, My GI was not able to indicate the extent of achalasia. he very quickly went down the route of Botox or surgery. The only thing he looked at initially was the Barium swallow report that indicated that the oesophagus was dilated. Later on, the manometry results followed. However, my GI never reviewed the Barium swallow films. Now, i am mnot sure if that is a good thing or not. I have an appointment with Dr. Westmoreland in Dallas Baylor Mmedical Center to review my case. So, hopefully, he confirms the diagnosis. Currently,I have transitioned to semi-solid foods and my symptoms have gone down to air trapped in the oesophagus. Is this a typical symptom? Regards, Santosh > > > > Hi, > > > > I have just been diagnosed with achalasia > > > > Welcome to the club. > > > based on the barium swallow ( that showed a dilated oesophagus) and > > the manometric results. I was hoping that somebody could look at the > > interpretation and confirm that the diagnosis is accurate. > > > > Well we can't diagnose but we are free to give our beliefs in a general way. > > > The patient had hihg resolution esophageal manometry performed on > > 10/31. The Sandhill HRiM probe was placed down the nares. No > > medication given and no difficulty seen. > > > > FINDINGS: > > > > 1) The LES: proximal LES was located at 40.6 cm, the distal LES was at > > 45 cm, the total LES lenght was 4.4 cm.The LES pressure was at 23 mm, > > normal between 10 and 45. The LES on residual pressure was l1.4, on > > both the liquid and viscous swallow. This is elevated. Normal is less > > than 8 mm. > > > > 2) Esophageal body; There is only 305 bolus transit with the liquid > > swallow. Normal is greater than 80%. This was consistent with viscous > > swallow. There was no complete bolus transit in viscous swallow. > > Normal viscous swallow is greater that 70%. The mid-oesophageal > > amplitude measured between 21 mm in the liquid which is normal. Normal > > is between 30 and 180 mm Hg. In the viscous swallow, the > > mid-oesophageal amplitude is 35 and 31 respectively. Again, normal is > > between 30 and 180 mm Hg. The distal oesophageal pressure was 31 and > > 37 for liquid and viscous. There was less than 20% peristaltic > > contractions on liquid and viscous. There is 50% simultaneous > > contractions with both liquid and viscous > > > > IMPRESSION: > > There is gross abnormal oesophageal motility study with incomplete > > bolus transit, 305 with liquids and 0% with solids.Esophageal > > pressures were low to lower limits of normal. There was elevated LES > > residual pressure. There was poor peristaltic contracstions and > > simultaneous contractions. All these findings are consistent with > > achalasia. > > > > There seems to be some typos and half a sentence missing, but figuring > what was likely being said, achalasia fits the findings. What it is > saying is that the muscles that are suppose to move food down your > esophagus (peristalsis) are not working right. They are sometimes weak > and uncoordinated and only do what they are suppose to less than one > fifth of the time. The Lower Esophageal Sphincter (LES), which is like a > valve made of rings of muscles at the end of the esophagus, does not > open as much as it should to let the food enter the stomach. Because of > the problems, not as much of a swallow makes it into your stomach as it > should. > > notan > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2011 Report Share Posted November 9, 2011 Hi everybody, I just shared my reports with Dr. Farzaneh Banki in Houston, who runs the Oesophageal Disease Center at Memorial-Hermann. She looked at my report and indicated that the symptoms are either early stages of achalasia or oesophageal spasms. She wanted to look at the video of the barium swallow instead of the still films to conclude on this. Unfortunately, it appears that most imaging centers do not record the voideos. Now I am thoroughly confused on what I actually have. The original line of thinking was the myotomy was the best option. Is there an issue with the diagnosis? Do doctors know how to interpret the data. I am meeting Dr. Westmoreland in Dallas tomorrow and will ask him the same question on the diagnosis. Regars, santosh > > > > > > Currently,I have transitioned to semi-solid foods and my symptoms have > > gone down to air trapped in the oesophagus. Is this a typical symptom? > > > > We are all different in the ways achalasia effects us, but yes, that > sounds like an achalasia kind of thing. > > notan > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2011 Report Share Posted November 9, 2011 Santosh wrote: > > ... She looked at my report and indicated that the symptoms are either > early stages of achalasia or oesophageal spasms. > That may be because your LES pressure was not very high (still in the normal range) and you had 50% simultaneous spasms. Those findings would be the kind of thing that esophageal spasm does. You also had a problem with the LES relaxing completely and your other esophageal pressures were on the low side but just barely normal. That is more typical of early achalasia. Later achalasia typically has less than normal esophageal pressures other than for the LES which tends to be high. You also indicated that your esophagus was dilated. That is more typical of achalasia than esophageal spasm. But that feeling of trapped air, could be spasms. It is also possible to have a crossover of disorders and have something like achalasia with esophageal spasm, or what is now being called type III achalasia. (See my earlier post about manometry in another thread). However, in type III achalasia the pressure of the spasm is typically high. Your's were not. It is also possible that what were call simultaneous contraction were actually pan-esophageal pressurization. In that case you may have type II achalasia. Type II has the best results with treatment and type III has the worst results. (Or at least that is what has been reported). Sometimes motility disorders are hard to classify and don't fit any exact definition. A lot of people with achalasia have spasms too. Spasms are frequently a topic in this support group. Also, some of the people in this support group don't have achalasia but have other motility disorders. Whatever they decide to call your's you are certainly one of us and welcome here. