Posts by Amy Ross5

vividsailor7 said:This case is definitely atypical. The hallmark feature of a manometry reading for achalasia is either an absent or incomplete relaxation of the LES. Furthermore, the resting pressure is usually elevated, sitting around 30-40mmHg.
Normal is 10-20mmHg, plus there's aperistalsis.
Look, unless you transcribe the results for me—or better yet, send over the actual images—it’s nearly impossible for me to give you anything concrete or coherent.

Hi, I tried to snap a photo but I keep getting an upload error, probably because the file size is too big. If I shrink the image, it becomes unreadable, so I'll just transcribe it here...

May 02, 2011 Medical History

For the last year and a half, they've had epigastric pain, dysphagia with liquids, and now even with solids, accompanied by regurgitation. Because of this, they were seen this past April by Dr. Rotkvić, who diagnosed AHALAZIJA based on endoscopic and radiological exams.
The clinical presentation and those tests point directly to that condition.
IMPRESSION
Prior to cardiac dilation, please perform esophageal manometry and a barium swallow at the Holy Spirit medical center under prof. Jurčić

September 05, 2011
HISTORY
Patient presents with manometry results that are non-specific: hypotensive lower esophageal sphincter and predominantly ineffective peristaltic activity.
RECOMMENDATIONS
Given these findings (X-ray, EGD, and esophageal manometry) along with the persistent dysphagia, I recommend hospitalization for further testing and a decision regarding cardiac dilation.

September 05, 2011
DIAGNOSIS

They were admitted to our facility on September 15, 2011, where we performed cardiac dilation using a non-expansive balloon—yet despite this, the dysphagia persists.
IMPRESSION
Please order an esophageal X-ray and a contrast swallow study; after reviewing the results, we will decide whether to repeat the procedure.

January 16, 2012
HISTORY

Presenting with swallowing study and esophagram results from December 23, 2011 showing a widened esophageal lumen and hypotonia; emptying is difficult through the distal segment, which has normal width and regular mucosal fold contours.
Manometry findings from May 2011: hypotensive lower esophageal sphincter and ineffective peristaltic activity.
Cardiac dilation was performed at our facility on September 15, 2011 (the radiologist's conclusion was AHALAZIJA). We suggested starting Controloc.

IMPRESSION
Considering the X-ray findings, the inconclusive manometry, and the poor response to cardiac dilation, we suggest using prokinetics (cisapride, domperidone, metoclopramide). Since we carry Reglan, we suggest attempting to improve peristalsis with metoclopramide (Reglan) 3x daily. Follow-up in 1 month.

February 27, 2012
History
Reglan isn't working, nor has there been any improvement. We recommend a soft food diet with more frequent, smaller meals. In case of heartburn, take Controloc 40 mg as needed.
We recommend an endoscopic follow-up in 18 months. However, if symptoms persist (dysphagia, increased heartburn), come in sooner.

Pre-op tests—X-rays, endoscopy, and esophageal manometry—all pointed toward AHALAZIJA. From what I gathered, the manometry showed a low-pressure lower esophageal sphincter and ineffective peristalsis, which is actually somewhat atypical for achalasia. After they performed the cardia disruption (which was done because the radiologist concluded it was achalasia), there was zero improvement. They also didn't find any other underlying issues, like neurological or myological conditions, that would explain the weak peristalsis. Following that, I was prescribed Reglan, but it didn't help at all; if anything, it made things worse because I started having more frequent nighttime regurgitation into my trachea. At my last checkup, they just recommended eating soft foods in smaller, more frequent meals and taking Controloc as needed... and then they scheduled me for an 18-month follow-up???
Regarding the lung/bronchial inflammation... after some heavy coughing, labored breathing, and a fever lasting four days, I went to the ER. They diagnosed me with a respiratory infection and prescribed Azithromycin (500mg once a day for three days), which cleared up the symptoms. Now, I'm wondering if that's totally unrelated to the achalasia, or if it's tied to it—specifically this coughing and spitting up mucus and food during the night (I should mention this used to happen maybe once a month, then weekly, but lately, it's happening every single night)
I hope that clears things up a bit... and I'm really hoping for some advice... thanks in advance! :-)

vividsailor7 said:It would be helpful to see the test results from both before and after the procedure. Also, could you go into more detail about this "pneumonia" you mentioned? What medications are you currently taking, and what were you on previously?

Hi,
I was diagnosed with AHALAZIJA about a year ago, so I went in for balloon dilation at a clinic in Chicago under Dr. Pulanić... which honestly didn't help at all. My symptoms haven't budged (it's hard to swallow anything thick or solid, I get sharp pains in my chest, and I deal with acid reflux into my windpipe at night, causing coughing...) but the doctor decided after the procedure that since the X-ray looked fine, I don't need any more dilations. It feels like they're totally ignoring the fact that my symptoms actually got worse... I even ended up on antibiotics recently for some bronchitis/lung inflammation, which I'm pretty sure was caused by that nightly reflux where food residue from dinner ends up in my lungs and I have to cough it out.
I'm really not sure what my next move should be... especially since I've been reading that these balloon dilations might not work or only offer short-term relief. Are there any alternative options out there, maybe acupuncture... or some way to get my esophagus working properly again? If anyone has any advice, I'd really appreciate it! :-)