stomach emptying test results

[Guest guest]

Hi everyone:

For those of you that remember me, I am a undiagnosed person with

persistant dysphagia following a lap. Nissen fundoplication about 1

yr ago. Before that operation, I had persistent swallowing

difficulties and NCCP that were attributed to acid reflux disease.

I had a barium swallow test in December which for the first time

(after numerous manometry studies showed normal readings), showed a

problem with the middle of my esophagus not pushing the food down.

Last week I had a gastric emptying test which I just got the results

of. The report shows I have no evidence of gastroparesis(sp?).

I was able to see during the test, that the isotope food I had

swallowed did go through my stomach.

This makes me feel so depressed. I feel like here I go again. Another

test is showing I'm just fine, although I know how I feel. Everything

I swallow seems to sit in my esophagus for some time before it goes

down. I dont go back to see my GI untill March, but already, I am

afraid he's going to say, it's all my imagination.

I'm sorry to be such a downer, I guess I'm just afraid of what they

will tell me.

Jan in Northern KY

[Guest guest]

Hi Jan,

I just went through a monometry study, those are not fun. I am sorry

you had to endure many of them. I am under the impression, that there

are various ways that swallowing is interupted in each of us. The

manometry study is usually a good indicator of symptoms, but maybe

the test was flawed.

Every instrumental analysis is dependant on proper set-up,

calibration and interpretation of the results.

Isn't the barium result enough to show there is something wrong?

Mention to your GI the Barium study, and stick to your guns.

Pete in Boston

> Hi everyone:

> For those of you that remember me, I am a undiagnosed person with

> persistant dysphagia following a lap. Nissen fundoplication about 1

> yr ago. Before that operation, I had persistent swallowing

> difficulties and NCCP that were attributed to acid reflux disease.

>

> I had a barium swallow test in December which for the first time

> (after numerous manometry studies showed normal readings), showed a

> problem with the middle of my esophagus not pushing the food down.

> Last week I had a gastric emptying test which I just got the

results

> of. The report shows I have no evidence of gastroparesis(sp?).

> I was able to see during the test, that the isotope food I had

> swallowed did go through my stomach.

>

> This makes me feel so depressed. I feel like here I go again.

Another

> test is showing I'm just fine, although I know how I feel.

Everything

> I swallow seems to sit in my esophagus for some time before it goes

> down. I dont go back to see my GI untill March, but already, I am

> afraid he's going to say, it's all my imagination.

> I'm sorry to be such a downer, I guess I'm just afraid of what they

> will tell me.

> Jan in Northern KY

[Guest guest]

Jan, do you have problems with ALL foods/liquids, or just "solids"??? (if it's just a lack of peristaltic contractions in the middle, but the rest is OK, then liquids eaten while vertical SHOULD go through w/o problems.)

Does the barium swallow show that the mid-section of the esophagus is "closing off" or just that it's not pushing stuff along when it gets to that point?

Did they show you the manometry report itself to show that the LES *is* relaxing/opening properly??? Sometimes it's a different doc reading the results and writing your report that your doc will receive, so he may not be completely familiar w/ your situation... if your LES is "abnormal" compared to a normal person, but the doc writing the report brushes that off as being "due to the fundoplication", he may conclude that the LES is "normal" b/c it's "normal for a fundoplication" even though it's not normal for a regular person?

Are your esophageal contractions peristaltic (meaning, in the proper order from top to bottom) for the entire esophagus EXCEPT for the middle?

Achalasia can be very "hit or miss" esp. in the beginning. If your test was done on a "good day" then the LES may have opened fine THAT TIME. Do you have problems 24/7/365, or do you have days of the week or times of the day that are better/worse? Tracking what you eat, when, and how it goes down (or up!) may help the doc to track this down, too.

Keep your spirits up... we'll figure this out somehow! *WE* know it's not all in your head!!!!Debbi in Michigan

Hi everyone:For those of you that remember me, I am a undiagnosed person with persistant dysphagia following a lap. Nissen fundoplication about 1 yr ago. Before that operation, I had persistent swallowing difficulties and NCCP that were attributed to acid reflux disease.I had a barium swallow test in December which for the first time (after numerous manometry studies showed normal readings), showed a problem with the middle of my esophagus not pushing the food down.Last week I had a gastric emptying test which I just got the results of. The report shows I have no evidence of gastroparesis(sp?). I was able to see during the test, that the isotope food I had swallowed did go through my stomach.This makes me feel so depressed. I feel like here I go again. Another test is showing I'm just fine, although I know how I feel. Everything I swallow seems to sit in my esophagus for some time before it goes down. I dont go back to see my GI untill March, but already, I am afraid he's going to say, it's all my imagination.

