Esophageal dysmotility

Posted by Brie @brie87144, Mar 17, 2017

Hello I'm not sure this is where I should ask or not but I need help understanding what all this is telling me and if anyone knows possible treatments or outcomes. I'll give a little bit of history. I've only had what I know as swallowing issues for the last 4-5 months at most. Sometimes I can't even get things to go down into my throat at all, other times I can but whatever it is just gets stuck and that's consistent. I've had chronic heartburn since 2006 ish and been taking Prilosec and or 300mg of Zantac daily since. Which neither of these mess seem to help. But they help better than anything else I've tried. I also have a condition called Ehlers-Danlos syndrome which is a collagen disorder, and I have type 3 (hyper mobile) with mild over lapping of type 4 (vascular). I also have POTs and other autonomic dysfunction. With that being said, I was sent to GI for a consult and so far have had the pudding esophageal motility test, and the Barium swallow X-ray. They have both come back abnormal. The esophageal motility test says:

Esophageal Motility
IMPRESSION: Esophageal transit is normal for water but delayed at mid esophagus for thin and thick semisolid boluses.
FINDINGS: Esophageal transit scintigraphy performed per protocol. Graphic processed scintigraphic display reviewed in addition to the dynamic imaging.
WATER BOLUS:  The water bolus passes normally into the stomach within 10 seconds.
BOLUS 1, THIN SEMISOLID: There is hang-up of the thin semisolid bolus in the mid esophagus and at the junction of the mid and lower third, with the tracer in the mid esophagus clearing after 25 seconds and the residual activity in the distal third of the esophagus clearing x 45 s.

BOLUS 2, THICK SEMISOLID: The thick semisolid bolus shows considerable retention in the mid esophagus which predominantly clears after the second dry swallow at 40 seconds.
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The Barium swallow X-ray says:
Esophagus
Moderate esophageal dysmotility is present with interrupted primary peristaltic wave, intermittent ineffective secondary peristaltic waves which are nonpropulsive. Subsequent peristaltic waves then stripped the barium bolus normally.

There is a small hiatal hernia present with free spontaneous gastroesophageal reflux noted with esophageal distention to the thoracic inlet. There is however no ulceration, stricture, or mass present. Barium pill was administered, which passed freely through the GE junction into the stomach.
---

My Drs impressions says esophageal motility disorder with cervical and esophageal components. 

My question is what is this all telling me. I keep looking things up but then get super confused and mixed up. I still have to go back for a upper endoscopy, an esophageal manometry, neuro speech assessment, and a video X-ray barium swallow. I can't find anything on the speech assessment. And I'm not understanding why I have to repeat the barium test? Since medicine isn't working what are some of the treatments or fixes to any of this. Can my esophagus just die? What happens if it stops working all together?

Sorry for the long message. I don't live near Mayo and have to travel to get there so I don't get a lot of time with the drs to ask these questions. They are just more concerned getting the tests done before they make sense of it to me it seems, and I am super lost and confused. Any help would be greatly appreciated

Interested in more discussions like this? Go to the Digestive Health Support Group.

Profile picture for Ingegerd Enscoe, Alumni Mentor @astaingegerdm

@kaforester3 - Welcome to Mayo Clinic Connect!
You have had to deal with a lot of new health issues and diagnosis lately. I don’t know much about esophageal webs, but I understand the dilations. I am feeling positive about your Mayo visit- something will be done. Before this visit maybe you should talk to your local doctors about your swallowing difficulties. Please stay in touch.

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I just saw my local GI doctor today and he said that he’s confused about the swallowing issues and doesn’t think that I have Crohn’s or GERD now. I just started seeing him for a little over a month now and he’s saying the last doctors were wrong and I should stop taking the Apriso, Pepcid, and protonix.
He is also sending me for another swallow test and hopefully we get some answers from that.

I almost just want to wait and see what the Mayo Clinic thinks before getting off the medicine and having another test done.

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Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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@kaforester3 - thanks for the update! I agree- it sounds very confusing. I understand that you hesitate to stop the meds. Since you have the Mayo appointment in April you could just stay on the meds. You can still have the swallow test- and bring the result with you. Of course, I don’t know why your local GI says you don’t have Crohn's or GERD

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Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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Have no fear about Mayo. Last year they saw a million patients —so I safely assume they have an answer. In addition their research is veryprogressive

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Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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Have you been to a Mayo? There are a variety of surgeries. I take Levsin when have spasm and it will relax esophagus. How anxious do you get when some upon solid to swallow. Take any meds for anxiety? Sounds very difficult, consider popsicles etc. soft casserole

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Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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Hi name Robert..I understand ..I have a problem too with swallowing meats & cookies etc that dose not go down easy but also stops at a certain point I wind up choking & try to clear it by intense coughing . What I do eat a lot of mainly instant oatmeal with hot water & then add the following.. banana frozen fruit. Whey protein powder. Table spoon peanut butter half spoon boric soda then add two spoon of milk & then place the bowel in the microwave for one minute & 25 seconds so it all mixes up good. Also I do have lots of vitamins ..vitamin D3 B12. Folic acid. .also acid reflux & joint health pills. I do also take two tabelspoon of honey every day plus pure CBD oil that is a Cannabis oil . I don't eat any red meat or chicken just canned tuna & makeral fish & boiled eggs for the protein in eggs. But do indulge with soft ice creams. Cake & Coffee. Hope This Helps.

REPLY
Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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You need to go and be evaluated by MD! You need an endoscopy. All those vitamins and supplements are not going affect you trouble swallowing.

