acalasia and a PEG

I have had a heller myotomy and fundiplication in 06.  I have had acalasia since 94. I am 36 years old.

I get gastric distention that puts my pain at a 10 and puts me on the floor.About once a week for the past 6 months, about once a month prior to that, I go to the ER to have an NG tube placed and get decompressed, which brings me to a tolerable 6.

My problem is now, with all my scarring and strictures, etc. I can no longer tolerate the NG tube. So, now I'm just going in to the ER, getting Dilaudid to calm me down in my pain, but of course it doesn't make it go away. My doc doesn't want to give me narcotics regularly since they can be constipating and I already have an issue with gas being unable to pass.

So, I recommended to my primary care provider, that we try a PEG to get access to my stomach.The VA has denied me this for years because I'm "too young" and risk of infection, etc. But since they have no treatment or pain medication for me, she's willing to ask the GI doctor to consider it. Ever hear of this method, or have an educated opinion?

Thanks,
Lana

[Ratnakar Kini, MD]

Hi,
Barium swallow/ esophageal manometry will provide data on the status of the esophagus and the lower esophageal sphincter.
If these tests point towards obstruction, then a forceful dilation or a reoperation would be helpful.
PEG is a simple procedure that may provide a solution to your problem. But it is usually not done for problems like this.
================================================================
The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.

[LanaM]

I have dilation once a year, when I get my EGDs. My swallowing is eased, but not my distention problem.

I have not had a recent manometry, but I have just moved and will see different providers, so perhaps I will get one. The surgeons think there is nothing more they can do for me. But with these new providers, maybe they will have an idea.

Thanks,
lana