Chest pains after POEM procedure 2.5 years post op

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I had my POEM procedure done for achalasia in June 2017. Since then I have been able to swallow liquids and solids. I still struggle with certain foods and usually need water or soda which helps to burp and get food down my throat smoothly. While things aren't perfect or as it used to be I'm happy with the results because I wasn't able to get down not even liquid or my own saliva before the procedure.

I was informed that acid reflux would be a side effect and normally I don't eat a lot of spicy food to avoid that most times. However, what my surgeon did not inform me was the severe chest pains that come with it. The day after I had the procedure I experienced some chest pains radiating from my right to left side but the doctors told me that it should be just a side effect.

It's been almost 3 years and the chest pains have gotten more severe and unbearable. They happen out of no where when I least suspect it to and it honestly feels like a cluser of heart attacks that just won't kill me. I get dizzy, anxious and nauseous when it comes. It's horrendous when it happens while I'm at work or in public and the only way to distract myself is if I drink several bottles of water which 8/10 times makes me vomit. The pain does not go away it'll throb and ache before slowly reseeding. It'll last anywhere from 10 to 20 minutes or if I'm lucky it'll pass after a few minutes. I've been to the doctor and they prescribed me anti-inflammatory meds which don't work and it gives me horrible side affects with my stomach. The pain has gotten worse and more frequent now.

Is there anyone else who experiences the same thing and if they have found a solution to the pain. It's like a pain you can't begin to describe. I get scarred every time it happens...

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  • Edited

    I am sorry to hear about your chest pains, but, yes, some people do experience these pains after surgery.

    To be fair on the surgeon it is unpredictable insofar as some people get them; others do not. For some the pains are not so bad as they might have suffered beforehand; for others they are just different; and some do not have them at all.

    Achalasia is a condition that affects the nerve endings that control the muscles that propel the food down through the oesophagus to the stomach rather than the muscles themselves. The nerve system is part of the vagus nerve that controls digestion amongst other things. So it might be that the surgery has interfered with those nerves and has made them more sensitive. The pains can be caused by reflux, nerve damage, or other factors.

    The easiest thing to think about is whether they are caused by reflux, so it is worth trying to experiment and check whether this is the main/sole cause. Try taking Gaviscon Advance, because that creates a protective raft against reflux. You should return to your medical team to be reviewed because of these pains, but this might need to be by telephone at the moment.Another appproach would be a review of any PPI medication you may be on (eg Esomeprazole).

    Some people think that the cause of the pains is to do with lack of blood supply to the nerve endings, so some people try Viagra, amyl nitrate spray, Buscopan, Lyrica/Pregabalin or other medications, but they are all liable to have side effects so you need to have a doctor giving you advice before you try them.

    This is all unqualified speculation on my part so make sure that you listen to your doctor.

    This will not sound very helpful, but increased stress, anxiety and tension is likely to make things worse so exploring relaxation techniques might help. There are also medications that help to relax the digestive system.

    Achalasia Action is planning a patient group meeting at St John's Wood London on spasms but this is on hold at the moment because of the COVID19 pandemic, but the best way of keeping in touch for when this happens is to sign up to the newsletter on the Achalasia Action charity website.

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    • Posted

      Thank you for the response! Yes I was taking Pantaprazole but that hasn't been working for months as the pains are still persistent. Gaviscon does not help in the slightest. I wonder if it is due to the acid reflux now that you mention it. I could have this occur on an empty stomach just as well as after eating food.

      Perhaps I should talk to a specialist instead because my GP isn't all that familiar with achalasia related pain.

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    • Posted

      Gosh I'm so sorry to hear this. Achalasia is a tricky and painful problem to manage and really should be under the care of a GI specialist.

      I absolutely have to be careful for a couple of hours after every meal not to lie down or recline. Sometimes it doesn't matter.

      Can get in touch with the GI specialty that did your POEM surgery for suggestions?

      I take Pantoprazole, Sucrafate, (Tums when needed), Tylenol and Lyrica to help with associated nerve pain.

      My GI surgeon and specialist instructed me to NOT take Ibuprofen, N-Saids or any anti inflammatory meds for fear that it could cause irritation to my esophagus and stomach.

      Praying that you get relief soon!

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  • Edited

    Hi,

    Sorry you are suffering. Have you ever tried ice cold water? If it is a muscular type spasm this really can work. If it might be acid or irritant related warm (just cooler than tea) water really helps. Some people dont even bother trying as it sounds too simple. But it works for most. If you google achalasia action charity there is a great leaflet on there about this kind of stuff...

