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

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Profile picture for Brie @brie87144

So much has happened since march ugh. I don't even know where to start. After this post I met with the neurospeach Dr which came back normal as well as the video barium swallow test. I also had and endoscopy which reveled a schatzi ring (sorry if I miss spelled that) and weak lower sphincter. He believes the mis to lower esophagus isn't functioning properly or the nerves aren't responding as they should so it's spastic. I also TRIED to have the esophageal manometry test. I failed miserably. I couldn't complete it because they couldn't get the scope thing down with out me throwing up. That was the worst hour of my life. That test is awful. The GI dr said I do have some moderate midesophageal dysphagia.

With all that said, they all refuse to do anything to help me because of my Ehlers-Danlos. So all they have me doing at this point is taking 40 mg of Prilosec 2x daily with 450 mg of ranitidine. That does seem so do anything either. I've resorted to sleeping in a recliner almost sitting straight up. I've restricted myself to almost a liquid diet because solid are just a sure way to be in pain. Not sure what or if they ever do anything.

Just as the refused to do anything, my septum collapse and created s bone spur in my left side of my nose and I can't breath out either side of my nose. Sounds great right? Stupid Ehlers danlos syndrome seems to have the upper hand here. We were trying to let my nose heal some, (I also have a large ulcer in my nose), but that didn't work and now I have exposed cartilage. So next week we are headed to mayo for surgery to get my septum rebuilt, a skin graft, and something for my valve support. Not really sure. Lol sorry

As far as Drs. I really like my GI dr. And my ENT. I have yet to find a neurologist within mayo or out of mayo that I like. They all act like they know everything even when u can show them they are wrong they don't wanna hear it. I gave up on neurology. Which sucks for me because of my neurology issues. I am like you that I prefer they don't dumb down anything because 90% of the time I understand just fine, expect with GI and the Ent. Man they speak foreign languages. It took me over 2 hours to understand my report from the ENT about my nose. The only thing I understood out of all of it was "her nose is severely screwed up". Maybe not so much in those terms but pretty much haha

So that's my chaotic life right now. Hopefully surgery goes smooth so I can get back on track with GI and nothing else gets screwed up along the way.

Man that all sound like a pain! I totally feel for you. My stomach valve stays 1/3-1/4 open pretty much all the time due to the weak valve and the hernia. I wish they would just fix one of the 2. Hopefully things don't start getting worse for either of us. It is awful enough.

Brie

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I was vomiting blood from my gerd at one point. They finally put me on Dexilant. Best medicine ever! I was able to drop down to EOD. I also notice that when my mast cell activation sydrome is flaired up it sets off my bronchial spasms which causes more phlem coughing and heartburn/ gerd. Then the gerd causes more broncial spasm more phlem ect .... you get the picture... ask if you can get dexilant samples, thats what my gastro gave me. Not sure about contraindications but my doc hasnt said anything about it otherwise. Ill be praying for you;)

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My issue is slightly different. I frequently aspirate food when swallowing that causes me to cough-up the food in my trachea. I lean forward when eating and chew long to swallow small amouts of food. I try to avoid any foods that are crumbly. Does anyone else have this problem? I would appreciate amy thoghts anyone may have. Thanks, John

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Profile picture for Cam @tryingtofindanswers

I've been dealing with swallowing issues for over a year and a half now. They began after a course of beta blockers. After two manometry tests, 3 barium swallows and two endoscopies, i've been diagnosed with ineffective esophageal motility disorder and a sliding hiatal hernia. I also have pretty bad acid reflux. I have trouble eating anything that isn't liquid now. The only solids I can eat are saltine crackers, graham crackers and shortbread cookies, basically anything that's a meltable solid. As part of this issue, i get what feels like random electric shock sensations over my chest. They are quick and usually are a result of how I'm sitting or something I've eaten that's more solid. My heart has been ruled out, so these sensations are coming from the esophagus, i assume. Has anyone experienced this sensation as part of esophageal motility issues or hiatal hernia? Also, just doing another random check-in to see if anyone has ever been successfully treated for esophageal motility disorders. I sure do miss the luxury of solid food. Curious as to what doctors at mayo are good to see about esophageal motility disorders that are not achalasia. Thanks!

