chocking causing vomiting

[Alice Mae]

When I eat, on occasion (2-6 times per month)I start to choke, I cannot breath or talk and them my body appears to take over and what I have eaten is expelled.  I cannot hold off the vomiting until I am in a more appropriate place it happens at the worst possible times.  It is a serious problem and I know I need to go get help but I keep hoping it won't happen again.  I have noticed that it tends to happen during busy stressful times. (Thanks Giving dinner that I prepared and served to 16 people, my husband's business dinners,etc)
Well meaning family members (g.p and internist) say it is probably a panic problem.  I believe if that were the problem I would have some control!  Please advise
Thank you

[COB]

Thanks Chicken Soup,

[tessa0825]

Any information you would like to share with me will be so much appreciated...I will look for your email....Thanks, Tessa

[JackieG]

Hi Tessa:

I'd be happy to email you about my personal recovery. I also have two post-esophagectomy diets from two of the top 50 US cancer hospitals, which I can send to you in case you need them in the future. Surprisingly, even some of the best cancer centers do not give good post-esophagectomy diet information, and in some cases I know of people who received no advice on post-surgery diet guidelines.

Please bear with me. I won't be able to respond until tomorrow. It may be a fairly long email.

Talk to you soon,
Chicken Soup

[JackieG]

The following excerpts were taken from a web site. I personally never had a manometry:

Esophageal Manometry:
The wall of the esophagus contains muscle that rhythmically contracts whenever a person swallows. This contraction occurs as a sweeping wave (peristalsis) carrying food down the esophagus. It literally strips the food or liquid from the throat to the stomach.

Another important part of the esophagus is the lower valve muscle (lower esophageal sphincter, or LES). This is a specialized muscle that remains closed most of the time, only opening when swallowed food or liquid is moved down the esophagus.

Esophageal manometry measures the pressure within the esophagus. It can evaluate the action of the stripping muscle waves in the main portion of the esophagus as well as the muscle valve at the end of it.

Equipment
The equipment for manometry consists of thin tubing with openings at various locations. When this tube is positioned in the esophagus, these openings sense the pressure in various parts of the esophagus. As the esophagus squeezes on the tube, these pressures are transmitted to a computer analyzer that records the pressures on moving graph paper. It is much like an electrocardiogram. The physician can evaluate these wave patterns to determine if they are normal or abnormal.

Reasons for the Exam
Esophageal manometry is very effective in evaluating the contraction function of the esophagus in many situations.

Preparation
The preparation for esophageal manometry is very simple. The patient should take no food or liquid for about eight hours before the exam. The physician will usually (although not always) want to study the esophagus in its natural state. In other words, there should not be any medicine in the body that can affect the function of the esophagus. The physician informs the patient what medications should and should not be taken.

The following drugs may affect the contractile pattern of the esophagus. They usually need to be discontinued at least 48 hours beforehand. Check with your physician about all your medications.

caffeine/coffee
Reglan (generic: metoclopramide)
Urecholine (generic: bethanechol)
Erythromycin (antibiotic - many brand names)
Nitroglycerin (Isordil, Nitro-Bid, others)
Calcium channel blockers (Procardia, Adalat, Calan, cardizem, others)
Betablockers (Inderal, Corgard, others)
Donnatol
Librax
Levsin
Tagamet (generic: cimetidine)
Zantac (generic: ranitidine)
Pepcid (generic: famotidine)
Axid (generic: nizatidine)
Prilosec (generic: omeprazole)
Prevacid (generic: lansoprazole)

The Procedure
The procedure takes about one hour from start to finish. While seated in a chair or lying on the side, thin soft tubing is gently passed through the nose, or occasionally the mouth. Upon swallowing, the tip of the tube enters the esophagus and the technician then quickly passes it down to the desired level. There is usually some slight gagging at this point, but it is easily controlled by following instructions. During the exam, the technician usually asks the patient to swallow saliva (called a dry swallow) or water (called a wet swallow). Pressure recordings are made and the tubing is withdrawn. Patients can usually resume regular activity, eating, and medicines immediately after the exam.

