diffuculty swallowing and gagging, and PVCs--had many tests to no avail

[subpar]

After reading quite a few comments/questions on this "forum or website", I am with you all in saying that PVC's and espophagus problems, GERD symptoms are very much related at least on my case though I agree the MDs "poo poo" any notion they are related. I have had chest pain, skipping beats, and even an a-fib episode (shocked out of it) in 1997. Since 1997 up to now I have had many heart related tests (echocardiogram, stress tests (2)) and several visits to the cardiologist. He has said my heart is fine, no problems at all, yes I have PVC's ( I carried around an "event monitor" to determine that) but he ahs me on  no heart meds, every thing is fine according to him. He says I can run a marathon if I want. But the symptoms (chest pain, heart arrythmias and more recently in the last year difficulty swallowing, esophageal pain and gagging episodes) NEVER have gone away. In 2000 I had an EGD??. All was fine, I had a 24 hour PH test, all was fine.....they implied I was/am nuts and that maybe I had a "spastic" esophagus. Anyway the symptoms NEVER and still have not gone  away, I too would wake up in the night with racing heart or even a abnormal beating heart, I called 911 twice, by the time I get to a hospital, my heart has straightened out. After learning there is no point in  going to the ER, I have spent many sleepless nights with chest pain, I had no idea if it was GERD or I am nuts. Well now I feel like I am gagging ALL the time along with pain and tightness in the chest. I had a barium swallow test just a month ago after another ER visit showed my heart was fine but a nice Doctor discussed my symptoms with me and said that I have the "swallow" test. They found a stricture then called it a  Schatzky's ring and did another EGD to dilate. They said there was no hiatal hernia. Anyway I am still gagging and choking ALL the time even after that--it is extremely uncomfortable these days-- I am an avid golfer and I gag so much with pain (upper esophagus) it is no fun to be out there playing,it hurts a lot. My gagging seems to be in my upper throat or esophagus, the "ring" they found was "distal". Whatever they did gave me no relief. Eating wears me out,swallowing gets difficult, feels like I have TMJ (jaws tired) as well, who the heck knows?? Anyway I have no idea what to do. I have had all the tests but I am not crazy. Talking some times gets tough too,---I can gag with nothing in my stomach or with something--eating some times makes my pain worse and definitely after eating my PVC's are worse....any ideas??? I mowed my lawn today and was gagging and dry heaving a few times (push mower) I am 47, white male, 6'1". 185 pounds in decent shape (ride my Scwhinn airdyne 3 times a wekk for  40 minutes and walk playing golf) and yes my doctor told me to take prilosec OTC twice a day which I am doing. Thanks for any input!! I NEED HELP!!!  Subpar

[Kevin Pho, MD]

You have had quite an extensive GI workup, including upper endoscopy and 24-hr pH study.  If the 24-hr pH study is negative, then you don't have GERD.  

You may want to consider an evaluation for an throat/upper esophagus disorder.  There are five major tests that can be used for the evaluation of oropharyngeal dysphagia: barium radiography, videofluoroscopy, upper endoscopy, fiberoptic nasopharyngeal laryngoscopy, esophageal manometry.  

A referral to an ENT physician (otolaryngologist) can be helpful in further evaluating the symptoms and discussing the tests mentioned above.    

Another test to consider would be a gastric emptying scan to evaluate for gastroparesis.  This particular test can be ordered in conjunction with your GI 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.

Thanks,
Kevin, M.D.

[tessa0825]

If I were you I would ask the Dr. about dialating your stricture again..Some people require more than one dilation for it to be effective...Also, I would ask to have the 24 hr PH probe test repeated..There is also 2 fairly new Ph type tests that seem to be getting alot more popular...One is a 24 HR impedance-PH procedure..The results of that test provide more information for the Drs. than the regular 24 hr PH probe. It will document acid as well as non-acid episodes of reflux, gas episodes, bolus exposure %, and bolus clearance time..I don't think it is yet available every where so you would probably have to have that at one of the bigger hosp. The other is the 48 Hr. Bravo test..This is probe free and is done by inserting a capsule directly on your esophagus during EGD. Information is transmitted to a monitor that you wear and you return that monitor after 48 hrs. for the info to be downloaded. There is no need to have a repeat EGD to remove the capsule..Might be better because it would pick up reflux for a longer time period and not as uncomfortable as having a tube down your nose and throat for 24 hrs...All of those are good tests to document reflux but they are only useful if you happen to be refluxing during the test period....There are guidelines to follow during the test but usually within those guidelines they want you to eat foods that produce symptoms, I would make sure I do that if you have it repeated....I also wouldn't hesitate to go to ER when you are having these chest pains....I think even for the medical profession it is tricky for them to know what might be coronary or esophageal in nature when it comes to chest pains..I know esophageal spasms can cause alot of chest area pains, some people with stricture have spasms that cause those pains.....I'm not in the medical profession but it makes sense to me to always take chest pains serious and to pursue them until you get an answer...Please don't allow yourself to become intimidated by anyone and put off seeking medical attention because of it....Hope you find some answers soon, Tessa