    Warmest,

    Neil

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    • Posted

      hi there, you are right. I drink ice water because when I drink that specifically it tends to help distract and slowly lessen the spasm. So far nothing else has worked in terms of naturally treating it

      thanks! I'll check out the website

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  • Posted

    I had the P.O.E.M. surgery in June 2019. Before the surgery and still after I suffer the same as you but my pain is mostly in my back near the shoulder blades and extends around my ribs and into the jaw. It is sudden and fierce. I have just discovered that using my T.E.N.S. on my back and the heating pad n my ribs helps considerably and fast. I used to suffer anywhere from 5 minutes up to and hour, often in the middle f the night. I am not yet sure what is causing this pain. I will start to see if there is a connection to GERD. I am glad to find someone else experiencing this same pain as I thought I was alone.

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    • Posted

      @pat2019 Thank you for commenting on this thread- you are the first person with achalasia that I have heard describe the exact same type of pain that I get (pain in the middle of the night in the back and chest along the ribcage, that radiates up to the jaw). Thanks for the suggestion of T.E.N.S. and heating pad; I'll try keeping these by my bed at night to use as needed. I just had my POEM surgery 1 week ago, but am still suffering from these pains as well.

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  • Edited

    Have your gallbladder checked. My husband just had the POEM in June and was having spasms at least once a month prior to the surgery, and more frequent and painful immediately after the surgery. His spasms were exactly as you described, I actually found your post when googling POEM post surgical spasms and pain because they were getting SO painful. My husband ended up in the hospital last week and had to have his gallbladder removed, it was full of stones. The description of gallbladder stones and attacks are the same as the spasms from Achalasia. They radiate in the exact same place as the Achalasia spasms and the pain is felt in his back as well. We wonder now if the spams were signs up his gallbladder starting to go bad and the doctor who did his POEM just never caught it or checked it while in there doing the testing and surgery for Achalasia. His swallowing is definitely way better since POEM, but he was having debilitating spasms that were getting worse and worse. He's been home for a week and a half since just having his gallbladder out and miraculously, NO SPASMS. Seriously, go to the your primary and have them do a sonogram and check your gallbladder.

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  • Edited

    i never heard of achalasia until literally three months ago. Starting with the chest pains back on 2020 then noticing swallowing issues, I had an endoscopy done with not my regular doctor. He proceeded to tell me that I had reflux add reflux and wanted to treat with medications. I told him I did not have that as I had one of the most healthiest stomachs going as I supplement; I had heartburn once in my life, when I was pregnant.

    They would not listen and insisted that I take 2 different prescription medications for reflux. Finally after one evening of food being stuck for 5 hours I called the office back and requested my previous doctor. During our tele-health video call he immediately told me I needed to schedule a particular type of X-ray drinking barium. Two days later I received a call from the office where they suspected the achalasia and then following up with him he said he wanted to do 2 more tests to confirm it, which it did. A few weeks later I had POEM.

    I pretty much eat constantly but it's all a variety of healthy foods so the liquid diet was a big challenge for me. Then moving on to the soft foods. So I'm about 2 weeks after the procedure and I haven't had any follow-up calls yet but I'm trying to eat a little bit more variety by chewing things really really really well. And I did notice that I got those severe chest pains and they do seem to happen at night. I'm grateful in the sense that other folks have experienced it because I have no idea what they are and how it was related to this disorder. Oddly, I had started with the drinking water for relief, not even knowing it was a viable way to help.

    I had an upset stomach last night and 🤢 and I'm hoping that didn't cause any damage.

    I'm sorry for the folks going thru this, bit I have some comfort seeing I'm not alone.

    ❤️

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  • Posted

    I had POEM surgery on May 13 2022

    I too still suffer from these spasms and before the surgery the only thing that would make it go away was ice cold water.

    Lately ive found eating a banana or a few blueberries actually any fruit helps it subside within seconds.

    Posting in case it could help someone else.

    Wishing you all the best.

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  • Posted

    just found this thread online I had the POEM surgery in January of this year after I was diagnosed with type 2 achalasia. I get the chest spasms about once every two weeks most the time during a workout and sometimes when stressed but its excruciating and I dont know what I can do to stop it usually I take advil or motrin and it kicks in in about 20 minutes but wondering what else I can do Don't think its food related because often time I am fasting when it occurs any new updates?

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