I'm sorry to be such a downer, I guess I'm just afraid of what they will tell me.Jan in Northern KY

[Guest guest]

In a message dated 2/9/2004 11:43:06 AM Eastern Standard Time, heiser@... writes:

Jan, do you have problems with ALL foods/liquids, or just "solids"??? (if it's just a lack of peristaltic contractions in the middle, but the rest is OK, then liquids eaten while vertical SHOULD go through w/o problems

Well, I'd put it this way, mostly I have trouble with solids, but I do have the feeling of not being able to swallow much of liquids as well, ie. it's hard to get a full glass of any liquid down, without feeling like I am drowning in it!

Does the barium swallow show that the mid-section of the esophagus is "closing off" or just that it's not pushing stuff along when it gets to that point?

Well, the GI did say at my last appt. that it appeared that the middle esophagus is not pushing the food down, that it just kind of bounces up again, and finally comes down .

Achalasia can be very "hit or miss" esp. in the beginning. If your test was done on a "good day" then the LES may have opened fine THAT TIME. Do you have problems 24/7/365, or do you have days of the week or times of the day that are better/worse? Tracking what you eat, when, and how it goes down (or up!) may help the doc to track this down, too.

I have found, as I have read from some posts by others, that some days I can swallow some foods that on other days give me lots of grief, but many days swallowing makes me feel like I simply cannot eat much for half a day or lots of time day and a half untill I feel like room has opened up for more food!

Keep your spirits up... we'll figure this out somehow! *WE* know it's not all in your head!!!!Debbi in Michigan

Thanks Debbi-

This has been one of the most trying times of my life.

Has there ever been anyone like me, who did not yet know if they were, in fact, suffering from Achalasia, but had swallowing problems? It's just that I guess sooner or later, I will just have to accept the fact that life will be like this for me and I'll have to learn how to deal with it and go on.

Thanks again for your support.

Jan in Northern Kentucky

[Guest guest]

In a message dated 2/9/2004 12:01:38 PM Eastern Standard Time, jenmunoz2000@... writes:

Don't let it go if you know something is wrong, butit just may take some time to show itself.Good luck, stay positive!Jenifer in Ohio

Thanks for the support,Jenifer. So many of my coworkers and friends keep asking me "How much weight are you going to loose before they do something!?" and I know they are very well meaning, but they keep asking me what is wrong with me, like I am supposed to badger doctors for an answer, when in truth, it sometimes takes time for a correct diagnosis, I guess.

In an era of "instant" everything, this swallowing problem I'm having just does not seem to have an "instant" solution.

I guess I just have to learn some patience.

Thanks again, you guys are the best!

Jan in Northern KY.

[Guest guest]

Jan,

Give yourself some time to see what happens.

The first few tests I had for A came back negative.

They said it was just too early. The manometry

showed I didn't have parastalis(sp?) in parts of

my E but the pressure on my LES was not high.

When I swallowed barium in my x-rays the barium

seemed to go down then up the separate, it was

all over the place.

I'd say about 9 months later I was re-tested.

This time in the manometry the pressure on my

LES was slightly higher. And this time when I

swallowed Barium it just kind of all filled

in my E like a column. It was just to early in

the disease to diagnose prior.

Don't let it go if you know something is wrong, but

it just may take some time to show itself.

Good luck, stay positive!

Jenifer in Ohio

> Hi everyone:

> For those of you that remember me, I am a undiagnosed person with

> persistant dysphagia following a lap. Nissen fundoplication about 1

> yr ago. Before that operation, I had persistent swallowing

> difficulties and NCCP that were attributed to acid reflux disease.

>

> I had a barium swallow test in December which for the first time

> (after numerous manometry studies showed normal readings), showed a

> problem with the middle of my esophagus not pushing the food down.

> Last week I had a gastric emptying test which I just got the

results

> of. The report shows I have no evidence of gastroparesis(sp?).

> I was able to see during the test, that the isotope food I had

> swallowed did go through my stomach.

>

> This makes me feel so depressed. I feel like here I go again.

Another

> test is showing I'm just fine, although I know how I feel.

Everything

> I swallow seems to sit in my esophagus for some time before it goes

> down. I dont go back to see my GI untill March, but already, I am

> afraid he's going to say, it's all my imagination.