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Hi
I'm sorry about your issues with motility.
Unfortunately I have experienced similar. I was on a bp med which had caused issues with my eosaphagus and gut. I did alot of research and found out the villi in small intestine becomes 'flat' so can't digest food properly. I like your version better that at your gastroentorologist told you that smooth muscles was flattened or smoothed too much.
I haven't had much support and was severely ill couldn't eat or digest so I ate baby food sachets, yoghurt and hummus. This was just to keep alive as I lost so much weight due to stress and inability to eat. No one believes me about having a toxity from the bp med and thinks it anxiety despite no history of this in my past l.
I had to find my own solution and researched Amolodipine which I found has caused the issues we have discussed. So I stopped taking them it has reduced pain and inability to eat. Now I think 1 year on it has damaged my intestine/ stomach.
Endoscopy, mri , digestive study eyc show no issues.
I'm glad nothing untoward was found but this makes it harder for gp etc to believe I still have pain, some digestive issues.
Currently taking amitriptyline, it is an antidepressant but it was given to me as it helps with dulling the gut pain.
So frustrating and scary so many blood tests, scans etc etc but no evidence apart from me telling them.....

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Profile picture for nicole0325 @nicole0325

I have had acid reflux and indigestion problems for years. I’ve seen a gastroenterologist for years as well.

I have a genetic problem that I have to go to University of Iowa hospitals, for that is called Ehlers Danlos syndrome. I have a hyper mobility of joints, which there is no cure, but I have along with that a connective tissue disorder, which affects my collagen and healing

I have for the last couple years, felt different as if stuff was getting stuck at the bottom of my back of my throat or bottom of my neck. I would still go to bed a couple hours after I’ve had supper, and would be inclined, and still regurgitate. I can drink liquid and still bend over shortly after and it comes back up.

I have met with the surgeon at the University of Iowa hospitals, and he explained with my issue and having Ehlers-Danlos Syndrome that my risks would outweigh my benefits, and I could be worse off. He said because of my connective tissue disorder that collagen issue would allow me to not heal. I also had an emergency splenectomy years ago and he said I would probably have quite a bit of scar tissue inside, which would be difficult as well to do the surgery. In August I am going to have a device put on my esophagus and I have to wear it for 48 hours to measure the acid in my stomach. He said if that measures extremely high, he may rethink surgery.

After all of this, I’ve said, I guess I’m just wondering what kind of stuff I can eat. I have been drinking meal replacement shakes for the most part. I can eat salad because it’s not hard and crunchy. I eat yogurt. Otherwise I might as well forget meat, and bread of any sort.

If anyone has any ideas of a diet or food that I could eat, please let me know.

Thank you so much

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I’m a healthy 67 year old female up until October 2024. I first was diagnosed then with acid reflux from pain in my chest, difficulty swallowing (globus sensation). I was put on PPI not feeling much relief. In January 2025 I had an endoscopy which came back normal. Was told by Gastro doctor to eat small meals, chew slower, etc. In February I had a manometry test showing I have ineffective esophageal motility. Told there is no cure or medication and just eat a prescribed diet. No more PPI and I am still in constant pain, especially in the chest no matter what I eat. I have lost 33 lbs since October down to 117 lbs. Doctors have not been helpful. I a as m terribly discouraged.

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Profile picture for bla1958 @bla1958

I’m a healthy 67 year old female up until October 2024. I first was diagnosed then with acid reflux from pain in my chest, difficulty swallowing (globus sensation). I was put on PPI not feeling much relief. In January 2025 I had an endoscopy which came back normal. Was told by Gastro doctor to eat small meals, chew slower, etc. In February I had a manometry test showing I have ineffective esophageal motility. Told there is no cure or medication and just eat a prescribed diet. No more PPI and I am still in constant pain, especially in the chest no matter what I eat. I have lost 33 lbs since October down to 117 lbs. Doctors have not been helpful. I a as m terribly discouraged.

