A While ago I learnt of the passing of someone who had been born unable to swallow, like myself but wasn’t a child, but an ADULT. That got me thinking and ok if you’re a child everything is geared up to help you,
but if like me your classed as an adult, your it seems in the forgotten land of, What did you say you have?
I am not sure what info if any we will find about being born unable to swallow and classed as an adult, but with your help then maybe just maybe we can find something worth reading.
This page here above the start will be at some point given over in memory of the Adult TOF or TEF who has left us behind, and who’s passing made me think further down the road.
On this page there are some cutting edge interesting up to date data, you just need the time to read and listen, some would say WOW.
Achalasia is rare. It may occur at any age but is most common in middle-aged or older adults. The problem may be inherited in some people.
Achalasia is an uncommon swallowing disorder that affects about 1 in every 100,000 people. The major symptom of achalasia is usually difficulty with swallowing. Most people are diagnosed between the ages of 25 and 60 years. Although the condition cannot be cured, the symptoms can usually be controlled with treatment.
PLEASE NOTE, Children are also known to have this too.
The tube that carries food from the mouth to the stomach is the oesophagus. Achalasia makes it harder for the oesophagus to move food into the stomach.
Achalasia is an oesophagal motor disorder characterised by increased lower oesophagal sphincter (LES) pressure, diminished to absent peristalsis in the distal portion of the oesophagus composed of smooth muscle, and lack of a coordinated LES relaxation in response to swallowing.
Barium swallow studies of achalasia are presented below. Barium swallow study demonstrating characteristics of achalasia, including the bird’s beak deformity and a dilated oesophagus.
Detail of a barium swallow study demonstrating the classic bird’s beak deformity of the distal oesophagus.
Primary achalasia is the most common subtype and is associated with loss of ganglion cells in the oesophagal myenteric plexus. These important inhibitory neurones induce LES relaxation and coordinate proximal-to-distal peristaltic contraction of the oesophagus.
Secondary achalasia is relatively uncommon. This condition exists when a process other than the intrinsic disease of the oesophagal myenteric plexus is the aetiology. Examples of maladies causing secondary achalasia include certain malignancies, diabetes mellitus, and Chagas disease. Sir Thomas Willis first described achalasia in 1674. Willis successfully treated a patient by dilating the LES with a cork-tipped whalebone. Not until 1929 did Hurt and Rake first realise that the primary pathophysiology resulting in achalasia was a failure in LES relaxation. Treatment options for achalasia include pharmacologic, mechanical, botulinum toxin, and surgical-based therapies.
For more photo’s etc http://emedicine.medscape.com/article/363551-overview
There is a muscular ring at the point where the oesophagus and stomach meet. It is called the lower oesophagal sphincter (LES). Normally, this muscle relaxes when you swallow to allow food to pass into the stomach. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the oesophagus (peristalsis) is reduced.
This problem is caused by damage to the nerves of the oesophagus. Other problems can cause similar symptoms, such as cancer of the oesophagus or upper stomach, and a parasite infection that causes.
Backflow (regurgitation) of food
Chest Pain which may increase after eating or may be felt in the back, neck, and arms
Difficulty swallowing liquids and solids
Heartburn (link has Video)
Unintentional weight loss
Exams and Tests
Physical exam may show signs of
Manometry a test to measure how well the esophagus is working
EDG (USA) or upper endoscopy, a test to examine the lining of the stomach and esophagus. It uses a flexible tube and camera.
X-Ray, taken to examine the esophagus, stomach, and small intestine.
The goal of treatment is to reduce the pressure at the sphincter muscle and allow food and liquids the passport easily into the stomach. Therapy may involve:
Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months.
Medications, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
Surgery (called a myotomy). In this procedure, the lower sphincter muscle is cut.
Widening (dilation) of the esophagus at the location of the narrowing. This is done during EGD.
Achalasia can sometimes be treated with medication that helps the lower esophageal sphincter relax. If medication is ineffective, however, esophageal dilatation can correct the problem. To open the esophagus, a balloon dilator is passed through the mouth down to the level of the lower esophageal sphincter, using an endoscope. The balloon is inflated, thus stretching the sphincter.
If achalasia recurs after balloon dilatation, surgery may be necessary to correct the defect. This surgery can often be done laparoscopically. Laparoscopic surgery involves a number of small incisions made in the upper abdomen, into which the surgeon inserts a long, thin camera and surgical instruments.