> I'm sorry to be such a downer, I guess I'm just afraid of what they

> will tell me.

> Jan in Northern KY

[Guest guest]

In a message dated 2/9/2004 5:24:31 PM Eastern Standard Time, heiser@... writes:

Did they do your barium swallow (meaning the esophageal portion, not the stomach-emptying portion) both standing up AND lying down?

Yes, as a matter of fact, they did have me standing up and reclining.

Did they videotape the whole thing, or just take still shots at different times? Did you have a radiologist in the room during the procedure, or just an "x-ray technician"?

Hmmmm.........., the radiologist was in the room the entire time, and whether or not they video taped it or not, that I do not know.

When you had your manometry done, was it done by someone who did a lot of them? Did they take their time w/ it and do multiple measurements?

The last manometry study was done in October 2003 and was done by an RN who specialized in doing them. As a matter of fact, she was assisted by a friend of mine, a experienced RN who told me that the RN who was running the test really knew what she was doing.

So, I'm not meaning to be nosy.... just trying to see exactly what they did and didn't do so far in case there's something else that they can try. I just hate to see anyone going through this crap....

Deb in Michigan

Oh, Deb, I don't mind your questions at all. When they sent me for the barium swallow, I think they also called it a videoesophagram. So, I guess they must have real time video of the swallowing.........

I just keep thinking........That from what I have been able to read about achalasia, the average time it takes for a diagnosis is two years. For those people who have related stories that they suffered for 5-10 yrs, I can't even imagine the frustrations and despair.

I feel like such a baby for complaining that I am having trouble swallowing for a yr.(give and take time for lap fundo surgeries).

I wish there were someone out there who might be going through the same thing I am: trouble swallowing, loosing weight, sick of surviving on liquid drinks and soup and having medical tests that show that nothing is wrong.

Sorry to rant and rave so much.

I tell most of my coworkers and my kids(21,19, and 15) that if it were'nt for the mentally retarded and developmentally disabled adults who look forward to seeing me each day,

I don't know where my reason to keep going would come from.

They give me lots of smiles and hugs and that is what makes life worth living.

Jan from Northern KY

[Guest guest]

Does the barium swallow show that the mid-section of the esophagus is "closing off" or just that it's not pushing stuff along when it gets to that point?

Well, the GI did say at my last appt. that it appeared that the middle esophagus is not pushing the food down, that it just kind of bounces up again, and finally comes down .

Did they do your barium swallow (meaning the esophageal portion, not the stomach-emptying portion) both standing up AND lying down?

Did they videotape the whole thing, or just take still shots at different times? Did you have a radiologist in the room during the procedure, or just an "x-ray technician"?

When you had your manometry done, was it done by someone who did a lot of them? Did they take their time w/ it and do multiple measurements?

Sorry for the 20 questions today -- I'm just trying to figure out some options for you. One thing I've noticed in this group is that different clinics do what we think is the "same test" in very different ways! (Like how some people are unconscious for endoscopy, some are mildly sedated but still awake, and yet others are fully conscious, etc.) If there's a test that may shed some light if it was performed in a different manner, it might answer some of your questions and lead your doc to a diagnosis.

One of my barium swallows was ONLY done in the vertical position.... well, liquid flows downhill, so that didn't show my lack of peristalsis!

One of my barium swallows was done horizontally, but the tech was scolding me the whole time for not drinking the shake "fast enough" -- uh, HELLO.... I'm here b/c I CAN'T SWALLOW YOU NIMROD!!!! They also only took timed shots, not real-time fluoroscopy video, so it didn't show if it was a lack of peristalsis or a lack of LES relaxation that caused the build-up of barium in the esophagus.

My first manometry was done by a quack -- he knocked me unconscious and did it w/ two dry swallows and two wet swallows. Plus, he read it wrong on top of that!!! All of my other manometries were done over the course of 45 minutes to an hour, taking great care to properly locate and identify the LES, measuring different depths, etc., and doing multiple wet swallows plus some "just sit there and don't talk or swallow" periods (which showed some kinda funky movements that happen all by themselves for no apparent reason -- dancing an Irish jig in there! LOL) to get the Big Picture.

So, I'm not meaning to be nosy.... just trying to see exactly what they did and didn't do so far in case there's something else that they can try. I just hate to see anyone going through this crap....

Deb in Michigan....

[Guest guest]

Did they do your barium swallow (meaning the esophageal portion, not the stomach-emptying portion) both standing up AND lying down?

Yes, as a matter of fact, they did have me standing up and reclining.

