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Can esophageal motility disorder or hiatus hernia cause persistent vomiting?

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Posted on Tue, 3 Oct 2017
Question: Hello, in the past few years I have developed a worsening condition of esophageal motility disorder. In 2015 a GI said I had a hiatus hernia, in 2016 a different GI said he saw nothing and it was all in my head. I basically throw up 90% of what I try to eat or drink. It's not temperature or texture related, I take maybe 3 bites, my throat feels like its closing and I vomit. I used to drink up to 5 litres of liquids , now I can't manage 1/2 of 1. I also have genital herpes since childhood. I've seen 2 GI specialists with differing opinions, I tried the esophageal manomytry test but couldn't get the tube down (I kept throwing up). Could there be a possible link between the herpes which is neurological and the esophageal constrictions?
doctor
Answered by Dr. Ramesh Kumar (26 minutes later)
Brief Answer:
can be anorexia nervosa kindly attach endoscopy report with follow up.

Detailed Answer:
Hello,
Thanks for query dear patient.
I have gone through your details and i can very well understand the level of frustration you must be having right now.

Please don't panic and rest assured and go through proper investigations to rule out the primary cause so that it can be treated.

As per your query yes there is a hypothesis that cells in the myenteric plexus(muscles of esophagus) of patients with achalasia may be activated by herpes simplex virus type 1 infection.Though it can't cause it but it can increase problem in patients with achalasia.
Achalasia is a failure of smooth muscle fibers to relax, which can cause a sphincter(at junction of food pipe and stomach) to remain closed hence patient has difficulty in swallowing food and water; esophagus is the tube that carries food from the throat to the stomach. Achalasia affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your XXXXXXX fails to open up during swallowing, which it’s supposed to do. Intense pain and difficulty in swallowing is one of the main feature of achalasia.If not treated properly this condition can cause carcinoma of esophagus also.

please attach report of endoscopy i want to see it.Before labelling it as something related to brain(anorexia nervosa) i want to go through all your reports.

In case you have any more query please revert back as follow up.

Wish you a great luck
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar (1 hour later)
I do not have copies of both endoscopies. My dr has them. And I have the genital herpes virus, type 2.
doctor
Answered by Dr. Ramesh Kumar (17 hours later)
Brief Answer:
Can be a variant of panic attack or Obsessive compulsive disorder.

Detailed Answer:
Hello again,
As endoscopies are normal my dear friend most likely your symptoms are related to anxiety disorders i.e it can be a variant of anxiety disorders explained below.
Please don't panic these conditions can easily be controlled by proper treatment and patience.
Panic disorder is a serious condition that can strike without any reason or warning Over time, a person with panic disorder develops a constant fear of having another panic attack, which can affect daily functioning and general quality of life.Most of the symptoms of a panic attack are physical, and many times these symptoms are so severe that people think they are having severe disease however all reports turns up to be normal.Although the exact causes of panic attacks and panic disorder are unclear, the tendency to have panic attacks runs in families. There also appears to be a connection with major life transitions such as graduating from college and entering the workplace, getting married, and having a baby. Severe stress, such as the death of a loved one, divorce, or job loss can also trigger a panic attack.

Obsessive Compulsive Disorder (OCD) is a disorder, which causes anxiety, and is also known as anxiety disorder. The disorder is featured by continuous, uncontrollable and unpleasant thoughts. OCD causes a patient’s mind to get stuck on a certain inclination. Obsessive thoughts and compulsive behavior patterns indicate OCD.

It's NOT CAUSED BY HERPES TYPE 2 VARIANT.
Therapy with SSRI'S should be started unde guidance and supervision of Pyschiatrist or Neurologist.


Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Ramesh Kumar (31 minutes later)
I am under the care of a psychiatrist and have been for over two years. As per my depression/anxiety, I take 300mg sr wellubutrin, 10mg of Cipralex, 50 mg of Trazadone, 50 mg of Seraquil and 1 mg of Clonazapam. The first 2 in the am and the last three in the pm. I take a daily 500 mg of valcyclavir. I do have random panic attacks but not like you've suggested above... I believe I am mildly OCD, but not obsessively so. I was just trying to determine if my herpes 2 was in any way related to the esophageal motility disorder.
doctor
Answered by Dr. Ramesh Kumar (3 hours later)
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again dear,
As per you query my dear patient no herpes 2 strain has not been found to be associated with any motility disorder of esophagus.

So you are clear from gastroenterology side dear.

You are on two SSRI
1 Anti psychotic and 1 antidepressant so can you plesae rate your progress in last 2 years on a scale of 10.