The surgeon then makes a long incision in the esophagus at the level of the esophageal sphincter. This releases the sphincter and allows it to relax. This surgery is very effective in curing achalasia, with over 90% of patients obtaining relief from symptoms post-operatively. Recovery is generally rapid, and most patients are able to leave the hospital within 1 to 3 days. Infrequently, the operation cannot be accomplished laparoscopically, and a larger incision is required. In these cases, hospitalization times may be longer.
The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one treatment is necessary
For better understanding click below.
I found this thought I would include it here, Patient Comments: Achalasia – Treatment
Video explaining Acid reflux
Acid reflux may cause heartburn and other symptoms. Dr Sarah Jarvis teaches us how we can treat and prevent the symptoms.
A few interesting finds
Doctor Michael Meyers co-Author of:
(Doctor Michael Meyers Supports this Website)
Surgical treatment of esophagogastric dysfunction forty years after reverse gastric tube esophagopathy for congenital esophageal anomaly.
- Division of Surgical Oncology, Department of Surgery, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill,
In 1968, Burrington first described the use of the reverse gastric tube esophagopathy for oesophagal replacement in children with oesophagal atresia or acquired stenosis. There are few documented cases of long-term follow-up of these patients.
We describe a 41-year-old female who presented with progressive dysphagia 40 years after reverse gastric tube for a congenital oesophagal stenosis as an infant. Repeated endoscopic dilations were unsuccessful in relieving her symptoms, and she subsequently underwent a modified Ivor-Lewis esophagogastrostomy with resection of the reverse gastric tube and reconstruction using her remaining gastric remnant.
This report describes what we believe to be the longest recorded follow-up after reverse gastric tube esophagopathy and highlights the potential for long-term complications after surgery for congenital anomalies.
Copyright © 2011. Published by Elsevier Inc. (This is OK as been given the OK by the Dr to share)
Hospital officials say it was the first known oesophagal transplant in the world
Minimally invasive esophagectomy has advanced to the point where it offers significant advantages
Full text is available as a scanned copy of the original print version.
A review of the experience with oesophagal atresia and tracheoesophageal fistula over a 25-year period
Long-term Functional results and quality of life after colon interposition for long-gap oesophageal atresia
Out of a series of 146 patients with oesophageal atresia 9 (6.2%) underwent colon interposition from 1963 to 1971. All eight surviving patients were seen at follow-up after a mean of 22 years. Three patients were free of specific symptoms according to the criteria of DeMeester, two had moderate and three severe distress. The mean time for consuming a standardised test meal was 15 minutes, compared to 8 minutes in healthy controls. Patients required 1-9 minutes to transport liquid barium through the transplant, compared to < 10 seconds in control subjects. Histological evaluation revealed a normal architecture of the colonic and ileal epithelium in three patients who underwent endoscopy. In none of these patients were contractions in the colon graft related to the act of swallowing recorded on manometry.
An unimpaired quality of life was indicated by the Spitzer index which scored a mean of nine out of ten points. However, on a 100 point visual analogue scale patients scored their global quality of life 66 and the mean Gastrointestinal Quality of Life Index was 92.2, compared to 107.6 in healthy control subjects (p < 0.05). This impairment was exclusively due to specific symptoms which scored 49.3 in patients and 59 in healthy individuals (p < 0.05). Physical and social functions, emotions, and inconvenience of a medical treatment were similar to control subjects. We conclude that colon interposition for long-gap oesophageal atresia achieves acceptable long-term functional results. However, specific symptoms lead to a considerable impairment in quality of life.
Most exciting technological break though coming…
Articles are written by UK doctors and are based on research evidence, UK and European Guidelines
Esophageal Dilation (I could not find a picture of higher up dilation with balloon so this gives you an idea)
What is Oesophagal Dilation?
OOesophagealdilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your oesophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy. Alternatively, your doctor might apply a local anaesthetic spray to the back of your throat and then pass a weighted dilator through your mouth and into your oesophagus.
Why is it Done?
The most common cause of narrowing of the oesophagus, or structure, is scarring of the oesophagus from reflux of acid occurring in patients with heartburn. Patients with a narrowed portion of the oesophagus often have trouble swallowing; food feels like it is “stuck” in the chest region, causing discomfort or pain. Less common causes of oesophagal narrowing are webs or rings (which are thin layers of excess tissue), cancer of the oesophagus, scarring after radiation treatment or a disorder of the way the oesophagus moves [motility disorder].