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Profile picture for robertcort @robertcort

Hi name Robert..I understand ..I have a problem too with swallowing meats & cookies etc that dose not go down easy but also stops at a certain point I wind up choking & try to clear it by intense coughing . What I do eat a lot of mainly instant oatmeal with hot water & then add the following.. banana frozen fruit. Whey protein powder. Table spoon peanut butter half spoon boric soda then add two spoon of milk & then place the bowel in the microwave for one minute & 25 seconds so it all mixes up good. Also I do have lots of vitamins ..vitamin D3 B12. Folic acid. .also acid reflux & joint health pills. I do also take two tabelspoon of honey every day plus pure CBD oil that is a Cannabis oil . I don't eat any red meat or chicken just canned tuna & makeral fish & boiled eggs for the protein in eggs. But do indulge with soft ice creams. Cake & Coffee. Hope This Helps.

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Hello @robertcort and welcome to Mayo Connect.

It sounds like you do understand about swallowing difficulties. Like most of us with swallowing problems, you have developed a soft diet which probably makes swallowing much easier. You do not mention the basis for your swallowing difficulties. Perhaps it is related to the esophagus? I'm wondering what treatments, other than the soft diet, you have had for this problem.

If you are comfortable sharing more could you share what your diagnosis is and how long you have had this problem?

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Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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Yes I do need a endoscopy done but did have it done in March 2020 & was suppose to go back end of April but the appointment was cancelled because of the virus issue so I have to wait till ?? In 2015 I was diagnosed with dysplasia then with excess saliva in 2017 & got treatment with Botox injections on my face/jaw for the excess saliva But it only got worse & started getting a lot of saliva pouring from mouth since now from the end 2019 . I found out by the internet that the ecophagus got narrowed & not by a doctor with a endoscopy. The vitamins I take is to keep my body strong because I am not young being 82 years old. This problem has also effected my speech too . Cant make any words speaking that anyone can understand... But keep looking forward to get a ecophagus dilation here in Jersey city NJ. Does anyone know where I could get it without any hold ups due this virus. Thanks

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Profile picture for robertcort @robertcort

Yes I do need a endoscopy done but did have it done in March 2020 & was suppose to go back end of April but the appointment was cancelled because of the virus issue so I have to wait till ?? In 2015 I was diagnosed with dysplasia then with excess saliva in 2017 & got treatment with Botox injections on my face/jaw for the excess saliva But it only got worse & started getting a lot of saliva pouring from mouth since now from the end 2019 . I found out by the internet that the ecophagus got narrowed & not by a doctor with a endoscopy. The vitamins I take is to keep my body strong because I am not young being 82 years old. This problem has also effected my speech too . Cant make any words speaking that anyone can understand... But keep looking forward to get a ecophagus dilation here in Jersey city NJ. Does anyone know where I could get it without any hold ups due this virus. Thanks

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Hello @robertcort,

I'm glad that you shared a little more about your health history. I also have swallowing issues and extra saliva. I have found that chewing gum can help the extra saliva in that it keeps you swallowing on a regular basis. Have you tried chewing gum?

Also, speech therapy can really help with swallowing issues. Speech therapists have specific exercises that they can teach you which will help with swallowing problems. Have you ever been referred to a speech therapist? If not, I recommend that you ask about getting a referral.

Regarding seeing a doctor sooner, that is hard to say. Most doctors and hospitals have a lot of catching up to do after the rush on medical services for COVID-19. Here is some information about getting an appointment at Mayo Clinic http://mayocl.in/1mtmR63.

In addition, Mayo Clinic has developed a method of self-dilation which might be of interest to you. Here is a video about that procedure,

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Profile picture for Cam @tryingtofindanswers

Hi I’m a 39 year old woman and I’ve got ineffective esophageal motility disorder, with spasms. My manometry showed 90% failed swallows. I can eat certain things like liquid drinks, smoothies, puréed soups and some solid foods like meltable solids such as shortbread cookies, cheetoh puffs, crackers,frozen yogurt, yogurt and basically anything you can give a baby. My doctors have told me there’s nothing they can do for me, that I’ve got to learn to deal and a nutritionist won’t be helpful. Ugh. They’ve been zero help. All they did was put me on Omeprazole and say it won’t get better and just hope it doesn’t get worse. So I’m looking for food ideas from others with this issue. I think from googling on my own I’ve realized maybe I can do mechanical soft, but I’m scared as when this began my swallow reflex would stop when something solid would get stuck and I don’t want to go backwards since I have to work full time and maintain my energy. I’ve been suffering with this for two years and lost a violent amount Of weight at first, so much so that my gall bladder went bad and had it removed in June. Ugh. It’s so hard “living” like this and these food holidays don’t help. Ugh. I’m tired of feeding my body liquid sugar and junk food because it goes down easy. I wish I could just bake a chicken breast and some broccoli. I’ve tried pureeing my food but I wanna vomit with puréed meat. Ugh. Any assistance with ideas for more solid/soft food that goes down for those with esophageal motility disorders would be beyond appreciated. Thank you.

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Yes I have tried chewing gum it didn't help & took speech therapy too but with speech therapy I could not keep up because of the very hard time trying to speak with all the saliva in my mouth & that was in 2018 but in 2019 the saliva even got worse with the saliva building up in my mouth & stays there & then pours out if I don't cover my mouth with a towel or kitchen paper & trying to speak with a mouthful of water is something else. I have tried mostly because every trick there is but I know that a dilation to the ecophagus is the way. I watched the self dilation video too but don't know to get the dilator...does anyone know here in Jersey city NJ ?? I would try it since I can't get a doctor cause of the virus problem...

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