Aspiration

[Pepita933]

I have achalasia with a failing esophagus. I have been having trouble with waking and aspirating before I get up. Do you have any recommendations? I do have bed risers inclining my bed.

[Mauser1905]

With the Hellers Myotomy done to your LES region its opened to make swallowing easier for you. however the collateral is the freeflow upwards due to gravity or pressure on your abdomen.

the aspiration bit is concern for catching chest infection for you. Typical GORD mitigation measures like eating few hours before evening, not staying up for long, being stress free completely, no smoek expsoure, or alcohol. and some time gaviscon advance to comfort the oesophagus while sleeping.

chances are while you are asleep you are moving in such a manner that the fluid is travelling upwards and getting trapped and aspiration happening.

[Pepita933 in reply to Mauser1905]

Yes, I know about the problems associated with the surgery I had back in 2014. However the aspiration is new. The sleep studies I have had indicate I am a back sleeper 99.9% of the time, so probably not doing a lot of moving around. This is new. I think it is related to the ‘failing’ esophagus.

[052517]

Sorry to hear your oesophagus is failing. I had achalasia, followed by Heller's myotomy. I am now nearly 4 years post oesophagectomy. You probably need to be on a PPI, the one that works for me is Dexlansoprazole. Most people take it in the morning , but it works better at night for me, because it is not for "heartburn". Decreases the overnight acid and minimizes the aspiration. Probably need gaviscon at night too. And ..increase the incline of the bed some more.

[Pepita933 in reply to 052517]

Our drugs and names for them might be different since I’m not in the UK. I do take PPI’s and have been for what feels like forever! I’ll try increasing the angle of the bed too.

[052517 in reply to Pepita933]

At the end stage I had a barium swallow, barely a trickle of food moved through. Aspiration could definitely be from days worth of food still waiting to move to stomach. Hope you can get a barium swallow or scope done soon.

[Pepita933 in reply to 052517]

I had an upper GI or barium swallow done in October. Food is still going down, I think one of the questions will be if I need the balloon dilation. My gastroenterologist told me that on a scale of 1-10 if you get diagnosed at a 8 you should have more time for interventions to work. He said 6 years ago when I was diagnosed I was probably more like a 5. So I guess I just don’t have the time that some have between the Heller Myotomy and the next stage that I would like.I gather the next thing they will do is some kind of motility study.

[052517 in reply to Pepita933]

I went 13 years from myotomy to esophagectomy. I know a lady that is 30 years post Hellers and still able to eat burger and bun. Everyone is different. Statistically very few go to end stage but no great treatment options for those of us that do. Not sure a motility study will tell you anything new, but would agree to what your gastroenterologist suggests.

[kiddy]

Hi yes aspiration can be a problem. Eat early and reduce what you drink before bedtime. I am on PPI's and Gaviscon advance. Cider vinegar in hot water can help . I have ginger to chew if it happens. Can make you cough next day and feel rubbish Best Wishes

Debbie

[Pepita933 in reply to kiddy]

Thanks for the advice. I am taking omeprazole 40 mg AM and 20 mg pm. I’ll try raising the head of the bed and see if that helps. I haveGaviscon, and use that more as a relief when it is bad at night. While I do decrease what I drink at night, I have Sjogren’s so my mouth is always dry.

[SurreyGuy]

Hi there,

I am 14 years post oesophagectomy for achalasia and about 20 since the Heller.

If you are concerned that this may be caused by a deteriorating oesophagus I would suggest you seek assistance from your hospital. Are you being cared for at an upper GI centre? If not, then I suggest you consider transferring to one as they see so much more achalasia. As your aspiration is new they will probably check to see if anything has changed.

When I developed a mega oesophagus I did start to inhale more frequently but I had continually had this occasionally but was young so never developed a chest infection. But, of course, as we get older it gets more serious.

So, i suggest you get it checked out properly rather than self treat. Just in case your concern turns out to be correct. But, fingers crossed and this turns out to be less significant.

[Pepita933 in reply to SurreyGuy]

I do have 2 appointments set (3 months from now—first available) with a doctor to check my peristalsis, which I think is non existent. The second is the head of Baylor College of medicine gastroenterology. For what ever reason this College has specialized in esophageal problems.So yes, I do think it is due to the progression of the disease. I just didn’t know if there is anything I could do to stop the aspiration.

I gather the esophagetomy is pretty rough. How have you faired since the surgery?

[SurreyGuy in reply to Pepita933]

Hi,

By the time I needed the oesophagectomy I had no choice. Nothing was getting through. I found yoga and baths helped a little as I think they altered the pressure in my chest and some liquids got through (i was only on liquids fir six months). The weight was falling off me. So, when the surgery arrived I knew whatever happens; there was no option.

The first three days were terrible. But, after that it got a lot easier. Swallowing is tough for a while. But, i was warned so I expected it. Then I was back at work after about 10 weeks. But, I think it took about 18 months to fully get over it.

After the first 10 days I had no post op problems from the surgery. I have developed two now. Satiety and SIBO. The second makes the first worse. But, it is nowhere near the suffering of achalasia. I have absolutely no regrets.

If you find you have a mega oesophagus don’t worry too much as the outcomes from surgery have massively improved. There was no robotic or key-hole when I had it done and I am sure you will now be offered one of those.

In the meantime, try and do everything you can to get the food/fluid through before bed time. As I said, try some yoga videos on youtube or a bath or whatever tricks you have developed.

All the best.

[Pepita933 in reply to SurreyGuy]

Thank you for sharing your experience. I feel like I’m kind of alone in this experience, but you guys have helped me start to get some perspective. I guess time will tell what my other diagnosis’s will be. I know my esophagus is very large, but I suspected that to be true for most of us with achalasia. I’ve described it as a big garbage chute that just works like those on buildings being built.This is such an unrelenting life altering disease.

[petercaron]

I am 3 1/2 years post esophogectomy and I still get the occasional aspiration of bile at night. In fact I am on an antibiotic right now due to it causing an infection in the lung.

I take protonix each night, sleep highly inclined on a sleep number bed and eat early and don’t drink alcohol . The last two night I slept in a recliner chair which usually is helpful to prevent aspiration. And it does work. Ok

I always find that my aspiration happens when a slide down off the incline to a more flat position. I also find that if I roll over onto to my left side, I am definitely more inclined to aspirate. I therefore try to sleep on my back and I raise my knees on the bed so I don’t slide down flat on the bed. That really has helped me.

I have my esophagus stretched at least once every year to make sure food is clearing my newly created esophagus quickly enough. But that does not seem to prevented my occasional aspiration anymore.

I have not tried Gaviscon and I will try that as many esophogectomy patients have noted that it has helped them with bile aspiration.

Btw, since my esophogectomy, there are not many things that I can’t eat. Just smaller portions for sure. I do not get heartburn at all since the surgery.

Best of luck to you!

[Pepita933]

Thank you Peter.