Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: Swallowing=chest contraction=black out

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Swallowing



Hi, I am a 32 year old male and occasionally when I am eating I have a sensation that swallowed materials are stuck in my esophagus. Simultaneously I have a very strong contraction in the same area and I begin to black out. One week ago I did completely blacked out. After blacking out I went to my Doctor and she ordered an Echo for my heart, EKG, and blood work, which all came back normal. Her explanation was either an esophageal spasm or a disorder of esophageal contractions and either one of those create enough pain that results in stimulation of my vagus nerve. This signals my heart to slow and blood pressure drops suddenly. The problem I have with the diagnosis is that it is somewhat painful, but I have experienced much greater pain than these episodes and have not come close to blacking out. My question, is there a physical connection between the esophagus and vagus nerve? If there is a physical connect between my esophagus and vagus nerve could my vagus nerve be effected without the theory of pain? Are there other issues I should be concerned about? Note: I have had acid indigestion for 10-12 years without ever seeking medical advice and when I was about 16 years old I was diagnosed with ( it is a French word and do not know how to spell it, so I will try and spell it how it sounds to me… Gilbear’s syndrome). Should I be satisfied with simply living with this or should I seek advice from a GI specialist?
Thanks Greg
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Dear Greg,
Intense pain of any cause can cause a slowing of the heart rate and a 'black out'. In these pages, we have also had patients write that esophageal inflammation is associated with a rapid heart rate. I think that you should be assessed by a gastroenterologist. An esophageal motility study, which measures the pressures in the esophagus during swallowing and the coordination of the esophageal muscle will allow the physician to demonstrate that an esophageal motor problem is the cause of your pain. Once the cuase is known, various nedical treatments can be tried.

Gilbert's Disease, a benign, congenital condition of the liver found in approximately 5% of the population, is due to an abnormality of bilirubin ( a breakdown product of hemoglobin) handling. The disease is not serious and does not indicate or predispose to other liver illnesses. Patients with Gilbert's Disease often have a slight elevation of bilirubin when fasting. Sometimes, they may even have jaundice. It has been suggested that the condition is found in individuals of above average intelligence.

This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.

If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and investigate your symptoms. You can arrange an appointment with Dr. Fogel, one of our experts in the investigation ofesophageal disorders. He can be reached by calling the Henry Ford Physician Referral Line at (800)653-6568.
HFHSM.D.-rf
*keywords: chest pain, esophageal motility disorder
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