Successful endoscopy .. results awaited .. suspected alchalasia

[Garysreflux]

This post describes my latest nhs appointmemt but before that id like to mention and get community advice on a new symptom thats becoming more noticeable that i have yet to mention to hospital; when i burp a gas comes up and i can feel it react with the back of my throat/nose. It doesnt burn (nor did i feel acid reflux burn) but theres a definate reaction. Any ideas pls.

After 2 failed endoscs (due to food lodged in dilated upper oesoph + severe narrowing nr lower oesoph sphincter .. suspected alchalasia resulting from acid reflux) i had a successful NHS endosc procedure on 5sep. Biopsies were taken of the stricture/scarring. Visually there are no signs of C; long may that last and i await the results. For your info and comment here’s a summary of the appointment + report.

My narrowing is now down to the size of a currant and a children's camera was used to perform the endosc; that’s bad; shld have gone medical route much earlier. Whilst they interpret results ive been asked to remain on liquidized and well chewed food to minimise food backup in oesoph. I was advised to go liquid only for 48hrs pre endosc; i did 68hrs to improve chances of success. They note that despite this the oesoph is markedly dilated and still contained food. After washing it was possible to advance to proximal stomach. There is a rolling hiatus hernia HH (ive had this for many years but only got reflux when gained weight) and it was not poss to advance to mid stomach but mucosa appears healthy. Biopsies taken from oesopheal side of GOJ (whats this??). Unfortunately technical hitch and photos lost. Appearance suggests achalasia and rolling HH.

In brief and prior to reviewing results, treatment is normally 1 of 4 options (hopefully ive got this right .. procedure had just completed) .. 1. Injection 2. Balloon stretch (doc thinks 1 and 2 unlikely given severity) 3. Operation entering via month .. chopping out scarred bit of oesoph and stretching down and rejoining (whats name of this op?? Pls). 4. Same as 3 but enter externally.

I now await biopsy results and advice about next course of action. There was no mention of treating my HH. Continue with 1×20mg omeprazole/day but switch from capsule to dissolvable tab (due to narrowing). Timescales .. no mention; junior docs strike may impact me thinks. Regards to all. G

[chris_usa]

GOJ stands for gastro-oesophageal junction, also known as LES (lower esophageal sphincter).

Achalasia cannot be determined by appearance on endoscope, but this test can rule out other causes that can mimic achalasia (known as pseudoachalasia) on barium swallow or manometry. In my opinion, if those were consistent with achalasia, then this endoscopy would give you a definitive diagnosis.

The removal of the lower esoph that you mention is the same as an Ivor-Lewis esophagectomy. This is a partial esophagectomy, where the lower esoph is removed and the stomach is pulled up to maintain continuity of the GI tract. This can be done open (abdomen and chest incision) or minimally invasive.

If your diet has been impacted greatly by this situation, as I imagine it has, please discuss with your surgeon the improvement of your nutritional status (if so impaired) before embarking on the surgery. A supermajor op done on a patient that is clinically malnourished can cause many more problems than just dealing with the effects of the op itself. That has caused me major problems in several organ systems that show no signs of improving.

The only way to deal with a very sick esophagus is to take it out. Not good news in that you have to deal with that, but it sounds like your only real chance to make things better. \wc

[Garysreflux in reply to chris_usa]

Chris . Thanks for time and info. Cheers.

[Hidden]

I wonder if what you are tasting is stale food that is fermenting and rising from your oesophagus? Does your breath smell of slightly rotted food (if you will forgive the question!). If so, it is probably better than some of the more complex reasons.

If your stomach is not receiving its proper portion of food at normal speed, it might have some form of an adverse reaction.

It would be worth seeing whether they can fix your hiatus hernia at the same time so that you have the best chance of a well-regulated system that also controls reflux.