By "reclining" do you mean like in a La-Z-Boy chair, or being completely horizontal / flat?

Did they videotape the whole thing, or just take still shots at different times? Did you have a radiologist in the room during the procedure, or just an "x-ray technician"?

Hmmmm.........., the radiologist was in the room the entire time, and whether or not they video taped it or not, that I do not know.When they sent me for the barium swallow, I think they also called it a videoesophagram. So, I guess they must have real time video of the swallowing.........

Yep, a video esophagram is indeed "video" or real-time viewing, also called fluoroscopy. I would ask if you could see your videotape, and try to find out if the GI saw it himself, or if just the radiologist viewed it and wrote a report to the GI. I think this is a key tool in figuring out a diagnosis for you.

When you had your manometry done, was it done by someone who did a lot of them? Did they take their time w/ it and do multiple measurements?

The last manometry study was done in October 2003 and was done by an RN who specialized in doing them. As a matter of fact, she was assisted by a friend of mine, a experienced RN who told me that the RN who was running the test really knew what she was doing.

Do you feel your symptoms have gotten better or worse or stayed the same since October? I ask b/c if there's been a change in your symptoms, manometry may indeed show a change in the LES function if it were performed again now.

I believe that in my case, the misfiring peristalsis was my first symptom, and it wasn't until later on that the LES became so dysfunctional. My first "episode" was simply a bite of a hamburger that got "stuck" for a moment, then finally went through; just like when a "normal" person doesn't chew up a hunk of steak properly and feels that momentary feeling of "ooh, that one's stuck" before it passes. I didn't have problems w/ accumulated food/saliva, spewing of the esophageal contents, etc., until later on, like a couple years or so. So if the first "stuckies" were JUST in the middle of my esophagus, my LES would have looked 'normal' at first too.

So, I'm not meaning to be nosy.... just trying to see exactly what they did and didn't do so far in case there's something else that they can try. I just hate to see anyone going through this crap....

Oh, Deb, I don't mind your questions at all.

Jan, I'm so glad you don't think I'm being nosey!

I just keep thinking........That from what I have been able to read about achalasia, the average time it takes for a diagnosis is two years. For those people who have related stories that they suffered for 5-10 yrs, I can't even imagine the frustrations and despair.

One other thing that I wanted to share w/ you -- as you no doubt have figured out, many of us are told we have GERD/reflux b/c of the regurgitation and chest pains, etc. I just can't help but wonder if you, too, had the beginnings of achalasia and were diagnosed w/ GERD and that your wrap was the exact OPPOSITE of what you needed. (I am NOT trying to say that "I know this is what happened" or anything! Just sharing a hypothesis here....) I believe you've actually indicated that you think this may be the case, too.

Did you see the post I did a few minutes ago about "esophageal manometry"? When I was reading that manufacturer's website, it discussed more than once the necessity for manometry (and also 24-hr pH testing) BEFORE surgery for GERD -- did you ever have this test done before your Nissen?

Here are some quotes (emphasis is mine):Research has shown that GERD cannot reliably be diagnosed based on symptoms alone (1) and may present with a wide variety of less common symptoms including chronic cough, hoarseness, recurrent pneumonia, and chest pain. Further, it is possible that a patient's classic symptoms and complications may be caused by something other than GERD. For example, achalasia, esophageal carcinoma and gastritis, have all been known to be associated with GERD like symptoms.

Besides technical factors, lack of a full appreciation by the surgeon of the patient's condition is a significant factor in the failure of antireflux operations. (4) "Inappropriate patient selection is a completely avoidable cause of dissatisfaction among patients with antireflux operations. This most often occurs when the operation has been performed for symptoms in the absence of objective documentation of gastroesophageal reflux disease or when the presence of a primary esophageal motor disorder-i.e., achalasia or diffuse esophageal spasm-is not recognized. Careful assessment with 24-hour esophageal pH monitoring and esophageal manometry is therefore mandatory in all patients in whom antireflux surgery is considered." (5)

If this testing was done before your Nissen, comparing those results to the Oct 2003 manometry will show if there's been a change in your function level. And if it shows poor motility before the surgery, your surgeon has some explaining to do about why he performed a Nissen on someone w/ poor motility! And if they DIDN'T do the manometry before the surgery, the surgeon still has some explaining to do about why he didn't ascertain your motility function before compromising it w/ a Nissen.

I feel like such a baby for complaining that I am having trouble swallowing for a yr.(give and take time for lap fundo surgeries).