[subpar]

Thanks for your input Tessa.  I really am truly embarassed to go to the ER anymore, so unless I am passed out, I doubt I will go. Plus I figure if it was my heart or clogged arteries, as long as I have had this (4-5 years), I would have had a heart attack by now and I have not, so it must be esophageal or GI in nature (I hope that is :)). I am really "Doctored" out, they really don't want to talk to me anymore nor I them, BUT I do want help (yes, strange I know). I was hoping some one out there has had some similar occurrences. I guess after a while I will have them dilate my "stricture" or "ring" again, but the area I am gagging seems to be way higher up--like the top of the throat, the "ring" is at the lower portion........anyway thanks, I really appreciate your input!! Subpar

[tessa0825]

What does your Dr. say as the reason why you have a "Schatzky's Ring"? If it isn't caused from reflux and you havent been drinking acid then what caused it? Another question, if they are certain that you don't have reflux, (based on the results of (1) 24 hr. test performed 4 years ago) then why do they have you taking a PPI?. Prilosec is for the treatment of acid reflux and works by shutting off some of the acid pumps in your stomach...There are people who have had 24 HR PH studies and were not symptomatic on test day and had the results come back negative...On repeat of same test and while symptomatic the results were positive for reflux....There are also other circumstances that effect results of PH studies..If you find eating, drinking liquids, or activity level being effected by having a tube down your nose and throat then not doing those things might compromise the results....I think a Schatzky's ring requiring dilation could certainly cause some of your symptoms....I hope you find a good Dr. that will listen to you and take your concerns seriously...Tessa

[subpar]

Well Tessa, they said the Schatzky's ring did indeed come from reflux. Of course when I had the test in 2000 (both the EGD and the 24 hr. PH test-yes it was that very uncomfortable tube down the nose and throat) the Doctor at that time told me there was no point in taking prilosec anymore so I quit taking it. Of course 4 years later I have the swallow test and they tell me at that time to take Prilosec  again. So I have started to take it again, as a matter of fact I am taking  it two times a day (the OTC kind, it is cheaper than my copay would be for Nexium). This is on the advice of the Dr.  who did the EGD just a few weeks ago, not my PCP.  I have not seen my regular Doctor (PCP)  since the test, but with modern insurance I have to see my PCP again before repeating any procedures (like the Schatzky's ring dilation). If things don't get better quick I will see my PCP again. I figured I'd give the medicine and the dilation a few weeks to figure out anything, so far in about 3 weeks I see no difference. How long does it take on average to get a Dr/s comment on this site out of curiousity?
Thanks Tessa,
Subpar

[tessa0825]

I went back and very carefuly read your initial post again...I think it might be worded a little misleading in the fact that you spoke of all these tests, done in the past, that have no relevance to right now.....In 2000 you had an EGD and PH probe that showed no damage and no reflux...However, you then went on to say that in the last 30 days you had a barium swallow that showed a Schatzky's ring caused by reflux that required EGD and dilatation...Everything that was or wasn't seen 4 years ago mean nothing now....You have a diagnosis, have received a procedure that will hopefully correct the swallowing problem and are on a PPI for the reflux...If the Drs. thought "you were nuts" when you had negative results 4 years ago, they most likely realize now that your symptoms are genuine....Forget that "Nuts" part...Sometimes I think that people worry that the Drs. might think that, when it probably isn't even anything they had considered...Follow through with what you know is going on now...If you are still choking and having dificulty swallowing since dilation, inform your drs. of it.....I had a stricture last year that required monthly dilations until I had surgery called gastroplasty to lengthen my esophagus and that helped my stricture problem as well.......Take care

[mao4]

