Question: Hello, I have been suffering from dysphagia for a little over a year, with solid food. I’ve had several tests, barium X-ray swallow, gastroscopy, detailed swallow analysis by a speech language pathologist, 2 MRIs, and most recently, esophageal manometry. The MRIs showed a small lesion on the left side of the pons, and “a few scattered nonspecific focus of increased T2/FLAIR signal within the supratentorial periventricular white matter that are stable. These may reflect mild chronic microangiopathic ischemic white matter changes.” I got the manometry report today, and my gastroenterologist was stumped. It showed mid respiratory resting pressure of the XXXXXXX slightly elevated, incomplete relaxation of the lower esophageal sphincter with the median IRP elevated. A pressure zone with rapid fluctuations of pressure is seen just above the XXXXXXX suggestive of cardiac or vascular artifact. 11 liquid swallows were obtained. Four demonstrated abnormal contractions with simultaneous or premature contractions. The other seven demonstrated normal paristalsis. With a challeng of bread swallows there were more abnormal contractions noted. Of the six bread swallows, four demonstrated a pattern of simultaneous or premature contractions. With impedance studies, it looked like there is good exit of the liquid bolus in the majority of swallows. Even though there was residual pressure in the XXXXXXX it could be seen that there is enough relaxation that the liquid bolus does pass easily through the XXXXXXX Upper Esophageal Sphincter: the resting UES pressure is elevated at 184 mmHg. There is a relaxation of the UES but it does appear that the interval of time for the complete relaxation is very short. The clinical significance of this is unknown.” Impression: This is a difficult study to interpret. I hesitated to report it until I had a chance to review it at the McMaster Motility rounds. All reviewers agree that this motility study does not fit into any recognizable pattern. Whereas most of the swallows appeared to be peristaltic and functional, there were clearly a few abnormal esophageal motility demonstrated, especially with the bread challenge, the functionality of the esophagus appears impaired at times also. Because the majority of swallows are peristaltic even with incomplete relaxation of the XXXXXXX it does not fit the criteria for achalasia. Early or evolving achalasia cannot be excluded. Some kind of spastic motility disorder is potentially suspected.” My question is this: because they couldn’t determine a diagnosis, is there a higher probability that I may have a neuro-motor disease? I’m frightened of ALS, and have a few other symptoms: muscle twitching, and vocal changes..loss of vocal range in singing, a bit of hoarseness. The speech language pathologist noted neck muscle straining in my normal speech. But since I’ve had dysphagia for more than a year, with no corresponding muscle weakness, does that point away from ALS? Also, should the MRI results be a cause for concern? I am trying to follow up with my neurologist, but it can take months to get an appointment. I have an anxiety disorder, so please keep this in mind as you respond. Much appreciated.

Thank you for your answer, I found it very reassuring.