Dyspa

Hi, I have had stomach problems for the past 8 years, 4 years ago after endoscopy and MRI and barium swallow and enema, I was diagnosed with, raised coeliac lymph nodes, 2 ulcers and hiatus hernia, I was then put onto Omeprazole 40mg twice a day with Ranitidine for the mop up of what was missed. However I then went on to have my gall bladder out and suffered a laryngeal spasm to which I then had anaphylaxis for the treatment. (I like to be difficult) in the back ground I had what was initially diagnosed as type 2 diabetes and Fibromyalgia. From about six months after this I started to get food stuck in my oesophagus, with really violent painful spasms which I assume is my body trying to get this food down, this was then checked out with a nasty tube down the back of my nose which confirmed the spasms and I was then put on Diltiazem, which my GP put me on at 30mg which did nothing, (whether this is because my pancreas has stopped producing insulin and they cant think of a better way of describing it I dont know) being a difficult being I then discover I a allergic to all kinds of insulin and am desensitised as best they can, and my sugars run at around 10 instead of 5-7. I have managed to stop all antihistamines until another visit to gastro, he puts me back on diltiazem 90mg which I seem to tolerate, but as soon as I up it to 180 after a week, guess who is covered in hives and back on chlorphenamine. Whether this is the insulin allergy rearing its ugly head which it is apt to do or the Diltiazem I don't know. I think I am back to the Gastro, and back in fed up land. I have read loads about Dysphagia, I just want to know is it worth having my oesophagus dilated, or do I risk larygeospasm again.....

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  • I think the only person who can answer your question properly is a specialist.

    As far as the passage of food through your oesophagus is concerned, is the food getting blocked by the lower oesophageal sphincter, the valve into your stomach? A barium swallow test would show whether this is occurring or not. As I understand it, spasms could be triggered by the strain on the oesophagus of food getting blocked there, but is what you are saying that the doctors think it is an allergy to too much insulin? If so, controlling the insulin might be the issue.

    You may not know the actual cause of the spasms you suffer. It sounds like it might have been some form of allergic reaction; on the other hand it might (also?) be something (else) in the nerve system The doctor may say that relieving the pressure of the lower oesophageal sphincter might make your system work better and this might reduce the chances of the spasms. It might also be true that interfering with the system might provoke a reaction in the nervous system that might make them worse. So it might be a medical dilemma.

    Generally, having your sphincter stretched is a fairly easy procedure with an endoscope that should not cause too much discomfort, especially if you have a sedative, and should not cause much in the way of side effects apart, possibly, from some (extra) reflux.

    I imagine that having food progressing well through your digestive system is worth trying to achieve as a problem with this might make other issues worse.

    So it comes back to a discussion with your specialist!

  • I have seen GP who stopped diltiazam and started me on imipramine tonight. The allergy rash has stopped. I have a few auto immune conditions which are all being treated separately. Fibromyalgia, hyperprolactinaemia, diabetes, under active thyroid, and this oesophageal thing which could be the fibromyalgia or the vagus nerve or diabetes, or anything. Barium swallow showed nothing but the thing they put down my nose showed the spasms. I can cope with fluids most of the time I do choke occasionally. I can cope with yoghurt consistency food most of the time . Most wet food casseroles soup etc. But potatoes bread cake etc is a no no. (Great for my diabetes when it gets stuck so I avoid it for a few days)😄

  • Why are you prescribed Diltiazem ?

  • To relax the muscles around the oesophageal. Update now diltiazam is stopped along with amitryptiline to start imipramine tonight. Insulin is reducing daily and since stopping diltiazam the allergy rash has gone. Weight loss now a stone and down 10 units of Lantus daily and 2 humalog at each meal. No piriton either. Let's see what tomorrow brings

  • When you had the manometry done did they assess the strength of and pattern of the contractions? Have your professionals ruled out Nutcracker Eosophagus ?

    Diltiazam was a good first choice of medication - as a calcium channel blocker it should dampen down the action of smooth muscle (which lines the gullet). But it often has unacceptable side effects.

    Glad to hear that you have been prescribed a new regimen - your GP is making an effort to get your multiple issues sorted.

    If the Imipramine doesn't do the trick then something along similar lines of reasoning you might want to discuss with him/her is Tri-cyclic Antidepressants - these have been shown to have a positive effect (via an as yet unknown mechanism) on spasm and could also be of wider benefit in helping you get to grips with your complex problems across the board.

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