Heartburn problem after myotomy

[Guest guest]

This is in response to a message I received in private. Much of this is

a repeat of recent messages.

When most people, even doctors, think of heartburn they think of acid

reflux. They also quickly think antacids or acid reducers (not the same

thing) are what is needed. With achalasia it is important to remember

that what feels like heartburn from acid reflux could be spasms or other

NCCP (Non-Cardiac Chest Pain) such as hypersensitive damaged nerves and

other neuropathies. Pain could even be unrelated to achalasia.

Taking a large enough dose of antacid should neutralize acid quickly and

bring quick relief. If it does not stop or reduce the heartburn then you

have to question if the cause is really acid. Acid reducers work to

reduce acid production but do not stop acid production. Even if taking

PPIs or H2 blocker there could still be enough acid produced by some

people that heartburn could happen. So even if one is already taking

those medications the antacid test can still be valuable.

If the antacid test leads you to believe that it is not an acid problem

then check with a doctor. He may be want to try changing medications or

doses first before doing anything else. If those changed don't work then

he may decide that a 24hr pH test is needed. You can also ask for the

test. It is not a pleasant test but it only lasts for one day. It should

determine if acid is a problem.

If the antacid test did make a difference then acid is likely part of

the problem. Again let your doctor know the results. He may try changing

your dose or medication. He may still want a 24hr pH test to see how

much acid reflux there remains with the medication. You can ask about

using more than one medication at a time or using an antacid as needed

along with your medications. Avoiding certain food may also help.

What seems like heartburn may not be from acid reflux. Sometime there is

no acid reflux but it still feels like there is heartburn. These could

be spasms or NCCP. Even if you do have an acid reflux problem and are

taking medications for it, you could still have spasms and/or NCCP. You

could have all three kinds of problems. You could even have pain

problems that have nothing to do with achalasia. Nothing says we can

only have one kind of chest pain.

Treatments for chronic pain such as low dose antidepressants help some

people with achalasia chest pains but not others. Treatment with calcium

channel blocker (CCB) or nitrate medications that relax smooth muscles,

like the muscles of the esophagus, help some people with achalasia chest

pains but not others. There are other kinds of muscle relaxers that help

some people but not others. There are also antispasmodic medications

that act on neurotransmitters to calm nerve that trigger spasms they

help some people but not others. Medication that do work often have side

effects or take some time to adjust to.

Be prepared to spend time making visits to your doctor to find what

works for you. Often a doctor may try one or two medications, such as a

CCB or nitrate and give up. In that case you need to speak up and say

you want to try the other kinds of medications or find a doctor that

will explore more options with you. It may also be time to check out

other sources of chest pain such as gallstones and heart problems, if

appropriate.

There are no guarantees that good enough help can be found. There are

people that find no relief until they have an esophagectomy. But

remember these pains can change over time. They may be worse following a

surgery and then reduce over time. They may also come and go like the

seasons or come and go with triggers like stress. Some people have more

problems in the early years of achalasia.

notan