Swallowing mechanism going kaflooey

[essdipity]

Lulu has asked me to give more details about the swallowing/esophagus problems I've been having intermittently. First I'll say that I'm no expert on this, and that not long ago Quix described the tests, pretty excruciating for her, that were done on her esophagus and stomach, as part of a big digestive system workup. I certainly defer to her personal and medical knowledge on this subject, and hope she'll correct any erroneous assumptions here. And also, of course, give us more information.

Starting last summer I've had quite a few episodes of agonizing pain immediately after swallowing. It feels as if I've eaten something huge, and that my throat muscles are being wildly stretched and contorted. Taking a sip of water doesn't help---it just sits there along with what I've swallowed. It has taken as long as 10 minutes for this to pass and for the food to get into my stomach. No choking and nothing blocking the airway. After a number of these 'spells,' the bottom end of the esophagus started getting into the act. I can tell when the stomach valve opens, because my chest feels flooded with fiery acid for 10 or 20 seconds, and when the valve closes again, that's gone. I became afraid that this malfunctioning might be injuring my esophagus.

I've recently had another and isolated episode of a different kind. I was eating soup, not choking or coughing, and swallowed a spoonful normally, or so I thought. However, all of it cascaded out of my nose and onto my clothes. Not a nice surprise.

Well, obviously I realized that something is wrong, but I haven't done anything about it yet. I did mention this to my PCP Friday when I was there for other things, in a sort of 'by the way' comment. I had just told him about my bladder diagnosis, and he said several times that that and the throat stuff are blatant (and he said blatant at least 3 times) symptoms of MS. He was quite concerned that I'm not getting the right treatment, and I reminded him I'm allergic to Copaxone and am on Avonex. Anyway, he called the swallowing thing Esophageal Motility Disorder, which I know has been described and discussed here from time to time. He gave me a referral to a swallowing center at the same hospital, but noted that if I'm not having trouble at the time, nothing might show up.

Some of our members might not know that this kind of thing is rather common with MS. If the trouble is mainly in completing the swallow, getting the food where it needs to be to do this, it's called dysphagia. Other difficulties, like mine, happen when the esophagus 'forgets' how to work properly. It's a mistake to think of the esophagus as simply a tube between the mouth and the stomach. In reality, there is a series of muscles all the way down, and these have to contract  the right way and in the right order for food to move the normal way. It's the first part of the peristalsis that occurs all the way through the digestive process.

Maybe it's time for more discussion on the forum. Is anyone else having this kind of problem? If so, is it all the time or just now and then? What have you done about it? Inquiring minds want to know!

Thanks,
ess

[meg321]

I have had for many years a hiatal hernia and acic reflux and have taken medication for it.
When i started this MS process an infection showed up in my chest or lungs and i was told that my swallowing mecanism was 'bad' ? And the word dysphagia was used.  There was more i cant remember, since i can't remember s**t now, and after my last blood test at the MS clinic the infection came up again and i  just had the blood done again.

Hopefully i can rememnber to let you know what they say about it.

hugs meg

[Fluffysmom]

I found that comment about the general population occasionally "forgetting how to swallow" as I've had that happen a few times, and it is a scary feeling.  I am very glad to hear that it is most likely not something I'll have to get used to.

I'm glad that there are tests to help figure out what is causing these extremely uncomfortable symptoms I've been reading about.  I hope that there are also treatments to help with them.  Heck, I suppose advice like "take small bites, chew thoroughly, eat small meals", etc. are helpful if a person hasn't already tried it themselves.

I learn so much from this forum; I really hadn't thought about an esophagus getting fatigued, Heather! I unfortunately have been known to give mine too much of a workout at times! LOL!

Kathy


I hope Craig's endo to repair his stricture is a complete success.

[essdipity]

So are your esophageal abnormalities being attributed to MS, or is this a separate ailment?

ess

[Quixotic1]

I was not contradicting your statement that swallowing problems are common in MS.  They are extremely common.  I was only making the statement that the occasional "forgetting how to swallow" is very common, even with the general population and need not arrouse concern.  Any consistent/frequent or chronic or increasing problem DOES certainly need to be checked out.  

And thanks for all the cites.  These are always helpful.

Quix

[Quixotic1]

Well, this is the right point for me to chime in and talk about seeing my GI guy for all my resluts ???  hmmm, results.

My endoscopies showed a noraml and healthy GI tract.  My gastric emptying study was normal, but he said I likely still have episodes of poor emptying and to eat smaller meals and try not to have fat and fiber together,

My Esophageal Manometry showed higher than normal pressure within the esophagus - not sky high, but still abnormal.  He thinks I am having what they call "Nutcracker Spasms" which are sudden extreme spasms which actually close off the esophagus for a short time.

I told him again about the episodes I get of pain radiating up my neck and then 10 or 15 seconds of crushing jaw pain, like my jaw (both sides) is being pressed in a vice.  He again shuddered, but I reminded him that I have had two cardiac stress tests which were "Cone, Stold Normal" in the words of a very good cardiologist.  The most recent one I had was associated with obvious reflux, so I am sure the episodes are of reflux and spasm and not cardiac in origin.

So that is my story of what the docs do when your swallowing goes all kaflooey.

Quix

[Lulu54]

Here's a good site and the information from there about spasms......
http://www.************.com/articles/Esophageal_spasm__Causes___Risk_factors_a154_f140.html

"Possible causes of esophageal spasms

Although the etiology of esophageal spasm is unknown, there are several possible scenarios:

•    Increased release of acetylcholine appears to be a factor, but the triggering event is not known.
  
•    Gastric reflux or a primary nerve or motor disorder.
•    Micro-vascular compression of the vagus nerve in the brainstem has been demonstrated in recent researches as the possible triggering event. "

I especially l perked up reading the vagus nerve in the brainstem....

Lulu