Achalasia is painful throat conditionDate: 12/19/2014 DEAR DR. ROACH: My adult son recently has been diagnosed with achalasia, after many months of being misdiagnosed. He has suffered unbelievable pain and difficulty eating or drinking. At first he thought he was having a heart attack. Fortunately, that was ruled out. He is going to a prominent gastroenterologist, who made the diagnosis and has been treating him. He had the balloon procedure, which was not successful. He then had a Botox procedure. This relieved him somewhat. However, he has still had some painful episodes. What can you tell us about this illness? Will he eventually be cured? – S.G.
ANSWER: Achalasia (awk-uh-LAY-shuh) is a swallowing problem caused by degeneration in the nerve cells in the esophagus, the muscular tube that carries food to the stomach. Nobody knows why it happens, but it might be autoimmune or related to a viral infection. Because the nerve cells no longer work properly, the esophagus cannot empty, and food stays in the bottom of the esophagus, causing a "stuck" feeling, which indeed can resemble the symptoms of heart disease. Both solids and liquids are affected.
Achalasia may be diagnosed with several different types of tests, including X-rays, barium swallow, endoscopy and esophageal manometry (measuring pressures inside the esophagus). It's important to get the right diagnosis, since other conditions, especially cancer of the esophagus, may look like achalasia.
The usual first treatment is to widen the opening at the bottom of the esophagus, the lower esophageal sphincter. Sometimes it takes several attempts to work, but it does work for about 60 percent of people. Botulinum toxin (Botox), which prevents muscle contraction, is effective up to 90 percent of the time, but it needs to be repeated since the effect of the toxin is temporary.
Surgery is the most definitive treatment, and it provides long-term relief for about 85 percent of people 10 years after treatment. There isn't a cure, but most people get relief from one of these treatments.
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DEAR DR. ROACH: I am 86 years old. I had pneumonia in May 2013 and was very sick for seven days in the hospital. Since I got home, I have had no sense of smell or taste. Can you tell me what caused it, and whether I will ever get it back? – L.M.
ANSWER: Since it happened in the hospital, it’s likely that something happened there to cause it. Sudden loss of smell and taste most likely are associated with infection, injury and medications. The organisms that cause pneumonia could possibly affect your sense of smell as well (disorders of both smell and taste usually are primarily related to loss of ability to smell). Injury can happen in the hospital, especially if you had to have a breathing tube placed through your nose. That leaves drugs as the other category, and MANY medications can cause loss of sense of smell.
Since this has been going on for more than a year and a half, the only common reversible cause is medication. It would be worthwhile to ask your doctor to review all of your medicines, especially any that might have been started around the time of the pneumonia.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.
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