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Facing difficulty in swallowing. X-ray showed hiatus hernia and schatzki's ring. Is this related to esophagus problem?

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Practicing since : 1962
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I am seeing a GI doctor and my GP for bad swallowing issues. X-rays were done and it appeared to be a "filling defect" at C3/C4, small hiatal hernia and a small area of localized thickening just above the GE junction involving the anterior wall and a mild Schatzki's ring. An endoscope was attempted but I had a reaction to the sedation and they had to stop the procedure because apparently I was fighting them. The GI doc then said it would have to be performed under full sedation however he wanted me to see a doctor at a larger hospital in case there were complications (perforation due to the narrowing). That was yesterday he said this so today was going to contact my GP for a referral to another GI. The swallowing issues have been on and off for years but this time they are severe and involve liquids too which never occurred before. It's been going on 4 months and I have lost 20 pounds. I had been constipated and not gone to the bathroom for 3 days (today is the 4th) took Miralax yesterday and went this morning with some pain at one point to get a firm section through the rectum. When I went to flush I seen blood at the end of the stool. It wasn't just a little nor was it a lot but a red very noticeable amount. I am now waiting to hear from my GP to call back and I am having severe anxiety due to this new issue. Is this something to worry about or could it possibly just be from not having gone for a few days. I just started Prevacid 30mg twice daily. I am a nervous wreck!! I did save a stool sample and put in freezer. Could this be an isolated incidence or does it have to be related to the esophagus problem? By the way, I also ate about 1/8 cup of shelled sunflower seeds yesterday alo if that may have any bearing. Thanks and I hope you can reassure me :)
Posted Tue, 30 Oct 2012 in Digestion and Bowels
Answered by Dr. Charles S Narasi 2 hours later
Your history is very striking as to the details you have provided.
Since you have had difficulty swallowing for a fairly long time
and you mention Hiatus hernia and Schatzki's ring and abnormal
wall thickening at the junction of esphagus and stomach, you
obviously have damage from long standing acid reflux.
Initially there is irritation and inflammation due to acid reflux.
If this goes on for a number of months or years, normal lining
of the espphagus changes to a different type of lining containing
abnormal cells. This , we call it Barrett's esphagus which is a
pre-cancerous condition, and leads to cancer of the esophagus.
This can be seen on endoscopy , but only way to tell about the
abnormal cells in the lining is by biopsy and examination by a
good pathologist. There are what we call grades of dysplasia.
(Degree of abnormal cells) From no dysplasia to, mild, moderate
and severe dysplasia. The severe the degree, chances of cancer
increases. It is possible to bleed from ulcers in that area. Usually
unless the bleeding is brisk, the blood will turn black when passed
in the stool. I think , in your case, from your history of constipation,
hard stool probably irritated a hemorrhoid (Internal or external)
and caused the bleeding.ther possibility is fissure or a crack in
the lining at the end of the rectum (Like a tear) that could bleed
from straining.
You definitely need an endoscopy and possibly under supervision
of an anesthesiologist and a experienced gastroenterologist who
can do the procedure carefully and take necessary biopsies.
Further care depends on the findings.
I really wish you the very best.
p.s: I don't think sunflower seeds had anything to do.
Above answer was peer-reviewed by
Follow-up: Facing difficulty in swallowing. X-ray showed hiatus hernia and schatzki's ring. Is this related to esophagus problem? 1 hour later
Dr. Narasi,

Thank you so much for your detailed answer. I do think myself (after calming down a little lol) the blood may have had to deal with hemrroids since even though the stool was relatively soft, there was a small firm part that caused pain during passing and I did have a little pressure on my rectum afterwards. I am hoping at least and when my GP called back he said he was not in the least bit concerned about the blood.

In regards to my swallowing issue, I never knew I had acid reflux (I did not suffer from symptoms) and was never told. A year ago my doctor had prescribed famotidine for a possible ulcer but because he never mentioned much else, I like a dummy never took the medicine. Maybe I could have spared myself the nightmare I am experiencing now with the swallowing difficulties if I had. Hind site is 20/20 they say. I have had swallowing issues on and off since I was around 20 yrs old (50 years young right now). It would last awhile then get better. Then 8-10 years later it would happen again. I also went through a period of feeling like there was something stuck in my throat during this time. I can't recall the test results from years ago except once I was told I didn't have acid disease and another time they felt it was from MS. Anyways, liquids were never really a problem even though I could never gulp down a glass of water. Three years ago when this occurred agin, test results showed the right side of my esophagus did not perform as needed and the SP told me to always turn my head to the right when swallowing (which did seem to help). In awhile it went away as usual and i was bak eating steaks and salads This time it is far worse and liquids are very difficult to swallow too. Somedays are better than others but not much. My doctor (after he seen the test results) keeps assuring me that it isn't cancer and to put it out of my head. He stressed how important it is for me to have the scope done to find out what the issue is to get it corrected. Of course I only think cancer and hate the words "filling defect" because I cannot find anything in the Internet that doesn't connect those words with tumor. Well actually there was some reference to scarring but I thought it was kinda high for that (C4/C5 location). The test reports say "possible scarring or Barrett's Esophagus" under the impressions section but also say the defect could be extrincit. Can a filling defect not be something fatal?
Answered by Dr. Charles S Narasi 3 hours later
Scope is extremely important to find out exactly what
is there at the junction of esophagus and stomach
The filling defect you mentioned earlier was at C 3-4
Level.That is too high.It may represent something
totally different like retained food etc.When they
say the defect could be extrinsic that means pressure
from outside,like spine(Bone spurs).
Please have the scope done and get the answers.
Wish you the very best.
Above answer was peer-reviewed by
Follow-up: Facing difficulty in swallowing. X-ray showed hiatus hernia and schatzki's ring. Is this related to esophagus problem? 1 hour later
Waiting for the referral call from my doctor to see another specialist to have it done. The gastro doctor I seen said the thickening was probably due to the GERD
I am sorry, my GP doctor may have been the one to say that. So confused because i am suffering from severe anxiety thinking I am dying of cancer. This started in June/july and I still don't have answers. None of the doctors seem to be treating this with the urgency it may need. With my neuro, that is 3 doctors who are aware of my condition. My GP had the first two tests done right away. Thanks again for your knowledge. I should have stopped with just one question cuz even though the bone bur possibility feels better your apparent concern of the thickening has sent me into another panic frenzy lol
Answered by Dr. Charles S Narasi 11 hours later
The thickening could be scar tissue, but as I have been
saying, only direct look and biopsy of that area will give
us the answers.
Wish you the very best and God bless.
Above answer was peer-reviewed by
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