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2011 Report Share Posted November 9, 2011 I thought achalasia and oesophageal spasms were the same thing and always came together! from Australia > > > > > > > > > Currently,I have transitioned to semi-solid foods and my symptoms have > > > gone down to air trapped in the oesophagus. Is this a typical symptom? > > > > > > > We are all different in the ways achalasia effects us, but yes, that > > sounds like an achalasia kind of thing. > > > > notan > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2011 Report Share Posted November 9, 2011 How do we we which type of A we have type II or III OR classic or vigorous? My HM is in only 5 days and I have been ready that if I have vigorous or type III then the outcome won't be as good. Now I am getting really worried: from Australia > > > > ... She looked at my report and indicated that the symptoms are either > > early stages of achalasia or oesophageal spasms. > > > > That may be because your LES pressure was not very high (still in the > normal range) and you had 50% simultaneous spasms. Those findings would > be the kind of thing that esophageal spasm does. You also had a problem > with the LES relaxing completely and your other esophageal pressures > were on the low side but just barely normal. That is more typical of > early achalasia. Later achalasia typically has less than normal > esophageal pressures other than for the LES which tends to be high. You > also indicated that your esophagus was dilated. That is more typical of > achalasia than esophageal spasm. But that feeling of trapped air, could > be spasms. > > It is also possible to have a crossover of disorders and have something > like achalasia with esophageal spasm, or what is now being called type > III achalasia. (See my earlier post about manometry in another thread). > However, in type III achalasia the pressure of the spasm is typically > high. Your's were not. It is also possible that what were call > simultaneous contraction were actually pan-esophageal pressurization. In > that case you may have type II achalasia. Type II has the best results > with treatment and type III has the worst results. (Or at least that is > what has been reported). > > Sometimes motility disorders are hard to classify and don't fit any > exact definition. A lot of people with achalasia have spasms too. Spasms > are frequently a topic in this support group. Also, some of the people > in this support group don't have achalasia but have other motility > disorders. Whatever they decide to call your's you are certainly one of > us and welcome here. > > notan > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2011 Report Share Posted November 10, 2011 wrote: > > How do we we which type of A we have type II or III OR classic or > vigorous? > With the old type of manometry achalasia was usually classified as Classic Achalasia or Vigorous Achalasia. Sometime when all the features were not completely present, especially if there was some DES type of spasms, it may have been called Early Achalasia. With high resolution manometry the new classification does not include vigorous achalasia. Those that would have been classified as vigorous in the old system would now be type II or III. In the past there were studies that said vigorous had worse results from treatment than classic but other studies said that was not so, some even found vigorous even had better results. Now that vigorous has been split into type II and type III, with type II getting the best results and type III getting the worst result it is understandable why vigorous got mixed results in studies. Some centers were probably putting more of the type II in with type I as classic and others were putting more type II in with the type III as vigorous, making whichever group the most type II ended up in getting the best results. The short answer to your question is, get a manometry. Best to get a high resolution manometry. Some doctors are still using the older terms and methods. So, the classification system you get depends on your doctor and the center you go to. > My HM is in only 5 days and I have been ready that if I have vigorous > or type III then the outcome won't be as good. Now I am getting really > worried: > It is a statistical thing. A classification does not mean you will or won't get good results, it just changes the odds. If we drop the classifications there is about a 90% chance that people will have a " successful " myotomy at a good center. That 90% doesn't tell how successful. Some are more successful than others. Still, success is a good thing. Type III may be more likely to not get as much of a good thing, but still likely to get a good thing. Of course there is that other 10% and anyone can end up there but type III may be more likely to end up there. Which ever type you are you still have the choice, Botox, dilatation or surgery. Would you choose differently if you were a III? Maybe, maybe not. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2011 Report Share Posted November 10, 2011 Hi. In one of my UGI scopy report i did find a mention that mine achalasia is Grade III.. However, A of any kind will trouble the individual and you can hardly find solace if you know that yours is a x grade or y grade or so on... I had my surgery in 2009 after two failed dilatations in 2008. Doing perfectly fine. Since you have a surgery lined up in next few days its time to relax because all these days, i suppose, you might have been waiting for the knife to make your LES relax permanantly.  All the best & Cheers...  Sanjiv from Mumbai ________________________________ From: lindsaykite <lindsaykite@...> achalasia Sent: Thursday, November 10, 2011 11:22 AM Subject: Re: My Manometry results  How do we we which type of A we have type II or III OR classic or vigorous? My HM is in only 5 days and I have been ready that if I have vigorous or type III then the outcome won't be as good. Now I am getting really worried: from Australia > > > > ... She looked at my report and indicated that the symptoms are either > > early stages of achalasia or oesophageal spasms. > > > > That may be because your LES pressure was not very high (still in the > normal range) and you had 50% simultaneous spasms. Those findings would > be the kind of thing that esophageal spasm does. You also had a problem > with the LES relaxing completely and your other esophageal pressures > were on the low side but just barely normal. That is more typical of > early achalasia. Later achalasia typically has less than normal > esophageal pressures other than for the LES which tends to be high. You > also indicated that your esophagus was dilated. That is more typical of > achalasia than esophageal spasm. But that feeling of trapped air, could > be spasms. > > It is also possible to have a crossover of disorders and have something > like achalasia with esophageal spasm, or what is now being called type > III achalasia. (See my earlier post about manometry in another thread). > However, in type III achalasia the pressure of the spasm is typically > high. Your's were not. It is also possible that what were call > simultaneous contraction were actually pan-esophageal pressurization. In > that case you may have type II achalasia. Type II has the best results > with treatment and type III has the worst results. (Or at least that is > what has been reported). > > Sometimes motility disorders are hard to classify and don't fit any > exact definition. A lot of people with achalasia have spasms too. Spasms > are frequently a topic in this support group. Also, some of the people > in this support group don't have achalasia but have other motility > disorders. Whatever they decide to call your's you are certainly one of > us and welcome here. > > notan > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2011 Report Share Posted November 10, 2011 Thanks Notan. I had a manometry before my scheduled reflux surgery just to 'rule out anything else'. Of course that is when A was diagnosed. I think I am just getting a little worried now that it's getting closer. Crossing fingers for a good result! > > > > How do we we which type of A we have type II or III OR classic or > > vigorous? > > > > With the old type of manometry achalasia was usually classified as > Classic Achalasia or Vigorous Achalasia. Sometime when all the features > were not completely present, especially if there was some DES type of > spasms, it may have been called Early Achalasia. With high resolution > manometry the new classification does not include vigorous achalasia. > Those that would have been classified as vigorous in the old system > would now be type II or III. > > In the past there were studies that said vigorous had worse results from > treatment than classic but other studies said that was not so, some even > found vigorous even had better results. Now that vigorous has been split > into type II and type III, with type II getting the best results and > type III getting the worst result it is understandable why vigorous got > mixed results in studies. Some centers were probably putting more of the > type II in with type I as classic and others were putting more type II > in with the type III as vigorous, making whichever group the most type > II ended up in getting the best results. > > The short answer to your question is, get a manometry. Best to get a > high resolution manometry. > > Some doctors are still using the older terms and methods. So, the > classification system you get depends on your doctor and the center you > go to. > > > My HM is in only 5 days and I have been ready that if I have vigorous > > or type III then the outcome won't be as good. Now I am getting really > > worried: > > > > It is a statistical thing. A classification does not mean you will or > won't get good results, it just changes the odds. If we drop the > classifications there is about a 90% chance that people will have a > " successful " myotomy at a good center. That 90% doesn't tell how > successful. Some are more successful than others. Still, success is a > good thing. Type III may be more likely to not get as much of a good > thing, but still likely to get a good thing. Of course there is that > other 10% and anyone can end up there but type III may be more likely to > end up there. > > Which ever type you are you still have the choice, Botox, dilatation or > surgery. Would you choose differently if you were a III? Maybe, maybe not. > > notan > > > > > > Quote Link to comment Share on other sites More sharing options...
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