Talk:Achalasia

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GERD[edit]

GERD isn't really a complication of Achalasia, it's a complication that can result after treatment of Achalasia. Some Achalasia patients also have GERD but they are separate conditions. Sorceress_Jade 10:53pm PST December 2, 2005


Under complications, I removed the percentages of achalasia patients who develop Barrett's and esophageal cancer, which had been flagged as needing a reference. In fact there are many references to increased risk in the literature, but when any statistics are included regarding the amount of increase, it tends to be a range rather than a specific percentage. See for example http://www.informaworld.com/smpp/content~content=a748020945~db=all Sssuuuzzzaaannn 18:32, 1 May 2007 (UTC)

It appears this condition does not receive the attention it deserves. As a sufferer I would hope someone would oome up with a better option than than the few that are available. Recently I discovered that Cialis helps, and it does! However it may not be a long term solution. Whilst some people may smile that one takes viagra to help a problem with the throat, the seriousness of my long term prognosis doesn't make me smile. What is the chances of gene therapy to solve this condition? If in the UK we can make certain blind people see using this method then surely there may be an option to use this method on achalasia.Any expert view/contacts welcome.

HRQOL[edit]

doi:10.1111/j.1365-2036.2007.03423.x JFW | T@lk 23:25, 2 July 2007 (UTC)

Someone at Blackwell forgot to press the DOI button. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2007.03423.x is the relevant URL. JFW | T@lk 21:08, 26 May 2008 (UTC)

Nosology and stem cells[edit]

I have deleted the comment regarding a proposal by O.A. Stiennon that "achalasia is not actually a unique disease, but a subset of hiatus hernia with special characteristics." This comment was apparently posted by Stiennon himself or a relative, and the reference website was promoting sales of his book on this subject. This idea is not a generally accepted opinion among medical professionals, and including it here is not suitable for an encyclopedic article.Sssuuuzzzaaannn 18:44, 22 August 2007 (UTC)

Is Stiennon a widely acknowledged expert? If not: Retry, Abort, [Ignore]. JFW | T@lk 21:08, 26 May 2008 (UTC)

To Jfdwolff: Some very preliminary research on the use of stem cells as a possible eventual treatment for achalasia is being done by P. Pasricha and M. Micci at University of Texas Medical Branch at Galveston.Sssuuuzzzaaannn 18:44, 22 August 2007 (UTC)

URL please? I know achalasia is an unpleasant lifelong condition, but... stem cells?!? JFW | T@lk 21:08, 26 May 2008 (UTC)

http://www3.interscience.wiley.com/journal/113390050/abstract?CRETRY=1&SRETRY=0 It's preliminary, but they have gotten stem cells to survive and function in the gut. Achalasia is one of the conditions they want to eventually try treating with stem cells. http://linkinghub.elsevier.com/retrieve/pii/S0016508505017737 Sssuuuzzzaaannn (talk) 01:16, 8 March 2009 (UTC)

ICC cells[edit]

doi:10.1111/j.1572-0241.2007.01667.x - ICC cells are depleted in achalasia. JFW | T@lk 00:20, 9 December 2007 (UTC)

Rewrite and stuff[edit]

I'm rewriting the page with references for as much as I can find. In the process I may temporarily remove content that I can't reference.

I removed "complications" (no source, contradicted by other sources):

  1. Gastroesophageal reflux disease (GERD) or heartburn.
  2. Achalasia patients have an increased risk of developing Barrett's esophagus or Barrett's mucosa, a premalignant condition which may lead to esophageal cancer over a period of years.
  3. Aspiration pneumonia: Food and liquid, including saliva, are retained in the esophagus and may be inhaled into the lungs, especially while sleeping in a horizontal position.

I realise that my main source is 10 years old, and I will ensure that the treatment section is more up-to-date. JFW | T@lk 20:54, 26 May 2008 (UTC)

References for complications (esophagitis/Barrett's and aspiration)[edit]

Alimentary Pharmacology & Therapeutics:Volume 23(8)April 2006 p 1197-1203. Oesophagitis is common in patients with achalasia after pneumatic dilatation. http://pt.wkhealth.com/pt/re/alpt/abstract.00001716-200604080-00019.htm;jsessionid=JzdfF2yT2J8tCpGp2vTqSh84v0vN15sV127WmzrvL6Rr12YnPXcB!751744069!181195628!8091!-1

"Barrett's Metaplasia and Dysplasia in Postmyotomy Achalasia Patients" http://www3.interscience.wiley.com/journal/120155580/abstract

McArthur MS. Pulmonary complications of benign esophageal diseases. Am J Surg 1986; 151:296–299. (no URL)

"What is the incidence of pulmonary complications in patients with achalasia?" http://www.hon.ch/OESO/free/Vol_4_Prim_Motility/Articles/ART105.HTML

Sssuuuzzzaaannn (talk) 01:32, 8 March 2009 (UTC)

Rewrite[edit]

I have some problems with certain changes made by Sssuuuzzzaaannn (talk · contribs). For details, see her talkpage. JFW | T@lk 17:43, 18 June 2008 (UTC)


Possible connection with Hypothyroidism? =[edit]

I have Achalasia and have had it for many years. About a year ago I had a health crisis apparently caued by a viral infection - it caused polymyalgia rheumatica, wrist arthritis, extreme tiredness, slow recovery from even short runs, much slower running times per heart rate , and so forth. When it didn't get better I went to various doctors and eventually got prednisone to take care of the polymyalgia rheumatica. I was also diagnosed with hypothyroidism and given Levothyroxin, currently 137mcg/day.

