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Ask Dr. David Your Own Question
Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45993
Experience:  Board Certified Physician
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Dear doctor I am suffering from jackhammer effect from lower

Customer Question

Dear doctor'
I am suffering from jackhammer effect from lower and upper osephagus. I am living with indescribable pain day and night. What are the treatment options as medication not efective
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
Dr. David :

This is Dr. David

Dr. David :

I am sorry you are having this bad jackhammer esophagus.

Dr. David :

you should ask your doctor to try imipramine which could help.

Dr. David :

diltiazem can help

Dr. David :

Nitrates also have been used with some success, like nitroglycerine or isosorbide dinitrate.

Dr. David :

hello?

Dr. David :

Sildenafil is a smooth muscle relaxant that can lower lower esophageal sphincter pressure and spastic contractions

Dr. David :

it doesn't sound like you have tried these medications.

Dr. David :

Zotrole is lansoprazole which is a proton pump acid blocker of the stomach

Dr. David :

your stomach pH levels are ok, so acid is not causing the problems.

Customer: Unsure if you received the additional information. Initially prescribed tranadol 50mg but had adverse reaction subsequently prescribed by trans patch and symptoms improved. I have had oesophagel manometry and 24 hr pH monitoring - no symptoms of acid reflux. Had further high resolution oesophegal manomrtry which indicated problems with both spincters. I also have hiatus hernia. Apart from medication, what agree the surgical possibilities which is what my initial question was
Customer: none of the medications you discuss have been suggested by my consultant
Dr. David :

you should talk to your consultants about these medication treatments first

Dr. David :

before any surgery.

Dr. David :

you can read more about medication treatments here.

Dr. David :

http://emedicine.medscape.com/article/174975-treatment

Dr. David :

if you are narrowing of your esophagus or achalasia, balloon dilation could help

Dr. David :

if there is an area where the muscles of the esophagus continue to cramp, botox injections directly into the wall of the esophagus could help for 3-6 months.

Dr. David :

surgical options are only left for the most extreme cases.

Dr. David :

which have failed all of the above treatment options.

Dr. David :

Myotomy, where the esophageal muscle is cut out, is effective for treating diffuse esophageal spasm. The myotomy should extend the entire length of the involved segment

Customer: OK. Thank you. I have been prescribed zotrole and adalat but no real success...professor that I'm under says what I have is rare. And they are now looking to a surgical resolution.
Dr. David :

I see.

Dr. David :

I would ask to try imipramine first

Dr. David :

and also nitrates and Sildenafil

Dr. David :

and a calcium channel blocker

Dr. David :

like amlodipine before doing surgery.

Dr. David :

these medications could help much more than your medications you have tried so far.

Dr. David :

surgery is always the last resort.

Dr. David :

once you do surgery, you can't go back.

Dr. David :

best of luck to you.

Dr. David :

let me know if you have other questions.

Dr. David :

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Dr. David :

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Dr. David :

http://www.justanswer.com/medical/expert-dr-david/

Dr. David :

is my website if you need to reach me again.

Dr. David :

thanks for using JustAnswer.com

Dr. David :

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Dr. David :

http://ent.about.com/od/entdisordersaz/fl/What-is-Jackhammer-Esophagus.htm

Dr. David :

you can read more there as well.

Dr. David :

hello?

Customer: Thank you so much. I will bring your suggestions to my care team. Thanks again
Dr. David :

you are welcome

Dr. David :

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Dr. David :

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Dr. David :

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Dr. David :

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