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Diphagia

I am a 54 year old women, living with MS for over 30 years.  In the last couple of years, I have had difficulty swallowing with certain foods, like certain breads, meats and even some of my larger size pills I have to take every day.  I had an endoscopy yesterday, and my GI doctor said she couldn't see any problem in my esophagas.  This problem always happens in the same area of my esophagas, behind the breast bone.  Could this be a symptom from my MS?

Thank you for reading my question, and look forward to hearing from you.

Susan
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198419 tn?1360242356
This is an oldie, but goodie.

Octarine, hope you get some responses.

-shell
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Avatar universal
You said:

Thyroid disease (autoimmune, especially), is common in MS.

I didn't know that!  I had a large thyroid nodule removed when I was 18.  It was nonfunctional and benign, and I haven't had to use any hormone replacement in the 30 years since.

Do you know if thyroid nodules are considered "thyroid disease" in general or "autoimmune" in particular?
Helpful - 0
147426 tn?1317265632
The Swallow test should not be a trigger for your gag reflex.  You swallow much less stuff than you  need to with the Upper GI.  Also, it is not an endoscopic test, just X-ray fluoroscopy - from the outside.  Also, they only need to see the liquid going down.  If you throw it up a little later it would be no problem.  I would inquire about it and see what they can do to help you tolerate the test.

SL - Since this is a problem (or IF this is a problem) with a damaged nerve giving a defective signal, there is not a treatment that I know of the relieve it.  If there is a chronic spasm, perhaps a GI anti-spasmodic could be used.  The important thing is to get it checked out.  It's easy for us to presume that all that goes wrong is caused by the MS, but, in truth, we are susceptible to all the things regular people get (I guess this means we are irregulars, but then we knew that).  You should be checked for reflux and spasm secondary to irritation from that and also for things that compress the throat like aberrant (misplaced) blood vessels pressing on the throat or tumors or things like an enlarged thyroid (goiter) which can cause pressure and difficulty swallowing.  Thyroid disease (autoimmune, especially), is common in MS.

We all have to be careful not to diagnose ourselves based on things "probably being from the MS."

Jen - A welcome from me, too.  Thanks for adding your experience.  I hope you stay on.  We're good people.

Quix
Helpful - 0
Avatar universal
Hi SL,

Thank you much for your kind welcome to the forum.  I only started on 12/05/07, and I already am learning new things, in regard to swallowing issues.  You know what they say, "You can't teach an old dogs new tricks."  Even though I was diagnosed with MS over 30 years ago, there is still so much more to be learned.

I would be happy to hear from anyone who is newly diagnosed, and I would also be happy to share my experiances from my long journey with this disease.

Take Care,
Susan (Sue556)
Helpful - 0
Avatar universal
Hi Quix,

Thank you for your kind welcome to the forum.  In addition, thank you for the tips on helping with the swallowing problems I have been having for some time now.  Are there any other tests, other than the fluoroscopic swallow test?  I have a sensitive gag reflex.  Some time ago, I had a barrium swallow test, in which wound up being a waist of time, as I kept throwing up this liquid.  The prep for a colonoscopy I was to have with the endoscopy a few days ago, didn't work either.  I couldn't keep the liquid prep down, thus colonoscopy was also a waist of time.  I'm finding doctors, other than neurologists, are just not knowledgeable enough about MS symptoms, unless they themselves have MS.  

Thanks again for your suggestions on handling this specific symptom.  I wish you well on your "MS Journey", throughout your life.  Look forward to hearig from you again.

Susan (Sue556)
Helpful - 0
198419 tn?1360242356
Well, then, you need a proper welcome! Welcome to our forum Jense!

I hope you enjoy your time here.  We are a unique crew, who support one another through it all, while educating ourselves and sharing our experiences.  

I thank you for providing this information.  I will pursue it further so I know for sure.  I do know that for me, it doesn't feel like your typical muslce spasm.  It is a chronic pressure, but the knot you describe late in the day, I can relate to, as it progresses as the day moves forward.

Thanks again, and I hope you stick around.

Be well,
SL
Helpful - 0
338416 tn?1420045702
Yup!  I'm new to this forum.  I've been hanging out at MSWorld, but haven't really checked any of the others out.

There's several reasons for your esophagus to spasm.  Sometimes the little valve at the top of your stomach can get weak and flappy, and acid will shoot up into your throat, irritating it.  I think that's what happened with me.  For about a month, I had what felt like a crampy throat.  There was a knot at the base of my throat, and it felt tired, like I'd been exercising it or something.  

