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Esophageal dysmotility
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.
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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
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@robertcort
I am sorry that the gum chewing and the speech therapy did not work for you. You could ask one of your local doctors if they know about the self-dilator. From the video, however, this looks like a Mayo product.
If you need to contact Mayo Clinic about this, here is their information about scheduling an appointment, http://mayocl.in/1mtmR63.
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1 ReactionNot sure how to post here. My problem is I have motility issues where my esophagus is wide open like a tube. I also have had one zenkers diverticulum, which was surgically repaired. I also have a sliding hiatal hernia. Now I have a second large diverticula pouch and my Dr. says the repair is extremely difficult because of the previous surgery ,too much scar tissue. He just tried a endoscopic procedure and stopped because he said it was too difficult. Leaving me with no solution to either the Zenkers pouch or the dismotility or the hiatal hernia. HELP
@popeye123
I don't want you to think no one is listening... just when you do not have the exact same problems as the person posting it can be hard to know what to say.
I have no motility of my esophagus. Most times I swallow and there is a spasm at the back of my throat and my food then drops down my esophagus to above my stomach. Then there can be another spasm. Sometimes it locks the sphincter and my food stacks in my esophagus until it decides to open.. food and water will not go down nor up.. and it is miserable.
I had to have a gastric bypass to fix my giant sliding hernia. I had to go to the Mayo Clinic (I went to Jacksonville) to have the hernia fixed because the mess a local surgeon made of a Nissen fundoplication. It sounds like you need a gastroenterologist .. and perhaps a surgeon... that has more experience with your conditions.
ZeeGee
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2 ReactionsThank you. I will look into a GI with experience.
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1 ReactionI've been having swallowing problems for a few years. A bolus often pauses until the upper esophageal sphincter opens. Then the rings in my esophagus fire randomly instead of in order. Then the bolus stops at the lower esophageal sphincter until it decides to open.
At lunch today I had two strips of crisp bacon, and it took 45 seconds to get from putting a small bite in my mouth to feeling it leave the esophagus. I'm losing weight slowly because I get tired of chewing and swallowing, and I often put the rest of my meal in a container in the fridge, to eat another day.
One of my sisters had significant swallowing issues along with other things and died after years of seeing all kinds of specialists with no diagnosis. She was in her 50s, and had always been very health conscious.
I'm not sure what to do next.
Jim
Hello Jim,
I had swallowing problems, I didn't have trouble with food, but with swallowing pills. I've been diagnosed with Barrett's esophagus and somewhere in my research I read swallowing issues mean you have GERD. I've been taking Dr. Gundry's Lectin Shield, Total Restore and eating a GERD diet. In the morning I have a bowl of rice cereal, fruit and a small bit of cheese. At dinner I have just a piece of meat and vegetables. I never eat fried foods, drink coffee or spicy food. After 2 years on the diet and meds I can swallow easily. Good luck to you. Remember no fried foods!
Jennifer
@jennifermims No fried food! That's unamerican, isn't it?
The only time I eat fried food is if we have to get lunch in town. I usually eat maybe 1/4 of a small fries. My wife doesn't fry anything except a stir fry or eggs. She uses the air fryer for some things.
I've never had a problem swallowing pills, which is good because I take a bunch. The only one that gives me trouble is tiny, and sometimes it gets away from the others. It tastes awful.
I have neuropathy, and my swallowing issues could be related to that. The primary symptom is numbness and tingling and burning pain in my feet. It started with no pain, then the pain started in the balls of my feet, and moved into my toes, then the whole foot, top and bottom, and a few months ago moved up to my ankles, and just recently I have it up to my knees. That's small fiber peripheral polyneuropathy and I'm starting to develop symptoms of autonomic neuropathy, with balance challenges, tinnitus, double vision, and bladder and bowel issues. Doesn't it sound like fun?
Doctors have mentioned GERD, and I take Omeprazole for it. The speech therapist said I have silent reflux associated with the esophagus malfunctions. I've read about Barrett's, but it doesn't fit me.
My wife enjoys cooking, and she always prepares a well balanced meal. I grow a number of vegetables and fruit, and we really like fresh from the garden or fruit stand. We rarely eat processed foods. Even so, I spend a lot of time chewing and swallowing. I've learned to take small bites.
I'm glad that you've been able to resolve your problem with pills. My mother never could take pills. She was able to get most meds in liquid form.
Thanks for taking time to respond to my frustration rant.
Jim
I was just diagnosed with this and I am just looking for guidance on how to deal with it and if there are any procedures to correct it. Thanks.
Hi @kaykay729 and welcome to Mayo Clinic Connect. There are several members that have discussed ineffective esophageal motility. You will see that I added you to one of the conversations that is talking about it.
There are also more discussions that I have included below so that you can read them as well.
https://connect.mayoclinic.org/discussion/esophagus-issues/
https://connect.mayoclinic.org/discussion/non-specific-esophageal-motility-disorder-caused-by-beta-blockers/
What did your physician suggest in the meantime? How long did you have symptoms before you were diagnosed?
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2 ReactionsI have been having GI symptoms since last May. The only thing I have now is a bad taste in my throat and when I am hungry it gets worse. It's almost like a gas is coming up from my stomach. I was diagnosed with SIBO back in July but really don't have anybody the symptoms but mild constipation. So he suggested the manometry because of the bad taste. A week later he told me I had ineffective esophageal motility and that there is nothing that can be done.