While a year later I'm still struggling to get back to running times, the good news is that my achalasia seems to have greatly moderated. Perhaps someone else has had this experience? Dr sfzed (talk) 00:37, 19 September 2008 (UTC)

Symptoms[edit]

Maybe I am wrong, but I was under the impression that Achalasia almost expressly does not have the symptom of heartburn. I can understand the sensation of a pressure behind the sternum, but since the problem is with an overly constricted LES, I would think that reflux of gastric juice into the esophagus would be one of the last things that should happen. (D.c.camero (talk) 00:37, 15 October 2008 (UTC))

The chest pain is not reflux-like at all, but results from progressive oesophageal distension. I have corrected this. JFW | T@lk 21:52, 16 October 2008 (UTC)

New classification[edit]

Based on manometry: doi:10.1053/j.gastro.2008.07.022 JFW | T@lk 14:22, 11 November 2008 (UTC)

Definition of achalasia[edit]

Conflict in sources over whether esophageal cancer can be a secondary cause of achalasia, or only causes a motility disorder. Pandolfino sources says that defining the disorder as achalasia requires excluding secondary causes like esophageal cancer. Kallimachus (talk) 20:46, 3 July 2010 (UTC)

The need for a cure[edit]

Whilst the academic writing and the corrections on the website are to be commended, I have the disease. I would appreciate any student or doctor who wants to make a name for themselves come up with a cure, rather than a treatment. If you are a sufferer you seem to have the choice of medicines with possible side effects, dilation which isn't wonderful (I've had this) or an op which certainly doesn't leave you like new. It may be seem a small number of suffers, however as with many other branches of science a cure here may be transferable (or vice-versa). If anyone is working on this, or close, I urge you to keep going. Does anyone think that a prize for the cure of achalasia would be of benefit? —Preceding unsigned comment added by 86.153.194.169 (talk) 23:35, 11 March 2011 (UTC)

Please don't use Wikipedia as a forum. WP:TALK makes it very clear what these talk pages are for. You are unlikely to reach your audience anyway.
It is difficult to envisage a "cure" without first knowing the reason why achalasia actually occurs. The microscopic changes to the autonomic nervous system in the oesophagus are well documented, but it is entirely unclear why this might be the case. Only high-quality basic science research will bring an answer to that question. JFW | T@lk 22:38, 12 March 2011 (UTC)

Review[edit]

Gut this week has this: doi:10.1136/gut.2010.212423 JFW | T@lk 03:05, 11 May 2011 (UTC)

This trial (PMID 21561346) compares pneumatic dilation with Heller's. Dilation is similarly effective. JFW | T@lk 18:46, 15 November 2011 (UTC)

"fail medical management"[edit]

The term "fail medical management" is controversial - from patients's perspective - although it is common parlance in "provider language." Especially for an incurable condition, where "all treatment is palliative" (citation needed - have to find where I read it), the phase "fail medical management" is especially offensive, particularly when the condition is can severely affect quality of life and become severely disabling. As relates to most "disabling conditions" the "politically correct" matter is that ""medical management failed the patient." Notwithstanding, the content, as written, is "reasonably correct" and in line with prevailing literature that can be cited. "Medical management" (I believe) refers to non-surgical interventions."

Perhaps, sub-sets of this commentary should be on different pages. (Advisory welcome.)

Re the specific example: Although must published sources I have seen refer to use of Calcium-channel blockers as a short-term intervention, while awaiting a more definitive approach, I am aware that people can use this Rx for years. (no citation known to me - as time allows, I could search for one. ) Note (again, no citation, but anecdotal data), many people are provided with inaccurate instructions as to how to use administer calcium Channel Blockers: No wonder it is not reported as more than limited success!

As time allows, I might be willing to re-write this article. However, I would really want some guidance as to WHAT people want to know. With relative priorities. I have much knowledge of topic. However, most of what I read on internet is either not what patients need to know, or is grossly out-of-date, etc.

Also, I need to know how to write an article without citations - and add them later, after it becomes clear that the framework and content of article is, essentially what is wanted. AFAIK -- different opinions welcome -- writing a solid first draft or a stub is first major step. (I don't consider existing article as suitable, largely because most of it is so out of date and/or not accurate to what is seen in clinical setting.)

AFAIK, people research this topic (as any other rare disease) because they have encountered someone (or themselves) with this diagnosis, and they seek basic information.

Does the medical project have a guideline for format for medical articles? Different format for articles about rare conditions or difficult to diagnose conditions?

This condition is considered one of the most well-known of a subset of somewhat similar conditions.

Because of my knowledge, I really need a better understanding of the relative wiki-priority of different medical topics - before I make commitments (or even offers) to assist with redoing articles. Apart from wiki-rules, my "logic" is priority increases to the extent that helpful, accurate, understandable, & non-biased information is not readily available/findable on the internet. Is this accurate? Previous sentence is difficult to decipher - because how is "bias" defined? Who has more bias: Researcher who is researching same question that has been asked "a dozen --KnowLimits (talk) 23:41, 25 November 2011 (UTC)ways" in more years than that - without advancing the knowledge, but producing peer-reviewed articles ("Publish or Perish")? Or, patients (sources of anecdotal data) who may know more about a rare disease than treating doctors do? --KnowLimits (talk) 23:41, 25 November 2011 (UTC)