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[Dysphagia] belching
I have a patient.... I have my own ideas with her, but thought I would throw her situation out there to see if anyone has any other thoughts or input....sorry for the long posting...
58 year old female. history of MS (1998) and CVA (2000).
The past 2 years she has developed a constant belching (with and without food/liquid). This only occurs when she is awake. (not when she is sleeping, despite the fact she snores). She initially reported that she felt as though she had "something" stuck in her throat, that only a belch would clear (throat clear, cough, etc would not get rid of this feeling she had). At the end of the conversation, she recanted this statement, staying she didn't feel like there was anything in her throat. She reported that if she did not belch, she felt as though she would have to vomit. She has been on Reglan and proton pump inhibitors without success in decreasing or eliminating the belching. She reported that she can stop the belch if she takes a deep breath when she feels the belch coming.
She has had a full GI workup: endoscopy was negative. upper GI was positive for spontaneous reflux, dilation of the esophagus without typical findings seen in achalasia. (the doctor does not feel it is achalasia), and hypoperistalsis. a motility study revealed very weak peristalsis with only 2 episodes of peristalis (despite the continuous swallows). the lower esopahgeal sphincter is reportedly "OK" (per MD verbal report). The GI doc has given her a diagnosis of nonspecific moderate-severe esophageal motility disorder.
Watching her breathe, she did occasionally "gasp" for air as she talked on little air and spoke in very long sentences. I reviewed possible strategies/techniques for aerophagia with her and she is to get back with me. (shot in the dark)
At this point, I feel as though she might have initially started the belching as a compensatory strategy to all of her GI issues, and now, it has become more of a habit.
any other thoughts? Thank you.
Julie Ennis, M.Ed, CCC-SLP
Sarasota Memorial HealthCare System
941-917-1395
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