I'll start with some background information. I'm a 23 year old male and have struggled with complications from EE and GERD the past couple of years. There has been remission or at least partial remission sporadically. However, for the past 5 months or so I've had no significant relief of symptoms of dysphagia. For my whole life I have been a slow eater. No one, including myself, ever really thought anything of it. Just assumed that this is how I ate and an underlying medical issue was never suspected.
I never had any episodes of food impaction in the esophagus until about
two years ago. After the second time I experienced impaction I went to a GI doctor and I had an endoscopy with a biopsy taken that confirmed eosinophilic esophagitis. I also went to an allergist to see if I was allergic to any foods or other potential allergens other than those I was aware of (poultry, most fish). Turns out I am also allergic to wheat, barley, most nuts, brewers/bakers yeast, candida, and some trees. All of these allergies were moderate except candida which was high.
I quit smoking cigarettes and marijuana, stayed away from all of these allergens and was prescribed Nexium 40 mg twice a day. Within weeks I was eating better than ever. Unfortunately I started smoking both cigarettes and marijuana again, although much more moderately, and drank to excess on weekends and basically ignored all instructions from my GI doctor to prevent acid reflux. Gradually symptoms started to reappear the past year until this past July when I started experiencing really bad dysphagia.
I went to a new GI who is supposed to be an expert in swallowing issues and EE. I was started on Nexium again, as well as Flovent. I also had several endoscopies with dilation, barium swallow, and manometry done. Manometry supposedly ruled out motility issues, and the barium swallow and endoscopies showed esophageal stricture. The Nexium helped with reflux, and according to several endoscopies with biopsies there was both visual improvement and no eosinophils found. After a couple weeks of treatment and abstaining from smoking and drinking entirely I started introducing solid foods such as rice and some vegetables into my diet and was able to swallow them. However this improvement was short lived. Dysphagia returned and I had some repeat endoscopies with dilation and this time the doctor could not understand why I was experiencing symptoms again after the dilations and with no eosinophils.
I was referred to the expert of all experts in these types of issues and went to the Mayo Clinic in Minnesota. There I gave the doctor my whole history and had an endoscopy. The doctor told me my symptoms were disproportionate with the endoscopic findings. He diagnosed me with a hypersensitive esophagus and prescribed me imipramine starting with 10 mg and going up 10 every weeks up until 50 mg if there was no improvement.
Before I forget, my dysphagia is limited to solids. When my symptoms came back I had some issues with liquid as well but that was resolved. The imipramine did absolutely nothing. I recently had a fluoroscopy done and confirmed that solids did not pass easily through my esophagus and showed stricture and poor contraction of the esophagus. Liquid passed with no issue, pudding went down slowly, banana went down slower, and apple straight up stopped somewhere in the esophagus but went down with the swallowing of the barium liquid.
The results were sent to my doctor who I had an appointment with today, who told me he is a bit baffled by my predicament and described it as the most difficult case he's ever had due to my persistent symptoms of dysphagia even with treatment. He said we would try another endoscopy with dilation to see if the issue is stricture returning and to dilate the esophagus again. He assured me I don't have achalasia because I can take down liquids, and said if it is a motility issue there isn't much to be done.
Am I continually being misdiagnosed? Am I developing a new disorder of the esophagus if the issue isn't from eosinophilia in the esophagus or inflammation from acid reflux? This is ruining my I just don't understand what's going on and any help from anyone who have had similar experiences or have any advice to give me would be greatly appreciated.
Post Edited (jaradical) : 12/23/2013 8:57:44 PM (GMT-7)