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I may have Achalasia or some sort of Esophagus Motility problem???

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Raellen
Raellen

I am looking for advise or answers from folks who have Esophagus Achalasia or Esophagus Motility issues who may offers some answers for me. I will be very appreciative of all replies.

Back in June, 2014, I started having the sensation that I had food stuck in the mid chest area of my esophagus, right between my breasts. At first it was just in the evening time, after comsuming my meal. Then it started happening almost after every meal. I would drink water, one 16 oz bottle after the other trying to make it go away, sometimes getting relief, most time not. It has never been painful, I have never had problems swallowing, just the sensation that the food was not going down. 

On July 1, 2014, I had an edoscopy done, things checked out that I did no have a stricture, no cancer according to the biopsy, but I did have redness and inflammation. My Gastro Doc said I may had been experinecing a spasm. He put me on reflux meds.

Now it is August, and I am not getting any relief from the meds, still having that feeling of stuck food after meals, and actually it is radiating a bit more area, but still mid chest. So I go back to the Dr., he says I maybe having some mobility issues? He wants me to have the Manometry test done! sad I am horrified! I have GAD, and only deal with it at an elevated stage when I have medical issues that require horrid test and cause little demons to run around me with stabbiNg me with their pitch forks!  I asked if I could please just do the Barium Xray test instead, and he was like, NO, I cannot help you if you do not do the Mano test. He has ordered the Barium test, but said it was a waste of money, as I would have to do the mano regardless of the Barium test outcome. 

I have been doing a lot of research and I am scared. In the early stages of Achalasia, has anyone had the symptoms I have shared? It has never been painful, I have never had problems swallowing, just the sensation that the food was not going down. I also  feel like I have to clear my throat all the time, not sure if this is a symptom of the acid reflex meds though. Could it be something else besides motility issues? Thank you for reading my post. 

1 like, 34 replies

34 Replies

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  • AlanJM
    AlanJM Raellen

    Posted

    I think it sounds as if your doctor is doing the right thing.   There are various motility conditions of which achalasia is one, and it is important to have all three tests done ie endoscopy, barium swallow and manometry.   The manometry is not comfortable by any means, but it really is important that this is done because it tends to show exactly where the problem is.   Otherwise the diagnosis involves a bit of informed guess work.   It is also important that the thorough diagnosis influences what treatment is offered to you.

    There are plenty of people who have been through a similar experience.   There are some notes on the website of the Oesophageal Patients Association - The Oesophagus.

    In many cases it is a problem with the nerve ends not operating the muscles that drive the peristalsis (swallowing function) properly.   It is easy for me to say, but my advice would be to try and get the best treatment as soon as you can, because the younger you are, the more responsive your system will be, but it won't be clear, until you have done the tests, exactly what is best for you.

    It is indeed a great burden to come to terms with what may be your diagnosis, but try not to think of the discomforts of tests and procedures;  concentrate on how much better you would feel afterwards.   Once the main diagnosis has been made, the issue of reflux could then be sorted out.   Long term exposure to reflux is not a good thing, and in any event you will need to have something to stop the redness and inflammation.   It will all depend on how the valve between your oesophagus and stomach is affected.

    This is easier said than done, but because the nerve system may be involved, taking steps to improve your relaxation, and reducing any tension, may well prove beneficial, regardless of what procedures are recommened or carried out, as there is often an element of contributory factors adding to the main issues.

    I hope this helps and I hope your treatment will be successful.

     

    • rosslyn21419
      rosslyn21419 AlanJM

      Posted

      Reading through your posts Alan you seem to know a lot about these conditions , I'm still in a grey area had all test apart from barium but again the oesophagus chest pain is the grip for me mainly , my wet swallow result was poor to none existent  that was water being swallowed , but the marshmallow and dry biscuit test was good , my lower oesophagus sphincter was closing so unlikly to be an acid issue . Only 2 episode of acid reflux with the test on 24 hours.couldnt eat much at all , consultant said it wouldn't on made a difference. , I just sometimes think when I have ate food that's when it feels inflamed and chest starts to have the heavy dull ache , I can wake up with the chest pain , but it's generally after food , I have a gaviscon tablet after food especially at work as it's busy and they help ! Not sure why when it's not acid related ! I have a hiatus herrnia 3 cm and that was found when the camera went down , but this is not the issue I'm told , all because the lower sphincter is closing , it's awkward ! So I will welcome any advice , I'm only doing fizzy water before each meal , and during food ! Cheers Roz 
    • AlanJM
      AlanJM rosslyn21419

      Posted

      It really is your doctor / specilaist who will be able to tell you what's wrong so you have to respect their diagnosis / judgement.   Sometimes there is a problem with nerves part way up the oesophagus and perhaps that is why the muscles go into spasm and cause your pain.   Veryt often there is a problem with the lower oesopahgeal sphincter not opening and closing properly but that does not sound like it is the case for you, which is good.   When you had the two episodes of acid reflux during the test, did those cause you any pain to your recollection?