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Mine is called dysphagia, for me it's a little bit of everything, I have seasonal allergies, I am a mouth breather and I am missing a couple of big chewing teeth. The combination of all of that causes me to choke and even aspirate at times. My GERD like symptoms almost disappeared after I gave up mammalian meat I have had Alpha Gal off and on for over 35 years. This time though the Alpha Gal was mimicking GERD and now thankfully other than the dysphagia things are much better. I also now take a peppermint oil capsule at meal time and it seems to help the throat relax. Not sure if you can relate to any of that but its' awful to have and I feel your pain!

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Profile picture for bla1958 @bla1958

I’m a healthy 67 year old female up until October 2024. I first was diagnosed then with acid reflux from pain in my chest, difficulty swallowing (globus sensation). I was put on PPI not feeling much relief. In January 2025 I had an endoscopy which came back normal. Was told by Gastro doctor to eat small meals, chew slower, etc. In February I had a manometry test showing I have ineffective esophageal motility. Told there is no cure or medication and just eat a prescribed diet. No more PPI and I am still in constant pain, especially in the chest no matter what I eat. I have lost 33 lbs since October down to 117 lbs. Doctors have not been helpful. I a as m terribly discouraged.

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Thank you. I’m working so hard to find food that doesn’t cause the feeling of something stuck in my throat and pain in chest. Frustrated that the doctors say I just have to live with it.

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Profile picture for bla1958 @bla1958

I’m a healthy 67 year old female up until October 2024. I first was diagnosed then with acid reflux from pain in my chest, difficulty swallowing (globus sensation). I was put on PPI not feeling much relief. In January 2025 I had an endoscopy which came back normal. Was told by Gastro doctor to eat small meals, chew slower, etc. In February I had a manometry test showing I have ineffective esophageal motility. Told there is no cure or medication and just eat a prescribed diet. No more PPI and I am still in constant pain, especially in the chest no matter what I eat. I have lost 33 lbs since October down to 117 lbs. Doctors have not been helpful. I a as m terribly discouraged.

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Considering contacting a GI doctor who is dual qualified in Naturopathic Medicine. Maybe helpful for folks with a myriad of GI issues.
Still Looking for Help.

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Profile picture for bla1958 @bla1958

I’m a healthy 67 year old female up until October 2024. I first was diagnosed then with acid reflux from pain in my chest, difficulty swallowing (globus sensation). I was put on PPI not feeling much relief. In January 2025 I had an endoscopy which came back normal. Was told by Gastro doctor to eat small meals, chew slower, etc. In February I had a manometry test showing I have ineffective esophageal motility. Told there is no cure or medication and just eat a prescribed diet. No more PPI and I am still in constant pain, especially in the chest no matter what I eat. I have lost 33 lbs since October down to 117 lbs. Doctors have not been helpful. I a as m terribly discouraged.

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I get esophageal spasms which hyoscyamine helps. It's a tiny pill that dissolves under your tongue. Did the doctor discuss if having your esophagus stretched would help? It's similar to having an endoscopy with a larger tube

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Profile picture for bla1958 @bla1958

I’m a healthy 67 year old female up until October 2024. I first was diagnosed then with acid reflux from pain in my chest, difficulty swallowing (globus sensation). I was put on PPI not feeling much relief. In January 2025 I had an endoscopy which came back normal. Was told by Gastro doctor to eat small meals, chew slower, etc. In February I had a manometry test showing I have ineffective esophageal motility. Told there is no cure or medication and just eat a prescribed diet. No more PPI and I am still in constant pain, especially in the chest no matter what I eat. I have lost 33 lbs since October down to 117 lbs. Doctors have not been helpful. I a as m terribly discouraged.

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Thank you for the info. Apparently my esophagus doesn’t need to be stretched. No structure. Muscle contractions in the esophagus are too weak or poorly coordinated to move food efficiently from the throat to the stomach.

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Profile picture for bla1958 @bla1958

Thank you for the info. Apparently my esophagus doesn’t need to be stretched. No structure. Muscle contractions in the esophagus are too weak or poorly coordinated to move food efficiently from the throat to the stomach.

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You could try lemon ice at the end of a meal that helped my mother in law

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