Resolved question:
I had an esophagram today. I was found to limited primary peristalsis in the upper thoracic esophagus, and failure of secondary peristalsis. A few tertiary contractions were observed i the distal thoracic esophagus. They said I had granular mucosal with mildly thickened folds. It may be indicative of reflux esophagitis given theat there was a demonstration of refluc to the level of the upper thoracic esophagus during the exam. There were no esophageal strictrures or mass examined. I am in my 40's, and otherwise fair health. I have a GERD issues with bronchitis, etc. I wonder is this necessarily something very bad or could it be something that is easy to treat or palliative, and where I can have a normal life?
Lastly, how should I follow this up? I was going to an ENT, is an ENT able to handle this? Should I go to a GI? Do you see this as a potential event that I should hastily take care of?
See below:
DIAGNOSTIC RADIOLOGY - Jun 22 2015 2:58PM - BARIUM SWALLOW/ESOPHAGUS
CLINICAL HISTORY: Dysphagia
FLUOROSCOPY TIME: 1 minute, 5 seconds.
COMMENT: An esophagram was performed following the patient's video speech
pathology exam. There is limited primary peristalsis in the upper
thoracic esophagus and failure of secondary peristalsis. A few tertiary
contractions are observed in the distal thoracic esophagus. The esophagus
demonstrates a granular mucosal with mildly thickened folds. This is
probably indicative of reflux esophagitis given demonstration of
gastroesophageal reflux to the level of the upper thoracic esophagus
during the exam. There is no esophageal stricture or mass at this time.
IMPRESSION:
1. Gastroesophageal reflux.
2. Pronounced esophageal dysmotility. It is not entirely clear that this
is secondary to the patient's gastroesophageal reflux disease.
Transcribed by: n/a : Jun 22 2015 3:35P
Dictated by: DONALD G SAMUELSON M.D.: Jun 22 2015
3:35P
Dictation signed by: DONALD G SAMUELSON M.D.: Jun 22 2015 3:39P
CPT Code: 74220
Submitted:
4 Days
Category:
Gastroenterologist, Medical
Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Your reports confirm GERD with reflux esophagitis.
I will suggest you meet a medical gastroenterologist who is better suited to handle this case.
The long standing GERD is the most likely reason here to be reflux esophagitis. The persitalsis is slow, which could also preogress to gastroparesis. Are you a diabetic? Long standing GERD also causes asthma.
I will advise you Medications like PPI along with prokinetics may be taken for relief ( For example - esomeprazole along with levosulpiride).
This should reduce your GERD as well as prevent further esophagitis.
Feel free to discuss further,
Regards.
Are you a GI doctor? Is there a chance that periostalisis will return, if the esophogitis is treated? Is there a relationship of Esophogitis to the periostolic muscles not working properly? Is this Acalasia? If normal periostalisis can return, is there a good chance? Also, I am not a diabetic, but I do also have Gout which was not mentioned.
Regards,
Mike
Hi,
The peristalsis issue is not related to esophagitis. It is due to motility disorder. That is the reason I want you to get a manometry done. It will let you know whether it achalasia or other motility issues.
Please get back to me with the manometry report.
Regards,
Dr.R.K.