Every day, when my symptoms were at their worst (around 3:00 pm or so) my throat would do its spasm thing, and it would feel like a heart attack.  Fortunately I figured out that a glass of warm water would help it to unclench.  I took acid reducers (cimetidine) which kept my stomach from being too agitated, but it wasn't enough to keep the spasm from happening.

Finally, it stopped!  I guess that bit healed up in my brain, or whatever was causing the problem.
Helpful - 0
198419 tn?1360242356
Hi Jense,

Thank you so much for responding!  Are you new to the forum?

My C-spine MRI from May reads that I have within the spinal cord at the level of C5 there is an ovoid foucs of high signal noted measuring 10mm in craniocaudal dimension x 6 mm in transverse diameter x 4 mm in AP diameter.  This is in the midline anteriorly withing the spinal cord and is consistent with a focal demyelinating plaque.  

The rest of the report is regarding HNP's and uncinate spur. . .

I haven't had any new MRI's since then.  I sure hope I don't have any new ones.  Was your esophageal spasm chronic, as if you had it all day, but some times were worse than others? Or, did it spasm like a muscle spasm?  Just trying to get an idea, if the feeling is the same.

I never considered it could be a flair, since it came on not long after starting treatment.

Thanks again,
Be well,
SL
Helpful - 0
338416 tn?1420045702
sllowe, have you had a cervical (neck) MRI?  A lesion in C1 (at the top of the neck) will affect swallowing, as it controls the little muscle right above the adam's apple.

I've had problems with esophageal spasm, but it's gone away as I've recovered from the flare.  Not looking forward to its return.
Helpful - 0
198419 tn?1360242356
Hi Susan, welcome to the forum.  Thanks Q, for this explanation.  There seems to be quite a few of us that seem to have swallowing issues.  So, I wanted to add a question to this as well.

I know you are very busy catching up, but I had a question related to the swallowing, specifically, and the test.

If they find coordination/contraction issues, you think there is there something they can do about it? Or, is it primarily something to contend with, i.e., the coping techniques, fluid first, liquid meds, etc.  Just curious, as I'm not sure what my problem is, it really affects me, but at the same time, I'm not feeling the energy to pursue it with the Dr.

My feeling is swelled, tight, pulling, which seems to affect the swallowing, but lower in the front of the neck, above and around the area of the bones in the front (by the groove in the front).

Sue, I'm so glad you've joined us, and I hope you find some relief w/the swallowing.  

With over 30 yrs of MS, I hope you'll be able to provide us some advice, and share things that you've learned along the way.

Be well,
SL


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293157 tn?1285873439
Hi, I'm not yet Dx...but that is one of my symptoms.  This is good info..thanks to both of you.
Helpful - 0
147426 tn?1317265632
Hi, Susan and welcome to the forum!  You may be the longest MSer we have!  Yes, dysphagia is a frequent part of MS and is usually a problem with one of the cranial nerves, just like optic neuritis, Bell's Palsy, or Trigeminal neuralgia.  The esophagus will be normal appearing on endoscopy and on biospy, because the problem is higher up in the nerves that control the swallowing.

Just a little abnormality in the motility (movement) of the swallowing muscles will put a kink in the whole business.  It sounds like you're having trouble with the larger, firmer boluses of food.  I have the same problem.  Mine appeared right at the beginning of my symptoms and also occurs with things like meat (especially the drier meats like chicken breast) and breads.  I have had to solve the problem by taking smaller bites and drinking some water with the swallow for foods that I know I have a problem with.  When the food gets stuck I often get a severely painful spasm (also right behind the breastbone) and sometimes the next sip of water (trying to get it to go down) will come back out like an explosion.  Does this happen to you?  Another trick is to moisten the path by sipping a liquid before swallowing the pills or food.  Also, a good pharmacist should be able to put some meds into a liquid form if need be.

You need a fluoroscopic Swallow test - often performed by a Speech Pathologist - to analyze the coordination of your swallow mechanism.  They often can see where the waves of contraction that force the food down become incoordinated or where the esophagus doesn't contract at all.  Your GI person (who was probably looking for an ulcer, tumor or compression with the endoscopy) can order this.

I hope this helps.  Quix, MD (retired and NOT a neurologist)
Helpful - 0
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