achalasia redux

For those new to this blog, I will define the above: It is the absence of the usual motile contractions of the esophagus when one swallows, terminating in the opening of the lower esophageal sphincter which permits the chewed food to enter the stomach and upon closing, stops the food from returning--with stomach acid--back into the esophagus. Those of us with achalasia--a rare group--don't have any of the above functions. Food slides down the esophagus only  by the force of gravity and remains there and ferments if not permitted to go farther. 

The condition is rare enough that the gastro docs, back in the day here in the far north of Utah didn't diagnose it. However they were sentient enough to send me to a gastro clinic at the University of Utah where I met an about-to-retire doc (Ashworth) who entubed me and diagnosed it in 30 seconds. He had only  seen 6 cases in over 30 years of practicing, so we shouldn't hammer too hard on the country docs of the time up here. Ashworth had a balloon at the end of the tube and inflated it to the point that the lower esophageal sphincter was rendered permanently open. This was an immediate cure which he tested by asking me to drink 8 oz of water at once. I could and did! Prior to this I had lost 35 pounds and was subject to frequent regurgitation along with painful heartburn.

The cure was not without its downsides. Since my esophagus was rendered permanently open to my stomach, the stomach acid had to be neutralized. Enter omeprazole, trade named, Prilosec. Ashworth said the Europeans had been taking 1000s of these things for long periods of time without side effects. So we titrated a dose--one morning, one evening-- that pretty much reduced my investment in (and dependence on) Rolaids. I have been taking omeprazole now for over 25 years. (All of this began with uncontrollable reflux ie heartburn). Not protecting the esophagus from acid causes the body to try to grow stomach tissue there and may result in Barrett's disease which is cancer of the lower esophagus.

The causes of achalasia are unknown but a South American parasite is suspected. My own case appeared a couple years after a trip to Peru.

So why bring all of this back to the light? Because, occasionally I get a flare up in which the esophagus starts to spasm. These are felt as deep hiccups and produce a heavy mucus. Usually they are caused by unregulated eating, eating too quickly, not chewing up fibrous foods, etc. I don't get these very often and they are usually solved by waiting for the esophagus to clear, that is, to let gravity do its work. This means cessation of eating and drinking. It stops my family cold when they see me stop my own part in the festivities. They have become adept at spotting this. But, as I say, it usually resolves without me having to leave the table. It doesn't appear to relate to the spiciness of foods.

However a few months ago whilst dining at a fine SLC establishment I had to seek out the restroom and regurgitate the contents of the meal. And the evening continued just fine. So yesterday I had fish and chips with a couple old friends at lunch. I had planned not to eat much for dinner and I think I held to that--but apparently, not sufficiently. (I had an apple and some peanuts. I was aware the apple had a very firm skin and I thought I chewed it thoroughly. A while later, still being hungry, I fixed myself a couple english muffins with peanut butter. A deadly combination!

After awhile the hiccups started as the esophagus rebelled. It took 5 hours to resolve with multiple trips to the sink to vomit. Each time I would get immediate relief only to have the pain--did I mention the pain?--start in again. I think this is first time that the spasms have been accompanied by pain. It was pretty excruciating, producing ague. When I finally let Jan talk me into going to the ER at about 12:30 am, I was weary of the pain and worried that there was no resolution without help. The motion of the car made me sick enough that we had to pull over so that I could upchuck once more. On this occasion I finally felt the relief that usually means the episode is over. We pulled into the parking lot of the ER and I determined that we didn't need to be there. Clean belches that are a harbinger that all is again well--they tasted of peanuts--were occurring. 

So much of late life is spent trying to figure out how not to hurt yourself. And I apparently haven't been working hard enough at that. Time to consider some things again--until the next unguarded moment!