      I think I would feel like keeping a careful food diary to see whether some food (eg spicy;  difficult consistency) causes more problems than others, but the fact that you coped with dry biscuits and marshmallow is interesting.   I am wondering also about why the fizzy water seems to help;  perhaps that is to do with encouraging gas / burping or somehow helping the liquid go down.    I wonder if your oesopahgus is inflamed or very sensitive at some point;  or perhaps there is something about the non fizzy water that it cannot quite cope with.   Does it make a difference if you sip still water very slowly?   Does it make a difference as to how you sit / stand when  you eat?   You might try making sure that you are in a relaxed position?   Gaviscon creates a protective raft for an hour or so (it is an alginate rather than antacid).   This is a bit unlikely, but it is possible that reflux can be bile, which is an alkali and therefore not combatted by anti acid medication;  but the difficulty you have in swallowing water does seemto be the most significant thing.   A hiatus hernia will be likely to create more acid.   Many people do not worry about having them repaired, but if it ever comes to having a surgical procedure for your problem they would probably do it then.

      I have not really got the answer I'm afraid!

    • rosslyn21419
      rosslyn21419 AlanJM

      Posted

      Thanks Alan for any advice you or any of us can offer , it's a waiting game for me , hot water bottle on me chest is the only way to relieve the chest ache ! The fizzy is to open the sphincter and move the food faster down the oesophagus ! I still feel it's an acid problem it feels like that at times , it's a tricky one , going to ask for a chest ex ray to fill in another piece of the puzzle, and maybe a low dose of lanzoprozal anti acid medication.  As I'm not sure about been on nothing as if it's inflamed I feel I should have protection until I have another camera in 11months time ! I have been regularly attending a chiropractor and I feel this helps as she works on the chest and upper back neck and jaw , so this is another way I cope ! Do you have a hiatus hernia ? 
    • AlanJM
      AlanJM rosslyn21419

      Posted

      No, I don't have a hiatus hernia myself (to the best of my knowledge!)

      If the gaviscon works that will give some level of protection.   I imagine that the chiropractor would be able to relax the muscles and this would have a beneficial effect.   Perhaps the lower oesophageal sphincter does remain open more than it should at times, or perhaps there are other things that might help with the acid.   How large you are below your diaphragm may act as an upward pressure for stomach acid (hence women getting heartburn when pregnant), and diet can create extra acid, as well as stress, tobacco, alcohol, and even excess chocolate!   Having an inflamed oesophagus is something that needs to be sorted out as soon as possible really, and perhaps concentrating on food and drink that may be more soothing to it might be worth exploring as well?

  • shellie28651
    shellie28651 Raellen

    Posted

    Sounds like you could have some sort of motility disorder but very important to have all 3 test done as to recieve the right help the mamotery test is not a comfortable one but I was 15 years into having alcalasia i just had the procedure done where they put the balloon down and rip the muscles 3 months ago and I had lost 50 pounds and was malnourished so I'm currently taking prenatal vitamins iron and vitamin D so please do not suffer and put off and have the test done and get relief I wish you the best of luck keep us posted
  • jen68518
    jen68518 Raellen

    Posted

    I just had the manometry this week.  It's pretty uncomfortable but not really painful.  I have a good amount of anxiety also.  I took something (benzo)  right before the procedure to calm me down and it really helped.  I asked ahead of time and they said it was fine to take.  If you don't have something prescribed, ask your doctor to prescribe you something to relax you before the procedure.
  • Raellen
    Raellen

    Posted

    Hi Everyone, thank you for the replies. Yes Jen, if I do have to do the manometry test, I will definitely need to take something during the tube insertion and through the  24 hour period! I hate having GAD, and medical procedures bring it out everytime!

