My dad aged 70 yrs is having achalasia cardiac having JT feeds 9 times a days. He weighs 37-39 kgs.

[roshan030872]

Need assistance on the corrective measures for this kind of condition. His condition is for a very long time now.

[chris_usa]

Sorry to hear. A little more info would be helpful, for example:

Have there been any interventions recently, such as stretching or medications? In older patients who cannot tolerate the more taxing endoscopic treatments, some medications can help relax the esophagus and help with swallowing and chest pain.

Is your dad able to swallow solids or liquids and keep them down?

Has this low weight been a recent occurrence or a long-standing issue?

Some of the persons on this site (including myself) are achalasia patients, and most if not all with severe or difficult forms of achalasia that required removal of the esophagus. Having to have the esophagus removed is very rare in achalasia. Most people can be treated successfully with far less draconian measures. A little more info would help us help you.

[roshan030872 in reply to chris_usa]

Yes there was interventions I mean he was admitted in intensive carein August 2010 with only about 10% of oxygen level and weight of 18-20 kgs. All the feed taken from the mouth before hospitalization were either being thrown out or thrown into the lungs there by his full lungs got infected and TB was detected. He was in the ICU for 2 months with different kind of medications/interventions. Post 3 years his weight is 36-39 kgs and respiration rate is normal, BP is normal, heart / pulse rate is fast. Have done an endoscopy just last week. The esophagus is dilated with J shaped towards the stomach. Nothing is taken from the mouth for the last 3 + years and feeding is done thru the JT only. He is fine otherwise but only his weight is not increasing and cannot eat food from his mouth. Let me know your feedback on the same.

[Hidden]

It is important that his nutritional needs are supplied in the short term.

The longer the condition has existed, the more difficult treatment becomes. This becomes a very specialist area and you would need to feel confident that your consultants are, if appropriate, seeking advice from others experienced at dealing with this stage of the condition. It is an unusual condition and surgeons are normally very receptive to the issue of second opinions.

[roshan030872 in reply to Hidden]

Yes I agree have consulted with at least 3-4 surgeons in India, Mumbai, but cannot get a positive way forward on my dad's issues. Can you recommend as he is having this issues from a very long time

[chris_usa]

Usually in achalasia the removal of the esophagus is recommended when the esophagus is grossly enlarged and sigmoid. Sigmoid means "S" shaped or curved. When you mentioned that his esophagus has a "J" shape, that is probably a sigmoid esophagus. In cases like this, surgical removal of the esophagus is about all that can be done.

The big question here is whether your dad is capable of undergoing such a major surgery and recovery in the shape he is in currently. I was moderately clinically malnourished at the time of my esophagectomy for end-stage achalasia (not for sigmoid esophagus, but something called common-cavity esophagus), and less than forty years old, and I am still trying to dig my way out four years post-op. In your Dad's case, surgery might not be a realistic option right now.

The feeding tube can build up his strength slowly over time. These major regurgitation / aspiration with the JT feedings can occur even if your Dad is sitting up all the time.

If I was in your position (and based on the information I have seen - please realize the limitations and forgive any conclusions that may not apply), I would request a consult with a licensed Dietician or Nutritionist to make sure the JT feedings are appropriate and see if there are other feeding products or rates which may cause less regurgitation. A constant 24 hour JT feeding may be better than bolus feedings if that is what your Dad is using.

If and when your Dad's nutritional status improves, then surgical removal of the esophagus may be an option. I doubt that stenting, botox, or medications would be much help, and dilations would appear to be counter-productive. Getting your Dad physically able to undergo the surgery may be the endpoint to strive for.

I hope this helps, and please realize this is all based on a little bit of info, my clinical training as a pharmacist, and my own experience with esophagectomy for end-stage achalasia. If there are any questions or concerns, please don't hesitate to ask. I know the agony of feeling like you're just wasting away with very few good options to halt it. Just realize you aren't alone. This is quite rare, but there are others in a similar situation that can provide moral support if nothing else.

[pferries31]

Hii. I too have Achalasia and my only option was to have surgery. I was 41 at the time and otherwise healthy. I am 18mths post op and I am still recovering with many ongoing problems. The operation is a very drastic one and I was no where near prepared for what was ahead of me. I no longer have my career or social life and I am still unable to eat properly. Ime hoping that one day I will be able to say differently. All I say is please, please research as much as you can and if you are fortunate to find the best help then do so. Good luck with it all x