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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64288
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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Can weak Perisatalsis made worse by reflux cause an impairment

Resolved Question:

Can weak Perisatalsis made worse by reflux cause an impairment to LES opening/relaxation, and if you treated the reflux can peristalsis return
Submitted: 2 years ago.
Category: Medical
Expert:  DrRussMD replied 2 years ago.
Hello
First of all, define what symptoms you are talking about when you say weak paristalsis, then I might have an answer for you
Customer: replied 2 years ago.
HI, I was diagnosed with small hiatal hernia 2cm and weak reflux going into throat in April 2012, 94 episodes of impedance and weak reflux with 22% going into throat causing upper dysphagia. Then my peristalsis was 54% intact with DCI mean 1169 mmHg and distal amplitude 65mmHg relaxation 40%, tertiary contractions lower third.
Now peristalis varies from 100% weak supine, with DCI 410 mmHG and perisatatic breaks 6.7 relaxation 26%' to sitting upright! peristalsis 31% intact! DCI 1816 mmHG distal amplitude 84mmHg, peristaltic breaks 3.5' relaxation 40%
Esophagus now slow to empty OES body duration 6 seconds, and I can feel food and fluid dribble down and spasm through the LES it's agony.
I am having a lot of TSLERs and when I take a drink when refluxing fluid goes straight through.
So is it - weak peristalis that has caused an impairment of the LES opening or is it the spasms that are causing the impairment
Can treating the reflux restore the peristalsis, or with weak Perisatalsis is a myotomy with fundo a better solution?
Expert:  DrRussMD replied 2 years ago.
They are not necessarily related.
In fact, it is more likely the reflux that is causing weak peristalsis, as part of GERD.
The LES problem is probably the preceeding cause.
Treating the reflux might improve the peristalsis, in fact.
The myotomy with fundo is only a solution if maximal and lengthly medical treatment fails.
OK, so that is an initial answer….
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Customer: replied 2 years ago.
What type of surgery if any is possible when the esophageal body is now so slow to empty and the LES is not relaxing properly?
Expert:  DrRussMD replied 2 years ago.
Fundoplication.
However that is not indicated by anything you have stated at this point.
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Customer: replied 2 years ago.
I thought you could not have a fundoplication when you have poor relaxation and your DCI is less than 500mmHg
Expert:  DrRussMD replied 2 years ago.

I don't think so, not with myotomy:

Who told you that?

Customer: replied 2 years ago.
No, to fix the reflux problem with a fundoplication not a myotomy - I thought you could not have one if your peristalsis was so poor?
Expert:  DrRussMD replied 2 years ago.
myotomay with fundo would typially be a solution.
However, it seems to me that you are anticipating problems.
Medical treatment should be done for a full year, or longer, before considering such surgery, unless there is an intractable problem, and the presence of barrett's esophagus.
I would focus on that at this point.
OK, so that is an initial answer….
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Customer: replied 2 years ago.
I would respectfully ***** ***** I already have now a major problem, when it is excruciating to swallow any liquid or food and even when I swallow my own saliva there is spasming pain at the LES.
Would endostim be feasible at this point to restore peristaltic function or has it gone beyond repair now at the les?
Expert:  DrRussMD replied 2 years ago.

I would try it. In this situations, it has to be tried to see if it helps. You would help the reflux. How long and how much the peristalsis would be helped, would be a guess. A doctor that has used this modality in a lot of patients would be needed to assess you and your chart. In person.

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