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What Causes Pressure In The Upper Esophagus?

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Posted on Wed, 19 Oct 2016
Question: Hi, I will start at the beginning where I think everything went wrong. A year and a half ago I fell out of the back of our pickup truck and LANDED on my feet with my knees to my chin. ( I am 5'4" and weighed about 198lbs at that time) I felt as if my esophogus was crushed into my throat and the pain was intense right behind my upper chest plate. (centerof chest) Adfter 10 minutes or so they pain went from extreme to very minor and then none. I brushed it off as I tend to do with fleeting pains. 2 nights later After eatin a large meal and ice cream I was asleep around 2am and I woke up and my heart rate was through the roof and my right arm was feeling as if were about to explode from the blood pressure. It was very scary but since it too went away after about a half hour, I chalked it up to a one off. 4 nights later, I had the same attack while I was sleeping and this time I decided to have my wife take me to the doctor the next day. (I am legally blind)
The doctor visit went as such.. (I had completely forgot to tell them about the falling accident because I was overwhelmed by the apparent heart issue)
EKG = OK
Blood pressure 150/98 (got prescription for 10mg lisenopril)
Fast forward... No longer on lisenopril (made my BP crater) but I have had spikes in BP here and there.
I started having pressure at my upper esophogus and where my stomach meet lower esophogus and have had spasms and tendernesss where my esophogus meets the stomach. . I have also started having reflux and Primary Doc put me on 40mlg Prilosec. Well the reflux went away but I was still having the pressure and spasms. I went to a GI doctor and did a endoscopy. He said that he saw nothing unusual and said I just had reflux. Well when I went back for followup, I told hime that I was still having the pressure and spasms and he said that I could go get a CT scan. So I want to know what the CT scan can show and is it going to cover my throat down to my stomach? Also, is there still a chance that I have a hiatal hernia even though he did not see it in endosopy? Are ther any other tests/scans I should ask for?

Thanks XXXXXXX
doctor
Answered by Dr. Dr.Arnab (6 hours later)
Brief Answer:
several possibilities can be there..thorough evaluation needed..

Detailed Answer:
Hello XXXXXXX Welcome to HCM,
I've gone through your query and understand your concern,

Yes, first of all, I'd like to really appreciate such a nicely written detailed history..

I can understand the doubts, specially since it's involving such a prolonged post traumatic period..yes it seems to be related with that traumatic fall only..

Upper GI Endoscopy can only give visual impression of the esophageal and the gastric and duodenal mucosa to some extent..but it can't give any impression of the surrounding structures and/ the diaphragm and it's surrounding organs..

To be specific, CT Scan (with and without contrast) of the whole abdomen along with thorax should be the considered at the earliest, as it'll give a complete picture of not only the esophagus and down to your stomach but the entire gastro-esophageal tract..

Hiatal hernia, to some extent is visible in endoscopy only, however since it's not picked up yet, CT scan will give a brief picture about it further..

Other than CT-scan of thorax and abdomen, there's conventional barium swallow, esophageal manometry to look in to the functional part of the gastroesphageal sphincters (the spasm and pressure symptoms can be due to any dysmotility ).. However it's advisable to go for the CT scan before as it'll give a much detailed picture and depending on the findings of the CT-scan, further planning for any investigations (if at all required) and management should be initiated..

Meanwhile please continue the Prilosec as your already taking.. have foods in small and frequent quantity, try to maintain a gap of 2.5-3 hrs between your dinner time and bedtime..try to sleep with head-end a bit elevated(an extra/bigger sized pillow will help)..

Please let me know if you've any further further queries, I'll be glad to clarify..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Dr.Arnab

Critical Care Specialist

Practicing since :2012

Answered : 1479 Questions

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What Causes Pressure In The Upper Esophagus?

Brief Answer: several possibilities can be there..thorough evaluation needed.. Detailed Answer: Hello XXXXXXX Welcome to HCM, I've gone through your query and understand your concern, Yes, first of all, I'd like to really appreciate such a nicely written detailed history.. I can understand the doubts, specially since it's involving such a prolonged post traumatic period..yes it seems to be related with that traumatic fall only.. Upper GI Endoscopy can only give visual impression of the esophageal and the gastric and duodenal mucosa to some extent..but it can't give any impression of the surrounding structures and/ the diaphragm and it's surrounding organs.. To be specific, CT Scan (with and without contrast) of the whole abdomen along with thorax should be the considered at the earliest, as it'll give a complete picture of not only the esophagus and down to your stomach but the entire gastro-esophageal tract.. Hiatal hernia, to some extent is visible in endoscopy only, however since it's not picked up yet, CT scan will give a brief picture about it further.. Other than CT-scan of thorax and abdomen, there's conventional barium swallow, esophageal manometry to look in to the functional part of the gastroesphageal sphincters (the spasm and pressure symptoms can be due to any dysmotility ).. However it's advisable to go for the CT scan before as it'll give a much detailed picture and depending on the findings of the CT-scan, further planning for any investigations (if at all required) and management should be initiated.. Meanwhile please continue the Prilosec as your already taking.. have foods in small and frequent quantity, try to maintain a gap of 2.5-3 hrs between your dinner time and bedtime..try to sleep with head-end a bit elevated(an extra/bigger sized pillow will help).. Please let me know if you've any further further queries, I'll be glad to clarify.. Take Care Kind Regards