    I had the barium test done yesterday. That did not bother me at all. I will not see my G Dr for the results until mid Septenber, so I asked the the technician who did the exrays what she thought she may have seen. She told me she thought I had three things going on, mild achalasia, a stricture, and most definitely reflux. I just don't understand why when my G Dr did the endoscopy July 1st, why he did not see anything like that. He reported no stricture, biopsy - no cancer, just redness of the esophagus. I was also supised that when I swallowed the pill during the barium, the tech said it went straight through my esophagus to my stomach so fast, she did not see it, that is why she had me swallow more of the barium solution again. This suprised me because I always have discomfert after swollening my gerd pills and BP pill. I was able to some of the exray activity at one point and I could see my espophagus contracting to move the barium solution down to my stomach. I realize I could not eat or drink prior to the procedure and that maybe this why the liquid and pill moved on down. Maybe they should have you eat actually food during these procedures? I don't know, just confused and hoping it is not achalasia.

    I think my symptoms have gotten worse since the Endoscopy, use to be just a small lump feeling in the sternum area, now it seems to spread out more in the area.

    I am just praying it will all go away!

    • jen68518
      jen68518 Raellen

      Posted

      I also had the upper GI months ago and they reported it was normal.  Also had the barium swallow which showed nothing either.  I almost didn't do the manometry because I thought that wouldn't show anything either. I'm so glad I did! 
  • rosslyn21419
    rosslyn21419 Raellen

    Posted

    Hi reading your message I was relating to what you had said I've problems with chest pain and I can swallow but have felt like the food is stuck but it passes ! My consultant had said it was a movement issue with my oesophagus with my wet swallows , I had the tube test and 24 hour test and I'm probably have to replete that a year on , it's the way it can check the strength of your swallow I suppose , saying all that , I've been left and now just have to wait to see if it improves or if he will go with medication.  My consultant doesn't believe in tablets for this at the moment for me , has me on fizzy water before each meal , it helps to get a good drink of fizz  , then have your food with continued fizz until you finished , it's not as sore after eating , you know some days it's sore all day oesophagus chest pain from eating or sometimes before food ! There are so many conditions it's a complicated one , it's also the fear that it might get worse ! But keeping a positive outlook helps too ! Hope this helps , Roz
  • susan94087
    susan94087 Raellen

    Posted

    You've probably had the manometry done by now, but if you haven't.  I just had it 2 days ago, and I handled it better than I could have imagined.  I have a phobia of vomiting and GAD.  I didn't gag or have any problem.  It was uncomfortable, and I wasn't having fun, but I focused on breathing through my mouth.  I was diagnosed with Achanasia.

  • jule44
    jule44 Raellen

    Posted

    I have just read all your posts and just wondering if anyone could help me understand what could be going on with my swallowing problems.

    It all started back mid 2014. 

    I started noticing feelings of my food being stuck. I would try to cough out my food to relieve the feelings. These feelings would come and go. Also now that I take medication three times a day my pills would start to burn the back of my throat even after washing them down with glasses of water. 

    After dinner I would feel like my food was sitting there in my throat.

    i spoke to my Doctor about it but it was not taken seriously and it was another doctor who referred me for a barium swallow.

    twSo I ended up doing a barium swallow test. There were two findings. After  eating solids some residual would end up pooling around the epiglottis. So they suggested washing this residual down with water which was effective. Then the most troubling finding was that I had a very slow transit time for the food and liquid to move down my lower esophagus and into the stomach. It should take 10 to 15 seconds standing up but it took more than a minute for it to transit and there appeared to be a residue left over. No one mentioned achalasia but I now have to see a gastroenterologist. The technician said it was unusually slow and seemed very abnormal. There was no other abnormal findings and nothing suggested reflux either.

    any thoughts appreciated?

     

    • AlanJM
      AlanJM jule44

      Posted

      The process by which food is taken down into your stomach is called peristalsis, and it relies on muscles contracting in sequence to propel the food towards your stomach.   There is a story of a lecturer in medical school who would demonstrate this by standing on his head and drinking a glass of milk, the contents of which went upwards, despite gravity, into his stomach.

      ?If thise muscles do not work, the system relies on gravity and sometimes the valve between your oesophagus and your stomach, the lower oesophageal sphincter, gets clamped tight shut, and this blocks food from entering your stomach, despite gravity.   There is a test called manometry which measures the pressure of the muscles at various points from your throat to your stomach, and this might show where the problem is occurring.   With achalasia, it is often the nerve endings that drive the muscles that are not working properly.   A good gastroenterologist may well refer you for a manometry test.   The value of this is that it will tend to indicate where the blockage is occurring (eg you mention your throat area) and it is important not to start thinking of treatment solutions until you know excatly where the pro0blem is occurring.

