Esophagus motility problems

35 yr old F.  I have had a series of health problems the past 2 years, including autoimmune (still unspecified) and immunodeficiency- and I have a lot of digestive problems- IBS, rectal bleeding  (worse with menstruation, I also have endometriosis), and frequent vomiting, stomach pain, almost constant nausea, also last 2 years.  Normal colonoscopy 1 yr ago.  6 mos. ago, the upper endoscopy showed a small hiatal hernia and gastristis.  Diag. w/GERD, put on 20 mg aciphex.  I had occasional problems with food getting stuck, until 6 weeks ago when that suddenly increased.  Now every single time I eat (even chewing lots small bites), often with liquids, always when taking pills, I ahve extreme pain in my neck/throat and chest.  I can feel things getting stuck in my neck- then in my chest, sometimes even 1/2 hr after swallowing.  We did an esophageal manometry that showed what my doctor called "lots of problems with motility."  

I just had my second upper endoscopy, and I'm very confused, the doctor said after the procedure that there was nothing but a hiatus hernia.  But now that I'm reading the test results, I see that it says "EGJ at 44cm, hiatus hernia (lower esophagus), columnar lined (lower esophagus), minimally irregular SCJ."  So aside from the hiatl hernia, I don't understand what any of those mean- are these other things significant?

I also had a bravo capsule put in.  And of course, he took a biopsy of the lower esophagus

I am very confused about these test results and about what could be causing the swallowing problems.  I have so much pain when I eat, that I just can't get past this, I am already underweight, and I'm continuing to drop more- would a hiatal hernia cause these problems?  Is there a way to treat these swallowing problems if there isn't a clear cause?

Also, given my autoimmune problems, did this study rule out scleroderma esophagus?

[Kevin Pho, MD]

I agree with the workup thus far.

The biopsy showed some changes in the lower esophagus.  With the hiatal hernia, and possible long-term GERD, Barrett's esophagus needs to be ruled out and monitored on a serial basis.  

The next step to evaluate the swallowing problems would be a modified barium swallow, done in conjunction with a speech pathologist.

An upper motility problem can be evaluated by an ENT if the modified barium swallow shows this.  

The upper endoscopy would evaluate for scleroderma affecting the esophagus.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[gerdy]

A related discussion, esophageal motility was started.