Results
To a layperson, the contractile pattern of the esophagus looks like a chaotic, wiggling line. However, the tracing has very specific meanings depending on how the esophagus contracts and exerts pressure through the tube into the manometry machine.

A normal pattern may be seen where the esophagus has regular, sweeping contraction waves and excellent function of the valve at the end of the esophagus.

A common abnormal pattern results when the lower esophageal valve is weak and does not close properly. This allows food and acid to reflux up into the food pipe.

Another abnormal pattern occurs when the esophagus has lost its normal sweeping waves. This condition is called dysmotility, and it means that there are ineffective, weak, or disorganized contractions. This pattern is often seen in older individuals.

Intense esophageal spasms may be found where severe pain originates in the esophagus. This pattern shows very intense contractions throughout the esophagus and may be accompanied by pain.

Finally, there is a condition called achalasia in which the lower valve is very spastic and tight and the body of the esophagus has weak contractions.

So there are a variety of findings possible. The physician reviews these findings with the patient and explains what they mean.

Benefits
The primary benefit of the exam is that the physician has clear documentation of the muscle function of the esophagus. With this information, a specific treatment program can be outlined or reassurance provided if the exam is normal.

Alternatives to Manometry
Nothing really takes the place of manometry. Other techniques that are used to study the esophagus include: upper GI x-ray series using swallowed liquid barium; fiberoptic or video endoscopy to visualize the inside lining of the esophagus; and a 24-hour probe left in the end of the esophagus to measure acidity as it refluxes from the stomach.

Side Effects and Complications
There are really no serious problems associated with manometry. Slight gagging is normal during the exam, and a temporary sore throat may be present afterward.

Summary
Esophageal manometry is a very valuable method of recording and evaluating the muscular function of the esophagus. The test is simple and quick to perform. With this information, the physician can usually develop effective treatment for most patients with esophageal muscle disorders.

Hope this helps,
Chicken Soup

[tessa0825]

Hi, I didnt realize you had went through an esophagectomy...Im so sorry you have had that, but, it must be a relief to not have this constant worry anymore.....May I ask about your post op recovery time and how long it took to regain your quality of life?......If you would like to email me my address is m_catarina***@**** care.........Tessa

[COB]

I'm a 39 yo female.For the past year when I eat food I feel it is getting stuck just after swallowing it. My doctor had me undergo an Endoscopy test. I was told that the muscle didn't appear to be working very well in my esophagus. After fasting the night before the test they found that the food in my esophagus was still there. I was told I now have to have a esophagus motility test , I think also known as a manometry . Has anyone had this test and if so is it uncomfortable, I was told I had to have it done awake. Also any info on this condition  Thanks .. COB

[JackieG]

Hi Tessa:

You certianly have enough life-changing events coming up to stress anyone out!  I am happy with your view on treatment choices if, heavean forbid, you progress to high grade dysplasia. I made the same choice in August, 2001, so obviously I think you decision is correct. I truly hope it never comes to that.

Good luck with your upcoming marriage!

Best regards,
Chicken Soup

[tessa0825]

Hi again, I forgot to mention there is no medium grade of dysplasia with barretts....you are either no dysplasia, low-grade, or high-grade....Thanks, Tessa

[tessa0825]

Hello, :)......Thanks for your advise and your concern.....Believe me I have researched Barretts esophagus and EC just about as through as it can be researched, Something I learned in college while earning my RN many yrs. ago.....As for my dysplasia, we are at an uncertain spot right now...I was initally diagnosed with low-grade....At last EGD, that set of biopsies showed some areas of high-grade...My GI Spec. sent everything off to another lab for a comparison...That path report came back conclusive for low-grade with no mention of high-grade...We decided to increase my meds. and work harder at getting the reflux back under control, we will repeat biopsies at a 3 month interval, which will happen in July....I will also, regardless of how biopsies come back, be evaluated at Cleveland Clinic later this summer....Am I feeling stress right now? WOW, you know I am.....Im not sure if this is a pro or a con, but I am also getting remarried on July 26th...I have biopsies on 22nd and wedding on 26th.....Be assured, I wont be having an esophagectomy unless I know I have high-grade..If that is the case then that is the treatment I will choose....PDT might be ok for some but I dont want it. To tell the truth, I would rather have the esophagectomy and be done with barretts esophagus and the constant worry of EC....What really bothers me is the stricture, I can only go about 4 weeks without being dilated....
BTW, I work as a district supervisor for lg. retail/grocery chain...I gave up nursing long time ago......I worked for 5 yrs. on adolescent physch...That did me in...When you go to work everyday and see 46 kids (age 8-17) doing the thorizine shuffle, just because it is easier on the medical profession, to keep them medicated than REALLY treat them, you burn out quick.......Take care...........Tessa

