Posted by: Christopher Maloney, Naturopathic Doctor | May 17, 2011

Achalasia: When You Just Can’t Swallow.

A CXR showing achalasia ( arrows point to the ...

Image via Wikipedia

When you look at NORD, the National Organization for Rare Diseases, Achalasia is listed as rare.  For those of you who have no problem swallowing, this post is unnecessary and very detailed.  But those of you who have some difficulty should probably read on. 

The curious part is that I’ve seen far more Achalasia patients than I have, say, Acromegaly or Alopecia Areata.  Both would also be rare diseases, chronic long-term issues that may or may not respond to conventional treatment just like Achalasia. 

What is the standard treatment?  Surgery.  The Mayo Clinic uses a team approach and minimally invasive surgery, but it’s still surgery.  The medicine net site lists heart medication (to relax the esophagus) surgery, more intense surgery, and botulinum toxin injections.  Of these, the Cochrane database has this to say: “

Laparoscopic myotomy should be the initial treatment for most patients with achalasia. Pneumatic dilatation is the most cost-effective alternative but its long-term efficacy is less than that of surgical myotomy. Endoscopic botulinum toxin injection can be considered when other forms of treatment are contraindicated.    (Ann Afr Med. 2008 Sep;7(3):141-8.)

Ok, we’ve got surgery, more surgery, and botulin injections.  Anyone want to try a different approach? 

Due to its status as a rare disease, achalasia isn’t getting the research dollars it needs.  Besides, we can just cut out that pesky sphincter.  But what is the outcome when you cut out the sphincter or dilate the heck out of it?  Why, reflux (GERD)!  It was actually much higher in the dilation crowd, because they tuck the stomach a bit during the surgery.  One study found 30% right after surgery

So what about trying to figure out why it happens?  Could it be the extremely common situation where muscles are experiencing cross-reaction from some viral or bacterial agent?  The body goes after the infection, thinks the muscles are involved, and then goes after the muscles. 

 Is it possible the at least a portion of patients are experiencing this situation.  It looks like Herpes Type I may be the culprit. 

Here’s the medicalese and the link. 

“Achalasia, a motor disorder of the esophagus, is characterized by myenteric plexitis leading to neuronal loss. Cytotoxic T cells, isolated from the lower esophageal sphincter of achalasia patients, respond to human herpes virus-1 (HSV-1) with gamma-IFN (and to a lesser extent IL-2) production and clonal proliferation. In addition, HSV-1 DNA was demonstrated in the vast majority of patients, but also in controls. These exciting data suggest that achalasia is an immune-mediated inflammatory disease in which a (latent) infection with HSV-1 leads to persistent immune activation and self-destruction of esophageal neurons, most likely in genetic susceptible subjects only.” (Am J Gastroenterol. 2008 Jul;103(7):1610-2. )

 So why aren’t we seeing more work being done with Achalasia and antivirals?  Wouldn’t that be more effective and less invasive than surgery?

If you go to my website, you will see that I don’t list that I treat Achalasia.  Truthfully, I haven’t been successful with the anti-herpes specific treatment with the few patients I’ve tried.  Admittedly these were very advanced cases, but I like to be sure I have something to offer before I list something on my treatment page. 

But I think in less advanced cases alternative medicine may have some good things to offer for the vast majority of cases where surgery isn’t yet a necessity but who are still having trouble swallowing.  If you are out-of-state, check the AANP for local licensed N.D.s.  Those in state but needing someone close can check the Maine Association of Naturopathic Doctors.  Remember, we’re all cats, meaning that we all do some very different things and don’t follow one set of protocols.  If you want to find me, the best place is via  http://www.maloneymedical.com/

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