      ?It sounds like your system is slow / sluggish, but that with care over the kind of food you eat (ie avoiding foods that congeal, or are stringy in texture) you may be able to improve things a little.

      ?The lower oesophageal sphincter acts to prevent stomach acid refluxing up, and if this is tightly closed it could explain why you do not suffer from reflux.  

      ?For the longer term, if this situation is not fixed properly, there is a risk that the increased pressure on the oesophagus might cause it to become 'baggy', and this can lead to extra complications.

    • jule44
      jule44 AlanJM

      Posted

      Thank you for reply and the information

      i will be seeing the gastroenterologist in a few days so I will be interested to see what she will say and what tests I need to do. 

      I will I'll be sure to let you know what happens and I will keep your suggestions in mind.

      thank you

       

    • jule44
      jule44 AlanJM

      Posted

      Oh I forgot to mention in my first post that the barium swallow report said that the food bollus did not move after a minute through the lower esophagus and it took two fluid washes to move it plus gravity. So it was more like five minutes. 
    • AlanJM
      AlanJM jule44

      Posted

      That is significant.   They may give you various items to eat of different consistencies eg marshmallow.   If you think of that time lag, it is not surprising that eating something like a meal would take a very long time.   And the more you eat, the more intense the build up becomes.

      ​I think gatsroenterologists can give your lower oesophageal sphincter a strecth with an endoscope, but beyond that it becomes a job for an experienced specialist surgeon.

    • jule44
      jule44 AlanJM

      Posted

      Thank you for your replies

      i have seen the gastroenterologist and I am going to do the manometry test soon to see what's going on so there is progress.

      A few things were mentioned at the appointment and achalasia was made a consideration based on the barium swallow results . I guess I well know soon. 

      One thing I read about achalasia is that it is hard to burp?

      i have no problem burping though which is a good thing as the valve must be  open for food to go into the stomach?

       

      I am looking forward to getting more answers.

      thanks

       

    • AlanJM
      AlanJM jule44

      Posted

      I think that a burp that originates from the stomach must involve the sphincter relaxing enough to let the excess gas escape upwards, so to that extent you are right. After surgery such as a myotomy with a fundoplication wrap, I think it would all depend on how tight the wrap was constructed. I have heard of people being unable to vomit after this surgery, but my guess is that this also would depend on pressure involved.
    • natalie-h75
      natalie-h75 AlanJM

      Posted

      Hi, I have esophageal-dysmotility and I have had a barrium swallow and a manometry test done a few months ago. My esophagus has no contractions and I have had this problem for over 2 years. To clarify what has been happening for two years it's that I feel as though food will get stuck in my esophagus and then it gets very, very difficult to breath. After that I drink a lot of water to try and "wash it down", sometimes it works, sometimes I cough it back up again, loosing my appetite. On top of that, like many of the other posts, I have acid reflux. For the reflux I am taking a prescribed 40mg Nexium capsules every night but it I still get the "burning" sensation about twice a week where I wake up in the middle of the night in a lot of pain then I try and take a tums or two and hope that it works. If it doesn't then I try other things but most only give me relief for not even a half of a hour. For the esophageal dysmotility (well, to help get food down my esophagus) I took bethanechol three times a day for 3 months but I didn't find much relief from that. Also in the barium swallow you could see that in one section my esophagus was almost the size of my spine. Now I have stopped taking the bethanechol and I haven't seen much of a difference. I am wondering if there are any other medications I could try or any procedures I could have to help. To put an age to this message, I am 14 years old. Not in high school yet. As of right now I do not want to eat near people because of my fear of suddenly coughing it up again (which happens about every other day) or not be able to breathe and then I try and walk/jump around to "try and get it down" (which happens often) . And I am not malnourished.

    • AlanJM
      AlanJM natalie-h75

      Posted

      I think you might download A Patient's Guide to Achalasia from the website of the Oesophageal Patients Association first. It is an unusual condition and it can effect people of your age, but the important thing is to be treated by a specialist experienced in this disease. It sounds to me that it is serious for you, not least because you lose quality of life if you fear earing with others (who may not understand anyway unless they are really good friends). I think you should consider returning to your physician for a discussion about options for future treatment. The longer you put this off, the worse it may become.Because of the rarity issue you may need a second opinion from an experienced oesophageal surgeon .

    • laura54061
      laura54061 natalie-h75

      Posted

      Hi did you specialist recommend bethanecol for you motility? My specialist said there are not treatments or drugs for it! 
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