Ask Dr. H: When food won't enter stomach

Question:

I was diagnosed with esophageal achalasia a few years ago. I did not have any reflux issues - just difficulty with food entering my stomach. I've had two dilation procedures, which helped for a while. Carbonated soda with meals seems to help the food move along. I rejected Botox injections of the esophagus because the effect is temporary. I haven't had any treatments in several years and food still collects at the point of stomach entry. Is a soft diet the best cure?

Answer: Sometimes we just can't relax. Our muscles tense up, and we feel uptight and uncomfortable. Achalasia is like that. It's when the band of muscle between the esophagus and the stomach just won't relax. It doesn't take a doctor to realize that if this lower esophageal sphincter muscle is squeezing down like a clenched fist, food is going to have a tough time getting into the stomach.

Achalasia is a coordination problem with the muscles involved in swallowing. There's supposed to be a contraction of the lower esophageal muscles, followed by a relaxation of the lower esophageal sphincter as food approaches. If there's damage or degeneration to the nerves that control all this, achalasia will result.

We take swallowing for granted (until there's a problem), but it's really a complex series of events possible only with fine motor coordination between the different muscle groups of the pharynx (tube that connects the mouth to the esophagus), larynx (voice box) and the esophagus.

Symptoms of achalasia include not only difficulty with swallowing but also may involve chest pain after eating; heartburn; cough; regurgitation of food; and weight loss from an inability to get food past the spasm.

Although we can't repair damaged or degenerated nerves, we can insert dilating tubes of gradually increasing diameter to stretch open the sphincter. There are also inflatable tubes that do the same thing. Success is seen in up to 75 percent of folks for a period of several years, but there's a 3 percent risk of rupturing the esophagus. Botox, the same drug used to treat facial wrinkles (i.e. - weaken frown muscles), has been effective for one year in 60 percent of folks when given under endoscopic guidance.

Surgery to cut through some of the constricting esophageal muscles is the treatment of last resort when everything else has failed. Moistened small mouthfuls of soft food may help to get past a constricted opening, but a sphincter's tone may be too strong to allow food to get through. Acid blockers should be taken after any treatment intervention.

Q: Would mold in the home cause fatigue, headaches and shortness of breath?

A: Molds, which are a fungus, will grow anywhere indoors where there's moisture. Outdoors, molds help in the natural decay of dead organic matter like leaves and plants. Indoors, their spores may land on a moist spot and begin growing. Molds produce allergy-provoking substances and irritants and may contain toxic substances that make us sick.

Fatigue, headaches, watery eyes, irritated lungs, shortness of breath, asthma and myriad other health conditions can be linked to fungal toxins. They are nonspecific symptoms, and may be due to something unrelated to mold.

Stachybotrys mold is considered the prototypical "toxic" mold. You may have seen this greenish-black mold growing on cellulose fiberboard or Sheetrock in your damp basement. Air-conditioning ducts and whole-house humidification units need to be watched for mold.

If you've found mold in your home, the type of mold is not important. Treat all mold as potentially harmful. The first thing is to address the moisture problem. Fix or clean up any leaks, and put a dehumidifier unit in your home. You must consider all ways to prevent more mold from growing. A weak bleach solution can clean mold from walls, ceilings, floors, and ducts (wear a mask). If you've had flooding, the carpet likely has mold growing underneath. Remove the carpet and replace it only when everything is dry and mold-free. Remove and replace moldy Sheetrock and insulation. When cleaning, never mix bleach with ammonia-based cleaners. You may want to hire a professional for this.

It's impossible to get rid of all mold and mold spores; some spores are airborne. But if the house is dry, mold will not grow. Here's a link to an EPA guide to mold: www.epa.gov/mold/moldguide.html.