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DEAR MAYO CLINIC: A recent manometry test indicated that I have very low upper esophageal sphincter resting pressures. I have esophageal discomfort and spasms in my chest. My doctor says it is probably caused by age (I am 74) and that nothing will help. Is there something that can be done?
The discomfort you’re having could be caused by age, but you may need some additional investigation to confirm that. Even if your condition results from aging, you can take steps that may help relieve your symptoms.
The esophagus is the tube that connects your mouth to your stomach. When you swallow, the circular band of muscle at the back of your throat (upper esophageal sphincter) relaxes and allows food and liquid into the tube. Muscles in the esophagus move in waves to push food downward, through a second relaxed ring of muscle (lower esophageal sphincter), and into your stomach. At rest, the esophageal sphincters are closed (contracted) to keep the esophagus clear. Problems that cause pain and discomfort can result if the lower esophageal sphincter relaxes abnormally or weakens.
Manometry measures pressure and assesses the effectiveness of your esophageal muscles when you swallow. Low resting pressure in the upper sphincter, as in your situation, isn’t a sign of disease. However, you may want to confirm with your physician that the upper, not the lower, sphincter had low pressure and that your manometry results didn’t reveal other abnormalities.
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If manometry shows low pressure in the lower sphincter, gastroesophageal reflux disease (GERD) may be to blame for discomfort. Stomach acid or bile flows back (refluxes) into your esophagus through a weakened or malfunctioning lower sphincter. Many esophageal problems are caused by GERD. In rare cases, low pressure in the lower sphincter could indicate scleroderma, a progressive disease that leads to hardening and tightening of the skin and connective tissues. Manometry can reveal motility disorders, such as achalasia, where the muscles within the esophagus don’t properly pump food down through the esophageal tube. Manometry can also show esophageal spasm where much of the esophagus contracts at the same time. Esophageal spasm is a rare condition and a rare cause of the common symptom of chest pain.
You don’t mention if you’ve had other diagnostic tests. Usually one of two tests, a barium swallow or an endoscopy of the upper gastrointestinal tract, is performed prior to manometry. If you haven’t had either of these tests, I recommend you ask your doctor for one of them.
A barium swallow uses a series of X-rays to examine your esophagus. During upper endoscopy, your doctor examines the inside of your esophagus and stomach using an endoscope — a thin, lighted tube with a tiny camera on the end that sends images to a TV monitor. These tests can reveal problems such as inflammation, narrowing (stricture), Barrett’s esophagus or cancer. If tests find an underlying condition, treatment for that disorder may provide relief.
Certain medications, such as alendronate (Fosamax), potassium, and some types of antibiotics, could lead to esophageal inflammation (irritation) and contribute to your condition. If you take medications, review them with your doctor to see if changes might help to decrease your symptoms.
If no other underlying cause can be found, the source of the problem may well be presbyesophagus. With presbyesophagus, the strength and coordination of esophageal muscle contractions decrease with age. Over time, a person’s esophagus may not work quite right. Dietary changes can make a difference. Eating dry foods, such as bread, often worsens symptoms. Chewing food carefully and keeping food moist by drinking plenty of liquids while you eat can help prevent discomfort. — G. Richard Locke III, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester.
E-mail a question to medicaledge@mayo.edu or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.
