32 yr old female als worries

[mylesaway]

Relative is very physically active and recently needed hospital attention for food stuck in throat last Oct 2011.  Had endoscopy done and biopsy.  Due to relocation, has been unable to obtain medical care in a timely fashion so has only been referred to a specialist (after many overbooked cancellations etc)..a few days ago.  Has a new appt for an endoscopy in 1 month.  Issues have been ongoing difficulty swallowing....altho thankfully no hospital visits - now eats smaller bites.  Also indicates unable to yawn...or if attempt at yawn, seems difficult to regain her breath.

Patient indicates that she has had Tonsils/adenoids removed at an early age and that there is a history of GERD.  States that they have ruled out allergies/anxiety and a few others that I forget.  I've noticed a weight loss since I saw her however, she does remain physically active daily as far as I know.  Any idea of the next step?  Unfortunately today you need to advocate for yourself so I'm trying to gather information.  Since I'm overly worried, relatives have told me to stay away from the internet but here I am.  Any advice is appreciated.  Thank you and good luck to everyone.

[Maks322]

I too have these issues swallowing and with food.  I have never been hospitalized, however.  I did have an endoctomy.  I then was placed on 5 different PPI's (nexium, etc).  None has helped. I have lost 15lbs since May.  I am being treated by a neuro.  He has been unable to nail down a diagnosis (I know often this isn't easy). My symptoms lie between MS and myasthenia gravis somewhere with no conclusive results.  Could you tell me what oropharyngeal dysphagia is?  I stopped seeing my endo, because they would just ask how the last pill worked and prescribe another kind, never got to actually see the doctor.i know the next step was more tests, but I feel my problems are nerve related.  Not sure they can really help
Thanks,
Maureen

[Dr. Kokil Mathur]

Hi!

Swallowing has 3 phases, oral, pharyngeal, and esophageal.  Hence it is important to analyze the pattern of dysphagia or difficulty in swallowing and important to know which phase is affected the most.

One possibility is that the person has oropharyngeal dysphagia which occurs due to neurological problems like MS, muscular dystrophy, Parkinson’s disease, brain or spinal cord injury.

If the person does not have any of the above neurological problems then there is a huge chance that she has achalasia as she also has GERD. This occurs when your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach. Specific tests for diagnosis of achalasia include barium swallow and esophageal manometry (or motility study).

The problem could also be due to a larger size epiglottis or due to a lingual thyroid.  A thyroid goiter can also press from outside and cause swallowing problems. Please consult your PCP for primary examination followed by proper referral. Take care!