spasms after surgery or procedure

I think (being unqualified medically) the important thing is to consult an experienced Upper GI surgeon and then consider their judgement about what procedure is best for you, because it is not as starightforward as you choosing a procedure from a menu of options.

Achalasia is typically caused by the muscles driving the peristalsis, or swallowing mechanism in your oesophagus, not moving in a co-ordinated sequence.   Sometimes they do not move at all, and it is simply gravity that allows the food bolus to move towards your stomach.   And the lower oesophageal sphincter (LOS), between your oesophagus and stomach, is likely to be clamped shut, making food back up into your oesopahgus and putting a strain on the muscles.   It is typically not the muscles themselves, but the nerve endings that seem not to send the signals to the brain, that causes the problem.  

The myotomy cuts the muscles holding the LOS and loosens it, allwing food to pass through into the stomach more easily with gravity.   POEM is a variation of this, where the muscles are cut within the lining of the LOS / oesophagus.   The advantage of having a looser LOS is that food passes down more easily, but the other side of the coin is that stomach acid can move upwards more easily too, because that is the purpose of the LOS.   So a myotomy, and possibly POEM will give you more reflux, and that in itself can have long term implications.   So invariably a myotomy is accompanied by a 'wrap' of the fundus, or top part of the stomach, around the base of the oesophagus, to recreate the effect of the LOS valve (called fundoplication).   You do not have a wrap with POEM, which is new to the UK.  

A dilatation is relatively quick and easy, as the LOS is stretched with a balloon on an endoscopy device that is inserted through your mouth.   Dilatation can be effective, but in many cases might have to be repeated.  

The spasms occur typically when the muscles at various points along your oesophagus are all contracting at the same time, probably because of the nerve signals they receive or do not receive.   It is very likely that if your LOS is sorted out, the spasms will improve markedly, so these spasms are related to what is going on around your LOS.    But there is no cast-iron guarantee.  There are medications like Buscopan that might help;  and the nerves / muscles are also likely to be affected by stress and tension, so whatever option you try, you will still have to try and relax for the eating process, which is easier said than done.

There is some information on the website of the Oesophageal Patients Association under The Oesophagus - Achalasia and meeting notes.

Some people have satisfactory results from dilatations, and as this is simpler all round, it is probably worth a try, but bear in mind that the best approach is to have a thorough examination and tests for a definitive diagnosisof exactly where the problem is, adn then go for the procedure that has best chance of success from the outset.   You can have repeat dilatations, but there is a risk that after a while the texture of the LOS area becomes fibrous, and this may inhibit  surgical options later on.   Neither do you want to put things off so long that your oesophagus becomes baggy and loses what muscle tone it might still have.  

When you gulp water, does it drain into your stomach OK?   You will know better than me that loading up your oesophagus can lead to more weight of food in it, and if it sags below the level of the LOS there can be great problems for it clearing.

 

Hi Alan and thank you for your reply.  I have been researching this for a while and understand what you've described.  At this point, I'm trying to gather some "case study" type evidence since there is not a lot available in any scientific study I have read regarding my specific question about spasms and procedures, before and after.

Personally, I had esophageal spasms for many years prior to having swallowing issues.  I think that spasms are the least understood of all esophageal symptoms related to Achalasia or as a disorder on their own.  There are different theories as to what causes them and there are a variety of different kinds of spasms that I've read about as well.  I don't really know what causes my particular spasms which makes this all the more difficult but I thought I'd start with this gathering of information before commiting to a particular surgery/procedure.  

As for talking to surgeons, I have done so, but they generally don't keep track of patients for long after their surgery and don't study spasms in particular.  All I've heard from them is that the surgery does not help with spasms, only with swallowing and regurgitation.  In regards to GERD, they also disagree about whether POEM is more of a risk.  The Cleveland Clinic recommends the Heller over POEM for this reason but a top surgeon I visited in Oregon claims that they are the same when it comes to this risk. (Of course, he is a known POEM surgeon and while he has done many HM's and POEMS, he has made a bit of name for himself as a POEM surgeon, so who knows if this colors his perceptions at all.) I am also concerned aboout GERD, but don't know if this is what is causing my spasms.  I don't really think so as I've had my esophagus checked prior to having Achalasia (when I just had spasms and GERD was a suspect) and I had no damage that would indicate GERD at that time.  Anyway the doctors don't offer a lot of information on this subject.  

I belong to some Achalasia Facebook groups and have read and participated in a few discussions on spasms in which people report different things about their spasms and their procedures but not enough to form any opinions on the subject.  Therefore, I'd love to hear from people who've had surgery or a procedure in which they can report a before and after scenerio regarding spasms.  I would be most appreciative of anything people could share.  Thank you!

Thank you, Alan.  You've given me some new things to think about.  If you do get some info. from others and can report back to me, I would appreciate it very much.  I'm just trying to make the most informed decision I can regarding what procedure/surgery to get with some foresight into the spasm issue.  One woman reported that since getting the surgery, her spasms last 8-10 hours a day and that what worked to alleviate them  pre-surgery no longer works post-surgery.  That's the worst case I've heard so far.  Another woman said that her spasms got much better since surgery.  And others claim they have stayed the same (I haven't heard anything about spasms  pre vs. post dilation yet).  So far, I only have a handful of reports about this, however, so I'm trying to get a large enough pool to, possibly, make some connections (which there may or may not be).  I think that this is an important issue for Achalasians as spasms cause so much suffering, are so elusive, and the medical community is so uniformed regarding them.

Hi Alan.  Thanks for the update.  Is there a way to communicate with the London Meetup without actually attending events?  I live in Berkeley, California in the United States so I'd be limited to email exchanges but if that's available, I'd be interesed.  I may also try to start a meetup group in my area.  While I love to exchange ideas with people online, it would also be great to find local people to meet with.  Could make for some interesting potluck dinners! (ironic humor intended - something you brits understand but which I'm used to having to explain here in the U.S.). 

Hi I have them everyday its been almost four years now and I'm finally going to get surgery my Dr tried to recommended me for the botox injections but, my GI speclaist said that it's too temporary and you'd have to continue most likely every 6-8 months and then could still lead to surgery and have complications due to tissue build up from the injections. The balloon dilation isn't as successful as you'd think either according to him it's also temporary. I'm having the one that involves putting a small ring of magnesium balls in the esophagus to stop the spasms. Hope this info helps.