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Oesophageal manometry test showed weak peristalsis with large peristaltic defects. Sugggestions

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Practicing since : 2000
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For 4 years I have had a stomach disorder where I experience pain (up to 8/10) in my stomach, bloating and less often a sense of fullness. All PPI / H2 antagonist and Baclofen medication has had nil response. I have had the following tests carried out and all have been negative/normal: CT scan, ultrasound, 3 x endoscopy including biopsy, blood tests for diseases such as Crohns disease and Lupus disease, C25, helicobacter pylori, barium swallow and meal, nuclear imaging (gastric emptying), Bravo pH monitoring. I have been treated for Helicobacter pylori with nil response. My symptoms are erratic and chaotic and usually occur late afternoon and evening but never overnight. The only relief I can get is lying down. The pain can be caused by drinking coffee, alcohol and eating spicy foods but these beverages/food may not cause the pain at other times. Since the problem began I have been on a strict diet to eliminate these foods as well as soft drinks, rich foods, onions, garlic, leeks, but the problem continues. I have been on two elimination diets. The low FODMAP diet and an elimination diet for amines, salicylates and glutamates with no improvement of symptoms. I had the oesophageal manometry test and this showed: Weak peristalsis with large peristaltic defects; normotensive UOS; normotensive LOS. I also had the oesophageal multi channel intraluminal impedance 24 hour test and this test showed: physiological distal oesophageal acid reflux; Increased weak acid oesophageal reflux; normal total oesophageal bolus exposure; normal proximal oesophageal reflux; no symptoms association with reflux events. I am female and 50 years of age; have very good health otherwise; I exercise 5 x week (running and gym); I have little stress in my life; I don’t have children; I do not have food allergies nor food intolerances. My husband and I grow our own vegetables and fruit and these foods form a large part of my diet. I am 5’ 3 “ and weigh 50kgs. My cholesterol levels are 3.2. I take no medications for any other conditions. I would be grateful if you could any advice on my problem.
Posted Tue, 31 Dec 2013 in Digestion and Bowels
Answered by Dr. Amit Jain 3 hours later
Brief Answer: Please see the details Detailed Answer: Hello! Thanks for putting your query in XXXXXXX I am a Gastroenterologist (DM). Your symptoms suggest that you are suffering from dyspepsia with reflux symptoms. So PPI alone will not work well, take a prokinetic agent like itopride along with a PPI like ilaprazole. Continue with less fatty diet, avoid tea or coffee and spicy food. Don't lie soon after meals at least for 2 hours. Also continue with exercise. You are already following healthy life style. I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too. Remain in touch and get-well soon.
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