I have had similar symptoms for several years with the gagging and swallowing getting continually worse until I finally choked on a steak and ended up in the ER.  Eventually they discovered I had a 9mm esophogeal opening, they balloon dialated it 15.  A month later I had it dialated again. It had closed back to a 12.  The GI Dr. explained with so much scar tissue 50% of the time it has to be re-dialated.  I truly believe my PVC's are somehow related to this problem .........now.  I also have had Holter monitors, Ekg's etc.  my heart is in great shape.  I have noticed since the dialation I have less of them and they come mostly when I eat a big meal or when I'm lying flat during sleeping.  I have suffered with these symptoms for years and now I think there is a correlation.   The GI dr. said he didn't think so.  The feeling you have in your throat is what I was experiencing, the Dr. told me it actually starts down in the Schotzky's ring but you feel it in your throat.  hope things get better...

[shellyB]

I started having the exact same choking and gagging symptoms you describe about 2 years ago. I would choke and it would come out of my nose. A barrium swallow study read, slowed transit of foods through the upper esophagus, pt. was aware of this and was able to accurately point to the area where food was accumulating. However, my OLD neurologist wrote in his notes that the barium swallow was normal. He had been treating me for MS with copaxone and stopped because he said he did not think I had MS, he believed I had somatoform disorder (nuts). I am now seeing a new neurologist who I had to show the actual radiology report to before he believed me. He was going by the old neurologist's written word, which he assumed was true. I was treated for myasthenia gravis by my old neurologist also. I had to change HMO's to get the medical help I so desperately needed for my neurological problems and other medical issues. I am now labeled with the somatoform although all of my symptoms have been backed up with clinical findings. My new neuro has just ordered a brain mri and an emg. If you are not getting the help you know you need do whatever it takes to get a second opinion or change doctors altogether. Good Luck, Shelly

[subpar]

Thanks Tessa, Shelly and Mao, I really appreciate at least having come internet support! At least I feel better and think I am not nuts (never did really but the MDs certainly leave that impression). Recently I have been having I guess you'd say "dry heaves" added to my symptoms. For the last week or so my upper throat gets kind of tickly feeling and then I actually feel like I am going to throw up, I heave a few times pretty hard but so far over a week I have not actually thrown up anything. This seems to almost happen about 3 hours AFTER I have eaten in the morning though realaly at any time ( i can even rub my esophagus at times and make the nauseus feeling come on). Yesterday I played in a golf tournament and just felt like **** all day (very tight throat/neck/esophagus mostly) so I dropped out of the second round (which was today). Today I stayed in bed all day thinking maybe yesterday was heightened anxiety (being nervous in a golf tournament)was causing my throat and neck to tighten up (my heart was also beating much faster than it should). So I thought anxiety was playing a role (headache, weak feelings, etc, were symptoms as well). Well maybe it was, but I have been in bed all day today lying quietly and still I have the tight esophagus, neck and have had two pretty severe episodes of the dry heaves (though again nothing came out--at tleas the heart rate has not been an issue today). So I don't know what the hell to do, I just was in the ER less than a month ago or so with these same symptoms (not the throwing up part though)........anyway I wonder what the throwing up dry heaves thing is telling me..any idea??? If I go to the Doctor I am sure they will say it is all anxiety though I still just don't think so---why wouldn't I be better lying quiety if that was it???) I did take Dr. Kevin's advice on this site and make an ENT appt. for tomorrow with one of them. It sure does seem more gastro than ENT but I just may  in fact be -----what was one of y'alls diagnosis? Somataform??? That would P _ _ _ me off as a diagnosis!!
Thanks again!
Subpar (in golf and in health)

[piewicket6]

Ok, here is my situation. I'm 35 years old and about a month ago tried to give blood. They would not allow me to give because of an irratic heart beat (PVC'S). Terrified, I saw my regular dr. he gave me an EKG, and placed me on a holter for 24 hrs. and did all types of blood work. After that, I was referred to a cardiologist. He issued a barium swallow (found mild reflux w/schatzki B Ring) and stress test. My cardiologist does not think the PVC's are a problem.(yeah for him) but he is passing the buck back to my regular dr. tomorrow I am stting an appointment with him to deiscuss the proceedure to correct the schatzki ring.
I too feel a lump in my throat almost constantly and after eating certain foods must drink something rather quickly to force it down. I dont gag though I get the hic-ups until I drink but I can see how someone could gag from it because it is right in the back of the throat. I too am wondering if the two (PVC's and schatzki ring) are not related. I am very healthy and very seldom get sick. Please let me know what you find

