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How to manage difficulty in swallowing and heartburn?

Q: I am a patient of achalasia cardia. I got dilatation done two years ago. My swallowing problem got about 95% better and the rest of the problems such as nocturnal regurgitation, vomiting, etc. all went away. Now after two years I feel I am developing a little problem in swallowing, esp dry, hard food and also an attack of heartburn now and then (which is in a way depends on my eating habit). The problem that I have developed lately is that in the morning when I get up, I get pain in the chest, substernal region which is deep and more painful on certain positions. I have a sore feeling in the region (I can make out that it is at the place of blockage/dilatation). This sore feeling lingers on till midday and in the evening it is almost gone. Because of this I feel sick in the mornings and this interferes with my daily activities. This happens inspite of taking precaution of sleeping at least 2 hours after dinner which I make sure is not a heavy/spicy one and occasional little walking. I am concerned whether this feeling will be life long.

A:There are two possibilities regarding your problem. You may have developed reflux disease (reflux of gastric secretions into the oesophagus or food pipe), which is a side effect of dilatation treatment for achalasia. Alternately, you have recurrence of the achalasia. I suggest you should have a repeat endoscopy to reassess the oesophagus and the lower oesophageal sphincter. Depending upon the findings you may need either treatment for reflux disease or another attempt at dilatation.

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