Initially, I thought I had GERD. I often experienced chest pain, and associated this with heartburn. After years of heartburn that seemed unaffected by various medications (Tums, Zantac, Prilosec, etc), I started having trouble swallowing food. It got to point where it was a real struggle to eat; I was also regurgitating undigested food in the morning, as well as at mealtime if I overate. I finally decided to get a referral from my primary care physician to get things checked out. The overall assumption being that my heartburn led to scarring in the esophagus, and a simple stretch of the esophagus would fix my problems.
There are 3 main tests to diagnosis Achalasia. Below I go through my experiences with each.
Test 1- Upper Endoscopy/Esophagram/EGD
First test. Probably the most nerve racking one, as I had to be put under anaesthetic for the first time ever. Overall, this test was probably the most pleasant, since I was asleep for it.
After being put under, the Doctor inserts a small flexible camera down my throat to observe the esophagus. Should be noted you cannot eat for 12 hours prior to this one. Actually, all of the tests (EGD, Barium Swallow, and esophageal manometry) require no food, and no liquids at a certain point before the test. Talk about annoying.
Results: After the test, the Dr told me "Everything went fine, but..." But is never a good thing in the medical world, or so I feel. So what came after the but? Basically he explained that they didn't see what they expected. There was no scarring, but even more odd was the fact that food was still present in the esophagus, even after my not eating for 12+ hours. Also, there was a high amount of pressure, and they were not able to get the scope into the stomach. The Dr recommended I go for a few more tests in order to determine what was going on.
At this point I was able to use the wonderful world wide web and Google to self diagnose myself. Which was a funny feeling. YAY, I self diagnosed myself correctly, but it's an incurable disease that will need surgery. Kind of a kill-joy. Oh well, on to the next tests!
Test 2 - Barium Swallow/Esophagography
Second Test. Really not so bad. Other than the whole not eating beforehand thing. During this test, you are asked to drink Barium (yum), while standing in front of an x-ray, so that the path of the liquid can be traced. I started out by drinking some gas crystals, to help open up the esophagus. After, while standing in various positions, I was asked to take various sips and swallows of the barium. It did not taste too bad, just very chalky. This was by far the coolest test, since I could see what was going on. I could see the liquid go down and then abruptly stop before entering the stomach. Which both the radiologist and nurse assisting her noted as odd; the nurse had never seen that happen before, and the radiologist mentioned she did not see that often. She also noted that the muscles seemed to be failing to propel the liquid.
Results: Findings were all typical with Achalasia. None of the fluid, except for a very tiny trickle, entered the stomach.
Test 3 - Esophageal Manometry
Third and final, and most unpleasant of the tests. This test was only supposed to take about 20 mins. I was there about an hour. During this test a small (yeah right!) tube is passed through your nasal cavity, down the throat, to the LES (Lower esophageal sphincter). This records the strength and coordination of the muscle contractions in the esophagus, as well as the LES. So why did it take an hour you ask? Well, the tube was not as small as I would have liked. The Dr. struggled getting it past my nasal cavity. After 20+ mins of trying to shove a tube in and out of my nose, he finally got it to go past the nasal cavity and into my throat. Of course much gagging and uncomfortableness followed. The tube is placed at the very bottom (about 35 cm from what I recall) of the esophagus, and the monitoring begins. Every so often the tube is pulled further out, so measurements can be taken all the way up the esophagus. I thanked the nurses profusely after this test; they were amazing at keeping me calm throughout the process.
Results: The LES and lower muscles in the esophagus are definitely broken. Sorry that is not a medical term. But that word about sums up how I felt that day. Broken. Mentally, physically etc. The test was exhausting, but at least there was final confirmation. I have Achalasia. I am part of the 1 in 100,000 a year that gets diagnosed. The .00001%...or something like that.
Conclusion
After all tests were completed, one of the physicians at the Center for Digestive Care followed up with me to let me know the diagnosis: Achalasia.
At this point, I had done vast amounts of online research, and already knew my options.
I decided to go ahead and schedule a surgical consult for the Heller Myotomy.
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