[subpar]

Hello Piewicket et al,
I doubt we will ever get an MD to agree that PVC's or any heart beat irregularity is at all realted to GERD, a Schatzki's ring or esophageal problems. However they sure do seem related don't they? I am not professing to be a MD because I am not, I am just a patient who needs to feel better, I have found albeit psychological or not, that taking a magnesium supplement (actually one of those calcium,magnesium and zinc combo pills) has helped my PVC's become much less frequent and bothersome (I did some research on the web after the cardiologist said to live with them that they mean nothing (BS IMO). Apparently minerals play a big role in heart rythhymn. My MD siad it wouldn't hurt me though he again poo pooed any notion it was helping.
Anyway to continue the thread I went to an ENT yesterday. He basically backed up what I had heard before, He stuck a tube down my nose (not comfortable) and looked down my throat and made me make weird noises (like EEEEEEEEE) and proclaimed me healthy. He says my symptoms (like I think Tessa had said already) could still be coming from the Schatzky's ring though it was dilated and maybe I'd have to have that done again. He also suggested a motility test maybe down the road. All I know is right now I stil have the symptoms despite 3-4 weeks now of Nexium and after the dilation so I guess I had better go at it again, this is no fun but I guess worth the fight! My quality of life still sucks with my throat feeling like I am being choked all of the time!!

[cwfstacy]

I have had episodes of throat spams (tightening and that feels like My throat.chest will explode then it passes for a few minutes and back again)off and on for most of my life.  I have allergies and asthma and Gerd.  Milk products always seems to cause the problems in my past.  I have had problems the last few weeks that keep getting worse.  I feel restricted in my throat and when I take a drink it delays going down my throat. I swallow...then feel it go down the left side of my throat.  I haven't eaten since yesterday because I am scared i will choke.  Any ideas?  I take prilosec for over 5 years now and I took another one this morning thinking it might help. so far it hasn't.  I have elivil at home and xanax.  I don't know if it will help but am willing to try it this evening now that I have read many of the posts here.  ANy info or help would be very appreciated.  
I have had ear pain and jaw pain in the last 2 months also, which was blown off by the dr.'s.  Now it seems this may have something to do with GERD also.  
My heart is fine it has been checked.

[mao4]

I'm amazed at the number of us that are experiencing these PVC's, GERD, strictures, etc.  I have to agree with Subpar- I also have been taking powder Magnesium 1 tsp a day (according to the bottle). It didn't seem to help until I also started taking a Multi-vitamin.  I also did some research and found that the Magnesium must be accompanied with the "B" vitamins, and Vitamin "C" to be properly absorbed.  This seems to have made the most difference for me so far.  Also this might sound crazy but I read a book called "How to Eat right for your blood type," by Dr. D'Adamo.  I'm type "A" and for 3 weeks I have tried to somewhat follow the type "A" reccomendations and possibly this is helping.  Dr. D'Adamo feels blood type "A" individuals have slow digestive systems and low stomach acid.  He also feels that they are more pron to cancers and problems of the stomach and esophagus because of this.  Wondered if anyone else happens to be type "A"  I guess I'm trying to find the needle in the haystack ........maybe I will!

[subpar]

Well I am O+ blood type so I don't what that means as far as your theory Mao. All I know is that my esophagus is still tight, hard to swallow with the gagging, it is definietly made worse in any type of social, wprk meetings or phyically active situation( golf), alone is when I am better off albeit only a bit. I was already on a 10mg does of prozac so I doubled it about a week ago hoping it would help my anxiety about this esophagus thing, but I don't know about you all, but when you feel like you are getting choked, your esophagus is tight,  your chest is tight it is no fun and tough to get through it,the prozac does not seem to help a bit. I would say it is all anxiety but I can go home, get in bed for a couple of hours and it STILL DOES NOT GO AWAY, so maybe stress of some sort makes it worse, but I don't think it is the sole cause-------I guess I have to really bug the doctors about this Schatzky's ring and see if more treatment for that might help---it is SOOOOOO hard to get help............. I just want to be normal again!!

[subpar]

Just an FYI, I had an esophageal manometry last week, I still do not have the results but the nurse that did it said I ahd the highest pressures she had ever seen. Not sure what that means--anyway I am waiting for the doctor to tell me something. Anyway if you ever  have a manometry, good luck, you will gag your eyes out--it was awful!

[hosam]

A related discussion, Problems swallowing and gaging was started.