dysphagia

[queentiny]

i had endoscopy done on dec 2007 w/ result of mild esophagitis, mild gastritis, neg.  h. pylori, neg for cancer. Even on medications, dietary modifications, i m still experiencing reflux.This may 2008 i started experiencing dysphagia to both solids and liquids up to this time.Im having an IV q day and i noticed that i can toletare liquids if i just woke up in the morning. Barium swallow done last may 29, 2008w/ result as Fluoroscopic evaluation demonstrates distal esophageal spasm, ulceration, mass, stricture cannot be excluded on the current examination.Motility test done on june 16,2008 w/ result of LOWER ESOPHAGEAL SPHINCTER; it was obvious during the beginning of this exam that this patient could not tolerate the indwelling manometry for any prolonged length of time. Accordingly, it was felt that atleast part of a body study should be performed to rule out achalasia. If all peristaltic contractions were noted, then achalasia could be excluded. This was done  but the findings were inconclusive. Approx.70 to 80 % of all the swallows taken were completely nonpropagated. In other words, no contraction of any type was noted. Abt. 20 to 30% of the swallows taken were followed by normal peristaltic contractions. The amplitude of these contractions was normal At 90.2mmHg. CONCLUSION: inconclusive partial study. This patient probably does not have achalasia, as occasional peristalsis is seen, and no simultaneous contractions. A definite esophageal dysmotility is present, due to the great majority of the contractions being completely nonpropagated. The lack of any simultaneous contractions also would make diffuse esophageal spasm doubtful. QUESTION: If not achalasia or DES, what's causing my dysphagia? What will i do next? My doctor referred me to a surgeon but was not reffered to ENT or speech pathologist. I had on and off vaginal yeast infection last year  and treated w/ one dose of diflucan. I read that esophageal or oral candidiasis can cause dysphagia too.Pls. help!

[Susie34]

please tell me howyou are now? I am experiencing a life debilitating dysphagia for 3 weeks now, hard to even swallow my own spit.  I have had recent yeast infections and UTI's......acid reflux?    oral thrush (oral yeast)  my tongue is white and swollen...... please let me know what you learn!!!!  im dying here :(  im on a liquid boost diet..and as a 34 year old woman with noknown previous conditions, this is frightening!!!!!!!!
                

[Kevin Pho, MD]

I agree with the tests that have been done thus far, and would exclude major GI causes of your symptoms.

A referral to a speech pathologist would be helpful.  A modified barium swallow can be done to evaluate the swallowing mechanism.  

Otherwise, medications can be considered to help with any esophageal dysmotility.  This can include calcium channel blockers or injection with Botulinum toxin.

Another GI opinion can be considered, preferably at a major academic medical center.

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

Kevin, M.D.
www.kevinmd.com