Hi there, I had a triple bypass graft 4 years ago, all is well in the ticker dept.
Then got fibromyalgia have to live with that one.. My question on here is the Doc has told me i have Oesophageal dysmotility. ie What goes down WILL come up had this for 2 years now twice had an Endoscopy all clear and the pipe down the nose job,Thankfully nothing upwards...
We are now nearing the end of the tablet road one new one to try, is there anything that works for someone that i have not tried i do not want to go down the operation road if at all poss Many thanks
The primary underlying neuropathology process in patients with achalasia cannot be cured; therefore, the primary goal of treatment is symptomatic relief. As the myenteric nerves do not regenerate, treatment goals are directed at relieving the physiologic obstruction at the level of the LES by surgical or endoscopic balloon disruption of the LES muscle or, less effectively, through medications that relax the LES smooth muscle. In the spastic motility disorders, relaxation of the esophageal body and LES smooth muscle lends some relief of dysphagia and atypical chest pain. In patients with scleroderma esophagus, treatment is more targeted, involving aggressive antireflux therapy and management of reflux complications (eg, stricture dilation).
Pharmacologic therapy-
Current pharmacologic therapy can provide some symptomatic relief to patients in the early stages of achalasia when disease activity is mild or moderate. More definitive therapy is spared for patients with advanced disease. In patients with spastic esophageal motility disorders, current pharmacologic therapy provides varying degrees of symptomatic relief.
Smooth muscle relaxants, including nitrates and calcium channel blockers, were the first medications to be used in all patients with esophageal motility disorders. The greatest experience has been with isosorbide dinitrate and nifedipine. The efficacy of these agents was demonstrated in case reports and retrospective studies primarily. Other drugs used less extensively include different types of anticholinergics, amyl nitrite, nitroglycerin, theophylline, beta2-agonists, and, recently, phosphodiesterase inhibitors. The experience with these drugs is limited.
Noncardiac chest pain in the setting of spastic esophageal dysmotility often shows good response to antireflux therapy, even in the absence of typical gastroesophageal reflux symptoms. Reassurance and control of anxiety is extremely important in this setting. If antireflux therapy fails, alternatives include different classes of muscle relaxants mentioned above and pain modulators such as tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and trazodone. Some studies report positive results from behavior modification programs and biofeedback.
Chronic pain management with TCAs is effective in managing noncardiac chest pain that is resistant to other therapies.
Botulinum toxin injection -
Botulinum toxin injections into the LES have been used in treating patients with achalasia. Botulinum toxin is a potent inhibitor of acetylcholine release from nerve terminals. A sclerotherapy needle is used to inject 80-100 units of botulinum toxin into the 4 quadrants of the LES.
This therapy may be a good alternative for poor surgical candidates, such as elderly patients or frail individuals. The major disadvantages are the high cost and the need for repeated therapeutic sessions.
Some data suggest efficacy in patients with DES and hypertensive LES dysfunction, especially focusing on symptomatic relief of pain, dysphagia, and regurgitation. More studies are needed to prove this effect.
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