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Bravo in progress, manometry showed motility issues...

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Posted 10/9/2013 7:02 AM (GMT 0)
An update,

So, today was my day of lame-o tests: manometry, EGD, and Bravo. I was surprised and sad to discover that my esophagus is not working properly and my resting pressure at the lower esoph. sphincter was pretty high. I'm 29, and I haven't ever had food get stuck, just reflux and now and again a difficult moment getting a pill down. Buuut, hardly any of my swallows were normal. Now I've got the Bravo in and have been staring obsessively at the Ph listed on the recording device. It's pretty much always up at 6 or 7 even five minutes after eating a burger, beer, a lot of dark chocolate and super acidic fizzy kombucha with a Ph of 3.

My symptoms are pretty much chest pain and pressure, sore throat, occasional nausea, and apparently swallowing difficulties. My PPis stopped doing much of anything last April. The doctor today said it could be due to reflux (my bravo is suggesting maybe not), or it could be due to my thyroid condition (even though it's well-controlled on replacement hormone) or it could be eosinophilic esophagitis (EE), or some other stuff. He took a biopsy to test for EE today, and I'm really wondering where this is all going to lead. Even if I do have acid reflux, I can't have any surgery for now due to the swallowing issues.

Sooo, I don't know where this is going. I'm still waiting on the rest of the results until probably next week. I guess I just wanted to get a little of this off my chest and hope somebody will read it and maybe offer thoughts or something.

Thanks for listening,

GC
Posted 10/9/2013 7:53 AM (GMT 0)
Hi Grover Cat,

I too have motility issues, but my LES pressure is too low. Did they say what your pressure was? Your symptoms sound very similar to mine and I have LPR (silent reflux) I'm not sure if a bravo detects acid at the upper sphincter?

I also have dysphagia now due to the acid and am looking at surgery.

Have you had a barium swallow done? And did your consultant offer any suggestions? I know you can have a dilation to stretch the sphincter to lower the pressure, but this would let more reflux through. You may be getting TSLER's which account for the LPR - and Baclofen can be used for this although it does have side effects. Try the Gaviscon advance half an hour after eating as it puts a raft on your stomach, and salt gargle to heal your throat.

Hope that this helps some.

Posted 10/9/2013 2:10 PM (GMT 0)
Hi GroverCat,

I'm sorry to read that your diagnosis is not straightforward. I was just looking up EE as I'd never heard of it http://www.eosinophilicesophagitishome.org/
If it turns out to be this at least there would seem to be several things that they could try, so don't give up hope.

Take care.
Posted 10/9/2013 4:06 PM (GMT 0)
Thanks for responding. GC1, I'm not sure what my pressure was at the lower end- just that the doctor said it was a tight resting pressure, but not abnormally tight- given my symptoms, I'd been expecting the opposite! What's TSLER? I don't know about LPR and the Bravo... my sense is it can't measure anything up top, but I should think that if there's acidity traveling into the airways to cause problems, it would have to pass the sensor to get up from the stomach and then into the airways... right? My understanding is that the place where you can aspirate food or acid etc... is near the top of the esophagus at the windpipe, but I'm certainly no expert on how LPR works exactly.

Thanks for your suggestions- I'd forgotten about the salt water aid- I used to do that as a kid when I had a sore throat.

Noelle,

Thanks for your thoughts. I'm hoping that all these unexpected things are just clues that will lead me to an answer- hopefully sooner than later.

Best,

GC
Posted 10/11/2013 1:36 AM (GMT 0)
Hi Grovercat,

I'm in a similar situation as you. I have had my thyroid out and am on hormone replacement for life. I too have GERD and LPR symptoms and am trying to deal with it. I did have the Ph and motility test before, on PPIs) as my initial GERD was horrible. They told me then that my motility was low-normal above my LES. I really don't know what this means, especially if Nissen is in my future.

Does anyone here know what happens to those people suffering from GERD and have motility issues? Can they have the Nissen? If not, what then?

Thanks in advance :)
Posted 10/11/2013 2:19 AM (GMT 0)
Hi all-

They can do a modified version of the Nissen. They wrap less around the LES.

It all depends on how bad the motility issue is. I have some issues now after my esophagus tore, but I still have a full wrap and no issues.

Take care,
Bill
Posted 10/11/2013 6:42 AM (GMT 0)
Stockster,

Sorry to hear you're also stuck in a similar boat. I'll have to wait until next week to get the results from my doctor, and I'll have to wait another month or two to do the barium swallow test he's ordering next... I really, really want to know where I stand and what my options are, so that I can move on too. Hope you find some answers too. I've found an esophageal specialist whom I trust. I'll let you know what I discover.

GC
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