[JackieG]

Hi Tessa:

I was not saying Dr. Kevin had made a determination that EC was the cause of Alice Mae's problem. He merely mentioned it as one possibility. From the description of her situation, EC can virtually be eliminated as the cause of intermittent swallowing problems. I merely wanted to assure her of that, because sometimes when faced with several possible outcomes, we tend to focus on the worst-case scenario, which in her case would only lead to needless anxiety.

Now for your case --- What grade of dysplasia do you have (High, medium or low)? You may want to consider Photo Dynamic Therapy ("PDT"), or even an esophagectomy while you still only have dysplasia. If it progresses to EC, you'll need the esophagectomy anyway, along with chemo and radiation, and once it progresses to cancer, the 5-year survival rates get pretty dismal. An esophagectomy now could rid you of that risk permanently.

I know it is a difficult choice, but hopefully you'll discuss it with your gastroenterologist.

Let me know if you need information....

Best regards,
Chicken Soup

[Alice Mae]

Thank you for your replies.  I now realize I need to see my doctor.  I forgot to mention in my question that I am 30 years old, and the mom of three small kids, so I truly hope "Chicken Soup's" reply is my scenerio. Txs

[tessa0825]

Hello, I also have swallowing problems and have had them for quite awhile now....I have Barretts esophagus with dysplasia and my swallowing is caused from strictures, that is one of the possibilities Dr. Kevin talks about......I have been having mine dilated alot recently and my barretts (esophageal precancer) seems to be unfortuanately progressing....I dont think Dr. Kevin was saying he thinks you have esophageal cancer,  he was just explaining all the possibilities....I am 50 yrs old and "female" at my last EGD I had some areas that were read as high-Grade dysplasia....If that is the case at a 3 month, (july) new set of biopsies then I already know Im in trouble.........My biggest complaint is food sticking and choking and sometimes pain that is SO BAD it completely inhibits swallowing..........This is not a fun illness and I agree you probably dont have EC but you do need to be evaluated and find out what is causing this problem...Good luck........Tessa

[JackieG]

Hi Alice Mae:

Your problem is almost assuredly not esophageal cancer ("EC"), which the doctor included in his reply as one possibility. EC is rare, with only 12,000 newly diagnosed cases per year in the US, out of a population of roughly 290,000,000. In addition, approximately 80% of all EC patients are male. More importantly, while swallowing difficulty is the classic symptom of EC, it is caused because a tumor has begun to obstruct the esophagus. This would not cause swallowing difficulties associated with stress, but rather would be a recurring problem.

Having said that, you should follow the doctor's advice and see a gastroenterologist, so you can see if there is a phsysical cause for your problem. I just didn't want you to be left with the impression that its esophageal cancer. It isn't, and you should not stress yourself out between now and the time you see the gastroenterologist worrying about EC.

Best wishes,
Chicken Soup

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note episodic dysphagia (problems swallowing).  There are many causes for this, including an esophageal obstruction (esophageal cancer, esophageal ring, peptic stricture) or motility disorder (i.e. esophageal spasm, scleroderma, achalasia).  Motility disorders may have an association with stress.  

The first test I would suggest would be a barium swallow to determine if there is any deficit in the swallowing mechanism.  Depending on what is found, your physician may then opt for an upper endoscopy for further evaluation.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.