I don't think ANYONE here considers you a "baby" for being upset about not being able to do a simple bodily function! Would someone w/ asthma be considered a baby for complaining about not being able to breathe??? WE UNDERSTAND, Jan! We've all been there.

I wish there were someone out there who might be going through the same thing I am: trouble swallowing, loosing weight, sick of surviving on liquid drinks and soup and having medical tests that show that nothing is wrong.

Actually, I was there -- back in the early/mid 1990's -- had a barium swallow and a barium swallow w/ small bowel (waiting until it left the stomach), an ultrasound of my gall bladder, MRI of my thyroid, endoscopy and manometry. "There's nothing wrong w/ you, you need to take tranquilizers and see a shrink" is what the "specialist" told me.

I'm not sure which part of KY you live in, but I'm guessing it's roughly a half-day drive to TCC. Knowing now what I do, I think it's worth your while to get a second opinion there. Even if it's NOT "achalasia" that you have, they are specialists in swallowing disorders -- like Jen said, it's written right on the wall/door of the clinic! They're more likely to be able to diagnose your problem than just a plain old GI specialist (who has never seen an achalasia patient before in his practice, more than likely!) This is just such a screwball disorder that it's hard to get a proper diagnosis unless you find someone w/ experience or GOOD training specifically in this disorder.

Sorry to rant and rave so much.I tell most of my coworkers and my kids(21,19, and 15) that if it were'nt for the mentally retarded and developmentally disabled adults who look forward to seeing me each day,I don't know where my reason to keep going would come from. They give me lots of smiles and hugs and that is what makes life worth living.

You rant and rave any time you feel like it (and honestly, I've done MUCH worse than I've ever seen you post here!) That's what this support group is all about!Lemme know if you have any questions about what I've written here -- I was interrupted a couple dozen times by this pesky thing called "my job" so I may not have come across as cohesively as if I'd written the whole thing at once...

Deb

[Guest guest]

In a message dated 2/10/2004 12:19:06 PM Eastern Standard Time, heiser@... writes:

By "reclining" do you mean like in a La-Z-Boy chair, or being completely horizontal / flat?

I'm back.............

Well, to answer your question, I was on this table that I had my back to standing up, then they lowered the table parallel to the floor, to have me completely laying down.

Do you feel your symptoms have gotten better or worse or stayed the same since October? I ask b/c if there's been a change in your symptoms, manometry may indeed show a change in the LES function if it were performed again now.

Actually, it seemed to get a lot worse starting in November/December. That's the first time I remember not wanting to drink much. I love drinking many cups of coffee in the morning, and now it's hard to get one cup down. It's hard to describe, but I always was a person who drank lots of water. Now after a few swallows, I feel like I just can't swallow any more. It feels like a clogged drain that is draining very slowly. The last couple of times I have seen my new GI, he has mentioned repeating the manometry again in several months. On the last visit, he mentioned achalasia as a possible explanation, but went no further.

I just can't help but wonder if you, too, had the beginnings of achalasia and were diagnosed w/ GERD and that your wrap was the exact OPPOSITE of what you needed. (I am NOT trying to say that "I know this is what happened" or anything! Just sharing a hypothesis here....) I believe you've actually indicated that you think this may be the case, too.

Great minds think alike!!

I mentioned this exact theory to my doctor. To my surprise, he said that he was thinking the exact thing. He said that it was possible that well meaning surgery may have exacerbated a problem that had it's beginning before the surgery, but didn't show up much on the before surgery manometry test.

You rant and rave any time you feel like it (and honestly, I've done MUCH worse than I've ever seen you post here!) That's what this support group is all about!Lemme know if you have any questions about what I've written here -- I was interrupted a couple dozen times by this pesky thing called "my job" so I may not have come across as cohesively as if I'd written the whole thing at once...

Deb

Deb,

Thanks for your patient understanding. I am going to stick with the doc I have for a little while longer, especially since he seems to have a "game plan" to help figure this out. ( the "game plan" were his words)!

He wants me to take liquid erythromycin to help the peristalsis in my esophagus.

I will try that next. I have a feeling that besides trying me on various medicines that may affect swallowing, that he may be trying to buy time. Perhaps I'm just in the early stages of this now, or not, who knows.

But if he gets to the point where he throws up his hands and says go away, then I will see if I can get in to TCC. It's only about a 6hr drive from here.

I feel very fortunate to have friends such as you to help me figure this out.

Thanks so much!

Jan in Northern KY

(part of greater Cincinnati, Ohio area)