I am a 40 year old mother of 2 young children and have suffered from dysphagia since last year, starting with pill dysphagia in the last months of pregnancy, and then gradually to solids which became acute in September 2018. I am obese, although have lost 12 kgs in the last 2.5 months due to not eating well. I am seeing consultants via NHS and another privately in London, and have been on Omeprazole 20 mg x 2 a day for nearly 6 weeks until 5 days before the manometry (on Saturday 1 Dec). The Omeprazole seemed to help a little. it stopped my excessive burping. I have Gaviscon after meals. Until the manometry, I was still eating soft solids after chewing them really well.
First & second tests - endoscopy was clear (no signs of esophagitis, biopsies OK), barium swallow was largely fine but showed a brief delay in clearance only when I was lying prone and drinking the Ba solution. However, the manometry was a spectacular fail. I found the process very distressful and nearly choked while the tube was going in. I failed all water swallows (not helped by a seemingly inexperienced technician / nurse). There was some evidence of peristalsis in the upper 3-5 cm of the esophagus but none below that, I was told. I could not even proceed to eating food with the tube in since i could feel it all the way and was very uncomfortable. it was a bit rushed and over in 15 mins. I was meant to get a 24 hour ph monitoring done after that but couldn't get through it. The LES was also slightly loose, he felt (I don't have the test report yet).
The lab nurse suggested the aperistalsis may be caused due to GERD, Achalasia (but none seen in endoscopy or Barium swallow) or by scleroderma. The last suggestion scared me I don't have other clear symptoms of scleroderma I think - I do have sporadic eczema, and mildly raised inflammation markers - CRP and ESR. I have got a blood test for ANA done today and awaiting the result.
Where do I go from here? Up till now, my private gastro consultant felt my dysphagia was linked to anxiety and had even suggested seeing a psychiatrist for it. Now there is a physical cause. I didn't take up his suggestion, but I realise that ongoing health anxiety is making eating worse. Stopping the omeprazole before manometry didnt have an immediate effect except a sour taste in my mouth, but now - even though I have been back on it for nearly 2 days - I still have excessive burping, the feeling of pressure behind the sternum,and I am barely able to eat - i feel food is getting stuck on the way down though I am chewing well (though I don't feel like vomiting). I wonder if this deterioration is due to anxiety from the manometry result. I am not due to see either of my GI doctors until later and I am terrified of the outcome. I am barely making 1,000 calories a day and don't have enough energy to take care of my children, and work.
1. Can GERD (without obvious signs like oesophageal erosion) cause such severe dysmotility?
2. Can oesophageal dysmotility be the presenting symptom for Scleoderma / systemic sclerosis? Other causes to explore? I read something about the vagus nerve.
3. Are there non-surgical ways to improve oesophageal motility (e.g. hot water swallows, Busiprone, etc.
4. How did you address anxiety around swallowing? I am experiencing food aversion, but at least my GP doesn't seem concerned.