Uncovering Achalasia

By Edeline Anne Goh

It took her 3 years and visits to a dozen medical specialists before she finally found a cause to her symptoms. This is the story of a brave, young woman’s struggles with a mysterious condition that very nearly derailed her personal and professional life.

It all began in 2010, when physiotherapist Balvinder Jit Kaur, was studying in India. One fine day, she experienced pain around her chest that started from her back and stretched right to her jaw.achalasia

 “That was my first symptom (chest pain) but I didn’t think anything of it. We often associate such pain to something related to the muscle, bone or nerve, which was what I was taught. Besides that, eating was never a problem at that point except for occasional discomfort when food gets stuck along the way, which I believe is something many people experience as well,” says Balvinder.

After a period of time, however, the pain in her chest became worse and she decided to seek medical help. “I first saw a general surgeon who then referred me to an orthopedic specialist.  There, I did a Magnetic Resonance Imaging (MRI) scan and yet the cause was still unknown.” Balvinder soon found herself talking to one doctor after another.  “I was sent to consult a spinal specialist, followed by a cardiologist and neurology surgeon. I also went to see a gastroenterologist and was prescribed medication to manage acid reflux symptoms. I did an endoscopy but they still couldn’t find the cause,” she recalls. “When the symptoms persisted, I was asked to visit a psychiatrist as my condition was thought to be stress related. I was prescribed anti-depression medication but in my heart, I knew that was not the cause.”

It reached a point where Balvinder, 25, was seeing a different specialist every 3 months in the hope of discovering the cause of her symptoms and finding a cure. Little did she know that it was only the beginning.

Instead of getting better, Balvinder’s symptoms worsened and she would occasionally throw up after eating. This left her body with very little food for energy and nourishment. Her low energy levels also affected her work as a physiotherapist — a job that requires plenty of physical activity.

In mid 2013, just 3 months before her wedding, Balvinder’s ongoing nightmare took a turn for the worse. “My symptoms started getting very bad. I couldn’t keep any food in me. Everything I ate or drank was vomited out. In just 2 months, I lost 9 kilogrammes!”

 Balvinder felt ill even during my wedding day. “I was not feeling my best as I was not able to digest much food and I experienced gastric pains. At my wedding reception, I was not able to sit still either. I had to rush to the toilet several times because each time I took a bite, I had to throw up.”

Since Balvinder’s symptoms were becoming more and more serious, she and her husband, Harvin Jit Singh, considered cancelling their honeymoon. They decided to consult a doctor about their dilemma and the doctor encouraged them to carry on as the symptoms were once again diagnosed as stress related, due to the wedding.

“We took the doctor’s advice and flew to Phuket. The first day was alright and I managed to enjoy some Thai food such as tom yam. However, at night I started experiencing the symptoms again. I could not sleep, I felt dizzy and I kept vomiting,” reveals Balvinder. “This continued throughout the honeymoon.” In the end, she resorted to drinking cold coconut water as a source of energy and to keep herself hydrated.

It was during her stay in Phuket, that Balvinder felt like the situation had reached rock bottom. “I just felt like hiding in a room. Thankfully, I have a very supportive family and my husband suggested that I should continue looking for answers. So, I decided to call my cousin — who is a doctor — for some advice.”

That was how Balvinder ended up consulting Datuk Dr. Ryan Ponnudurai, a gastroenterologist. Gastroenterologists are medical practitioners who specialise in treating gastrointestinal tract disorders. Balvinder detailed her symptoms to Datuk Dr. Ryan Ponnudurai. “He put me through a series of tests which were the barium swallow and esophageal manometry and based on the test results, I was diagnosed with achalasia.”

Balvinder remembers feeling a huge sense of relief that the cause of all her misery had finally been identified. “He didn’t need to convince me to opt for the surgery when we were discussing my treatment options. I was more than willing to undergo any treatment necessary,” she says with a smile.  “Ironically, throughout the years and my many visits to different medical specialists, no one asked me if there was a problem with my oesophagus.”

This is the main reason why Balvinder strongly believes that there is a need for awareness about achalasia. “It was God’s blessing that I found a doctor who was able to diagnose the problem. As of now, I’m looking forward to a full recovery and as a foodie I can finally enjoy the food that I love,” shares Balvinder. “I’m thankful for an understanding and supportive family who made sure that I found a cause to my symptoms. Plus, I’m also grateful to have a husband by my side through the ups and downs!”

Urban Health speaks to Datuk Dr. Ryan Ponnudurai, an Internal Medicine and Gastroenterology specialist at Prince Court Medical Centre, who shares his expert insight into achalasia.

Urban Health: What is achalasia?

Datuk Dr. Ryan Ponnudurai: Achalasia is a disease that affects the muscle of the oesophagus (swallowing tube). The term achalasia means “failure to relax “. In other words, the lower oesophageal sphincter does not open up enough to allow food to pass into the stomach.

UH: Is there a particular age group or gender that is more susceptible to this medical condition?

DDRP: It is most common among the 20 to 40 age group. However, this condition can appear at any age.

UH: How is achalasia diagnosed?

DDRP: It is diagnosed when patients give a classical history of difficulty swallowing solids and liquids.

The investigations conducted to diagnose the condition include upper endsocopy, barium swallow and manometry, which will assess the pressure in the oesophagus.

UH: What are the treatment options available?

DDRP: The treatment options for achalasia include Endoscopic balloon dilation, which tears the muscle fibres and this allows the patient to eat. The other option is laparoscopic hellers myotomy. This is a key hole surgery which is performed to dissect the muscle fibres of the lower oesophageal sphincter.

UH: Both doctors and patients tend to misinterpret the symptoms of achalasia. What is your advice on this?

DDRP: The symptoms can vary from chest pain, gastroesophageal reflux disease, cancer and even stress. The physician needs to be aware of this condition and refer to a gastroenterologist for appropriate investigations.

UH: Can a patient with achalasia be fully relieved from symptoms after undergoing the necessary treatments?

DDRP: Yes, patients can feel better and are able to eat and drink after treatment.

UH: Do patients have to make amendments to their food choices?

DDRP: After treatment, patients can actually eat normally and lead a normal lifestyle.

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