Question: Hi - I've been diagnosed with 6cm Barrett's esophagus which shows no dysplasia after two endoscopic procedures six months apart. No strictures were found but I have swallowing difficulties still six months after sudden onset of the dysphagia during a flu virus in October of 2013. I've been through several tests including barium swallow and video fluoroscopy, gastric emptying scan, and the endoscopy sessions, along with nerve conduction and electromyelography when it was suggested that the dysphagia may be neurological. All tests have come back normal. At this point I'm simply at a loss as to what could be causing the dysphagia. It's not that I cannot swallow at all - the food simply feels as if it's sticking before passing into my esophagus. It doesn't happen every time or with all types of food. Saliva can sometimes be difficult also. I started having quite a bit of anxiety as a result and my primary prescribed Xanax, which I'm taking .5 mg of twice a day. It seems to help a bit but not always. Because Xanax has antispasmodic effects I'm starting to feel that the problem may be something like cricopharyngeal spasm or some kind of laryngeal hypersensitivity, but I cannot seem to get my doctors to listen long enough to investigate this. I'm having a hard time buying that this is anxiety-driven, as it came on suddenly during the flu and I had no anxiety prior to this issue. I apologize for rambling but this is a frustrating problem for me and I'm just looking for answers. Any information and advice is greatly appreciated. Thank you.

Hi Dr. Kuttikrishnan, Thank you for your time and response. I was given three different PPI medications over the course of a few months: omeprazole, lansoprazole, and dexlansoprazole. Due to terrible side effects (e.g., nausea, stomach cramping, dizziness, headaches, etc...), I could not take any of them and eventually switched to taking H2 antagonists like famotidine. These may not be as effective at acid control, but they seem to have no side effects for me. I've also switched to a low-acid diet and stopped eating grains of any kind, as they seem to be a reflux trigger for me. The new diet is helping and I've lost quite a bit of extra weight in the past five months or so (around 40 pounds). My main concern with the dysphagia is the sudden onset during a flu viral infection last year and the fact that it has lingered for almost six months after. I started doing some research and learned about post viral vagal neuropathy (PVVN) and laryngeal hypersensitivity (LH), both of which are also helped by antidepressants/antispasmodics like amitryptiline (Elavil) and Xanax. I'm not sure that PVVN or LH have anything to do with my condition and ultimately it may just be anxiety as you noted. But rather than remain on a benzodiazepine like Xanax for too long, I'm planning to discuss a different option with my primary physician. One other question I have is related to ablation therapies for Barrett's esophagus. My gastroenterologist says that when there is no dysplasia, the usual protocol is not to ablate. But I'm reading journals and other sources that are indicating this treatment can and possibly should be done even in nondysplastic cases - for example: Sampliner, R. "Management of Nondysplastic XXXXXXX Esophagus with Ablation Therapy", in Gastroenterology & Hepatology Volume 7, Issue 7 July 2011 XXXXXXX V., et al, "Balloon-Based, Circumferential, Endoscopic Radiofrequency Ablation of Barrett's Esophagus: 1-Year Follow-Up of 100 Patients", in Gastrointestinal Endoscopy Volume 65, No. 2: 2007 There are other papers available as well that indicate some usefulness in this approach. But I would also like your opinion on this as well, please. I'm not sure if my insurance would cover the procedure in a case like mine that might be deemed medically unnecessary. But my personal view is that if one can eradicate Barrett's early on before dysplasia and then make appropriate dietary and lifestyle changes to prevent it from recurring in the future, it seems worth the effort. Thank you again for your time and assistance.

Hi, Thank you Dr. Kuttikrishnan. I will definitely look into yoga - two of my friends are Bikram style yoga students and they go to a center that is little more than 5 miles from my home. I believe it can help me and will take your advice. Best regards and have a nice day!