achalasia and copd/asthma

After being diagnosed with emphysema and slight asthma I am going to request to my doctor a ct scan as I have severe acid reflux caused by achalasia and would like to know if the achalasia is making my copd worse, in fact has it affected the results of my spirometry as I know i was having it quite bad at the time of the pft test, and after reading a number of posts I realised that acid can spill over to the lungs  My question is do you think a ct scan is more reliable and accurate for diagnosing the possibility and also the degree of emphysema than a pft test?   Thankyou so much for your opinion. Withie

[Ratnakar Kini, MD]

Hi withie,,
Achlasia (achalasia) and GERD (acid reflux) are different. In achalsia, the lower esophageal sphincter fails to relax. In GERD, the sphincter relaxes abnormally allowing acid to go up in to the esophagus.

But both can cause lung symptoms. In GERD, the acid content may get aspirated and cause symptoms. In achalasia, the food that stays above the tight sphincter may get regurgitated and aspirated in to the lungs.

A manometry and 24 hours pH monitoring will be helpful to know whether it is GERD or achalasia.

Regarding COPD, CT scan is the most sensitive test that can be done for diagnosis.
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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.

[withie]

Thankyou very much for your reply, yes I have had a manometry test done and that is how the achalasia was diagnosed several years ago I also had a dilatation done (ready for redoing I feel) and on regular medication for acid.  I am not actually sick with the achalasia but mostly I feel like the food goes no further than just under my breastbone. and sometimes if I am laid down fluid will just come up to the back of my throat but not a vomiting feeling.   Would I know if the aspiration was taking place into my lungs other than the  intermittent shortness of breath, or is this how it presents if it has? thankyou once again you are so helpful. Withie.

[Ratnakar Kini, MD]

Hi withie,
Dilatation done for achalasia provides only symptomatic relief. It does not cure the underlying cause. So there are chances of recurrence.

As said eralier, the lower esophageal sphincter fails to relax propely and food stays above in the esophagus itself.
Whatever symptoms you have now may be because  of statis of food due to recurrence of achalasia. Manometry / barium swallow may help to see whether it has recurred.

If recurrence is there, you need a dilatation again.

You may also try some postural changes to clear this food stasis. The postural changes which many adopt are - raising the arms above the head, straightening the back and standing at very erect posture . Slow ,deliberate swallowing may also relieve the symptoms you have mentioned.
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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.