How Should I Prepare for the Procedure?
An empty stomach allows for the best and safest examination, so you should have nothing to drink, including water, for at least six hours before the examination. Your doctor will tell you when to start fasting.
Tell your doctor in advance about any medications you take, particularly aspirin products or anticoagulants (blood thinners). Most medications can be continued as usual, but you might need to adjust your usual dose before the examination. Your doctor will give you specific guidance. Tell your doctor if you have any allergies to medications as well as medical conditions such as heart or lung disease. Also, tell your doctor if you require antibiotics prior to dental procedures because you might need antibiotics prior to oesophagal dilation as well.
What Can I Expect during Esophageal Dilation?
Your doctor might perform oesophagal dilation with sedation along with an upper endoscopy. Your doctor may spray your throat with a local anaesthetic spray, and then give you sedatives to help you relax. Your doctor then will pass the endoscope through your mouth and into the oesophagus, stomach and duodenum. The endoscope does not interfere with your breathing. At this point, your doctor will determine whether to use a dilating balloon or plastic dilators over a guiding wire to stretch your oesophagus. You might experience mild pressure in the back of your throat or in your chest during the procedure. Alternatively, your doctor might start by spraying your throat with a local anaesthetic. Your doctor will then pass a tapered dilating instrument through your mouth and guide it into the oesophagus.
What Can I Expect after Esophageal Dilation?
After the dilation is done, you will probably be observed for a short period of time and then allowed to return to your normal activities. You may resume drinking when the anesthetic no longer causes numbness to your throat unless your doctor instructs you otherwise. Most patients experience no symptoms after this procedure and can resume eating the next day, but you might experience a mild sore throat for the remainder of the day.
If you received sedatives, you probably will be monitored in a recovery area until you are ready to leave. You will not be allowed to drive after the procedure even though you might not feel tired. You should arrange for someone to accompany you home, because the sedatives might affect your judgment and reflexes for the rest of the day.
What are the Potential Complications of Esophageal Dilation?
Although complications can occur even when the procedure is performed correctly, they are rare when performed by doctors who are specially trained. A perforation, or hole, of the esophagus lining occurs in a small percentage of cases and may require surgery. A tear of the esophagus lining may occur and bleeding may result. Complications from heart or lung diseases are potential risks if sedatives were used.
It is important to recognize early signs of possible complications. If you have chest pain, fever, difficulty swallowing, bleeding or black bowel movements after the test, tell your doctor immediately.
Will Repeat Dilations be Necessary?
Depending on the degree of narrowing of your esophagus and its cause, it is common to require repeat dilations. This allows the dilation to be performed gradually and decreases the risks of the procedure. Once the stricture, or narrowed esophagus, is completely dilated, repeat dilations may not be required. If the stricture was due to acid reflux, acid-suppressing medicines can decrease the risk of stricture recurrence.
Reprinted from the American Society for Gastrointestinal Endoscopy (ASGE).
Esophageal Dilation due to a narrowing of the esophagus
What is Esophageal Dilation?
Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy
Dilation of an Esophageal-Jejunal Anastomotic Stricture (To give you an insight as to what happens)
Published on Feb 13, 2014
Dilation of an Esophageal-Jejunal Anastomotic Stricture with the CRE™ Wireguided 12/15 mm Balloon, featuring Dr. Vanbiervliet.
Dumping syndrome is common after gastric surgery.
Dumping syndrome is common after gastric surgery. It is a group of symptoms that may result from having part of your stomach removed or from other surgery involving the stomach. The symptoms range from mild to severe and often subside with time. Although you may find dumping syndrome alarming at first, it is not life threatening. You can control it by making changes in what and how you eat. By controlling dumping syndrome, you will also be avoiding the foods that tend to make you gain weight.
Causes of Dumping Syndrome
After gastric surgery, it can be more difficult to regulate movement of food, which dumps too quickly into the small intestine. Eating certain foods makes dumping syndrome more likely. For example, refined sugars rapidly absorb water from the body, causing symptoms. Symptoms may also happen after eating dairy products and certain fats or fried foods.