Waiting.
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Ramesh Kumar (1 hour later)
With one being the worst and 10 being the best, I have gone from a ten to a negative. Each morning when I take my meds, I invariably throw up the water. Actually, I feel the sensation to expel and I just open my mouth and the liquid pours out, sometimes through my nose. When I'm eating, after the 3rd or 4th bite (which I chew slowly and completely) I again feel the sensation and will vomit into my mouth, back and forth as I run to the toilet. Everything seems to be heavily coated, encased almost, in a thick layer of mucous. My eyes water excessively and my nose runs. Most of the time, actually more often than not, I get a deep pain just above my breast bone. I experience wretched heart burn because my stomach is empty.
For the depression and anxiety, I've been moving forward. I still have random anxiety attacks and have days where I'm not my happiest, but I believe that is to be expected. And I have been on these 2 SSRI's for over 2 years.
doctor
Answered by Dr. Ramesh Kumar (20 hours later)
Brief Answer:
Have your doctor ever considered cyclic vomiting syndrome

Detailed Answer:
Hi again,

It can be CVS!
Cyclic vomiting syndrome (CVS) is an uncommon disorder affecting both children and adults and characterized by recurrent, episodes of severe nausea and vomiting. The associated nausea and vomiting can be severe enough to incapacitate the individual who may be unable to walk or talk and/or be bedridden. The hallmark of cyclic vomiting syndrome is recurrent episodes of severe nausea and vomiting. The nausea and vomiting that characterize these episodes are often quite severe. Unlike most other gastrointestinal disorders, the vomiting in CVS does not typically relieve the nausea. This is very often confused with confused with a psychogenic cause.Researchers have found a strong relationship between CVS and migraines, and some theorize that CVS is a migraine variant.Additional factors that may be associated with the development of CVS include dysfunction of the autonomic nervous system. The autonomic nervous system is the system that controls or regulates certain involuntary body functions including heart rate, blood pressure, sweating, the production and release of certain hormones, and bowel and bladder control. Autonomic “functional” disturbances are common during episodes.GERD may occur along with CVS, especially among adults. Thus, nausea from GERD can be present between vomiting episodes. However, if both GERD and CVS are present, during vomiting episodes the nausea is particularly intense, and then returns to its previous lower baseline between episodes.


Before declaring you as a pyschogenic patient have your gastro ever told you about this rare condition?

Waiting!
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Ramesh Kumar (8 hours later)
No neither gastro mentioned it at all. But I don't feel nauseous. It's almost like whenever my throat feels anything trying to enter it, it constricts, spasmically. And, since I couldn't complete the manometry test, my gastro said he didn't have enough information and there fore couldn't help me. ????? I am seeing my family doctor on Tuesday so I can ask him but he, like the others , have climbed aboard the "it's all in your head" train. This whatever this is has caused me to be quite lethargic, I've lost weight, I am not getting the proper vitamins and mineral into my body. If I don't act on my coffee energy in the morning, simple things like doing the dishes are taxing.
doctor
Answered by Dr. Ramesh Kumar (16 hours later)
Brief Answer:
follow up.

Detailed Answer:
My dear patient i know that most of your doccters have labelled the cause as pyschiatric in origin.Big problem with rare disorder is that most of the doctors are not well versed in dealing with such patients and often labelling them as pyschiatric is the best way out.

However after being on 4 pyschatric medicines you are not relieved.I don't feel its related to brain only.

Its not necessary that all symptoms are present always in every patient.
Though your symptoms are quiet random yet most likely they are not related just to brain.
Talk about the syndrome i explained to you earlier yo your GP and ask him to evaluate you on lines of that
Thanks!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Ramesh Kumar (3 hours later)
I want you to know how very heartened I am with your willingness to help me. I am very grateful for your correspondence. I will definitely talk to my gp about the CVS. Are there any tests that can be run to better determine this? I have had an ultrasound for thyroid and the soft tissue of my neck where the technician revealed that I have a very pronounced esophagus. I'm not sure what that means. Again, I am very grateful for your help.
doctor
Answered by Dr. Ramesh Kumar (18 hours later)
Brief Answer:
Follow up answer.

Detailed Answer:
Hey,
Cyclic vomiting syndrome is difficult to diagnose. There's no specific test to confirm the diagnosis, and vomiting is a sign of many conditions that must be ruled out first(already done in your case).
So a Ct scan abdomen should be done and you should try once again for manometry. In case both these tests turns up to be normal you could be given a trial 3 months therapy for CVS.
Follow up with reports of CT.

Hope i was helpful dear patient.
Wish you a great luck and a happy life ahead.



Above answer was peer-reviewed by : Dr. Kampana
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Dr. Ramesh Kumar

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Can esophageal motility disorder or hiatus hernia cause persistent vomiting?

Brief Answer: can be anorexia nervosa kindly attach endoscopy report with follow up. Detailed Answer: Hello, Thanks for query dear patient. I have gone through your details and i can very well understand the level of frustration you must be having right now. Please don't panic and rest assured and go through proper investigations to rule out the primary cause so that it can be treated. As per your query yes there is a hypothesis that cells in the myenteric plexus(muscles of esophagus) of patients with achalasia may be activated by herpes simplex virus type 1 infection.Though it can't cause it but it can increase problem in patients with achalasia. Achalasia is a failure of smooth muscle fibers to relax, which can cause a sphincter(at junction of food pipe and stomach) to remain closed hence patient has difficulty in swallowing food and water; esophagus is the tube that carries food from the throat to the stomach. Achalasia affects your esophagus. The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your XXXXXXX fails to open up during swallowing, which it’s supposed to do. Intense pain and difficulty in swallowing is one of the main feature of achalasia.If not treated properly this condition can cause carcinoma of esophagus also. please attach report of endoscopy i want to see it.Before labelling it as something related to brain(anorexia nervosa) i want to go through all your reports. In case you have any more query please revert back as follow up. Wish you a great luck