Dumping Syndrome: Symptoms of the Early Phase
An early dumping phase may happen about 30 to 60 minutes after you eat. Symptoms can last about an hour and may include:
- A feeling of fullness, even after eating just a small amount
- Abdominal cramping or pain
- Nausea or vomiting
- Severe diarrhea
- Sweating, flushing, or light-headedness
- Rapid heartbern
Dumping Syndrome: Causes of the Early Phase
Symptoms of an early phase happen because food is rapidly “dumping” into the small intestine. This may be due to factors such as these:
- The small intestine stretches.
- Water pulled out of the bloodstream moves into the small intestine.
- Hormones released from the small intestine into the bloodstream affect blood pressure.
Dumping Syndrome: Symptoms of the Late Phase
A late dumping phase may happen about 1 to 3 hours after eating. Symptoms may include:
- Fatigue or weakness
- Flushing or sweating
- Shakiness, dizziness, fainting, or passing out
- Loss of concentration or mental confusion
- Feelings of hunger
- Rapid heartbeat
Dumping Syndrome: Causes of the Late Phase
The symptoms of this late phase may happen due to a rapid rise and fall in blood sugar levels. The cause of this rapid swing in blood sugar may be worse when eating sweets or other simple
Dumping Syndrome Treatment
Many people find that taking steps like these greatly reduces symptoms of dumping syndrome.
Foods to avoid. Avoid eating sugar and other sweets such as:
- Sweet drinks
- Sweetened breads
Also avoid dairy products and alcohol. And avoid eating solids and drinking liquids during the same meal. In fact, don’t drink 30 minutes before and 30 minutes after meals.
Foods to eat.
To help with symptoms, also try these tips:
- Use fiber supplements, such as psyllium (Metamucil or Konsyl), methylcellulose (Citrucel), or guar gum (Benefiber).
- Use sugar replacements, such as Splenda, Equal, or Sweet’N Low, instead of sugar.
- Go for complex carbohydrates, such as vegetables and whole-wheat bread, instead of simple carbohydrates, such as sweet rolls and ice cream.
- To prevent dehydration, drink more than 4 cups of water or other sugar-free, decaffeinated, noncarbonated beverages throughout the day.
How to eat.
Here are some other ways to lessen symptoms of dumping syndrome:
- Eat five or six small meals or snacks a day.
- Keep portions small, such as 1 ounce of meat or 1/4 cup of vegetables.
- Cut food into very small pieces. Chew well before swallowing.
- Combine proteins or fats along with fruits or starches. (For example, combine fruit with cottage cheese.)
- Stop eating when you first begin to feel full.
- Drink liquids 30 to 45 minutes after meals.
- Reclining after eating may help prevent light-headedness.
When to Call the Doctor About Dumping Syndrome
It is important to manage dumping syndrome so you stay well-nourished and don’t lose too much weight. Talk to your health care provider about any symptoms you have and what else you can do.
In some cases, medication or surgery may help correct the symptoms of dumping syndrome.
Can cancer of the esophagus be found early?
Looking for a disease in someone without symptoms is called screening. The goal of screening is to find a disease like cancer in an early, more curable stage, in order to help people live longer, healthier lives.In the United States, screening the general public for esophageal cancer is not recommended by any professional organization at this time. This is because no screening test has been shown to lower the risk of dying from esophageal cancer in people who are at average risk.
However, people who have a high risk of esophageal cancer, such as those with Barrett’s esophagus, are often followed closely to look for early cancers and pre-cancers.
Testing people at high risk
Many experts recommend that people with a high risk of esophageal cancer, such as those with Barrett’s esophagus, have upper endoscopy regularly. For this test, the doctor looks at the inside of the esophagus through a flexible lighted tube called an endoscope. The doctor may remove small samples of tissue (biopsies) from the area of Barrett’s so that they can be checked for dysplasia (pre-cancer cells) or cancer cells.Doctors aren’t certain how often the test should be repeated, but most recommend testing more often if areas of dysplasia are found. This testing is repeated even more often if there is high-grade dysplasia (the cells appear very abnormal).
If the area of Barrett’s is large and/or there is high-grade dysplasia, treatment of the abnormal area might be advised because of the high risk that an adenocarcinoma is either already present (but was not found) or will develop within a few years. Treatment options for high-grade dysplasia might include surgery to remove part of the esophagus with the abnormal area, endoscopic mucosal resection (EMR), photodynamic therapy (PDT), and radiofrequency ablation (RFA). The outlook for these patients is relatively good after treatment.
Careful monitoring and treatment (if needed) may help prevent some esophageal cancers from developing. It may also detect some cancers early, when they are more likely to be treated successfully.