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Esophageal Narrowing due to riding in aero? UPDATE - Achalasia - Anyone living with this?
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Calling all GI’s and others with experience with esophageal conditions... I am finally able to get a gastroscopy scheduled next week to determine the cause of my difficulty swallowing that started about six months ago. My lazy rear end took several months to get motivated to do something about it and of course COVID-19 shut downs struck the week I moved forward with talking with a GI. I have been on an anti-acid medication (pantoprazole) for the last six weeks and have strictly adhered to the six-food elimination diet (been really easy during this quarantine.. let me tell you!). Unfortunately, there has been no change to my condition and I could argue that it might be worsening slightly.

I was suspect of the acid reflux idea as I do not have any symptoms of the burning or typical acid reflux disease you hear about. My symptoms are best described as the food getting stuck half way down my esophagus. I have been tracking all my meals since deciding to get this straight and there is no rhyme or reason to it. Doesn’t matter the type of food, time of day, or how big my bites are. It just happens either once a meal or never during a meal. On several occasions now, I have no choice but to vomit up the food. Once I do and restart my meal, I am pretty much fine for the remaining meal. I also have trouble burping if I swallow air, it is like a plumbing vent being clogged.

So I have been thinking for several days on posting to this forum to see if any fellow riders that ride in aero predominantly have had this trouble. I searched the forum and found a few interesting articles that led me to the SFED diet idea and I am appreciative of that recommendation and will probably adapt many parts of the diet. However, I was really discouraged this morning during my workout because even drinking water during my rides is becoming problematic. I fully suspect some form of narrowing caused by either a growth or inflammation is going to be found. Maybe even webs or rings that might have been caused by reflux. Any successful treatment stories out there? Obviously, I am also hoping and praying that the big “C” is not found. Certainly biopsies will be taken.

Fire away folks, I would love to hear any insights you might have. Thank you Slowtwichers!

2020-08-01 UPDATE:
Testing, Treatment, and Results to Date since late January:
1. Upper Endoscopy and Biopsy - All results completely normal, no evidence of acid damage, etc.
2. Did 6 food elimination diet for nine weeks with no improvement of symptoms
3. Esophagram with and without Barium Swallow - No evidence of a problem
4. Brain MRI with and without contrast- Normal
5. Every blood test possible including autoimmune disorders, normal panels, neurological markers - all 100% normal

6. Manometry Testing - Diagnosis - Early onset of Achalasia - Don't have full report back yet but tech who performed the test told me that there was definitely several seizures of my esophagus during the test.



Any Slowtwitchers out there living and racing with Achalasia? Tips, tricks to cope? Nutrition ideas that don't get stuck or at least are easy to swallow? For me water, shakes, or even gels are not always tolerated at times (very random moments when it all gets stuck). Of course doctors don't know what to do with me being so healthy and active and just tell me that I might have to stop racing long distances if I can't swallow my nutrition. I am not to that point of a problem, but seems like it will get progressively worse.



Thank y'all for your thoughts!




Last edited by: Jayjuno: Aug 1, 20 12:05
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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Jayjuno wrote:
Fire away folks, I would love to hear any insights you might have. Thank you Slowtwichers!

Have a look at the links.

Your symptoms are similar to what I first had.

https://www.mayoclinic.org/...-causes/syc-20352841

https://www.drugs.com/...ett-s-esophagus.html

I suffer from Barretts and take rabeprazole to reduce symptoms.

I have taken it long term for more than two decades.

It's best to get a check of the throat and a biopsy to rule out any nasty cancer cells by a specialist.
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Re: Esophageal Narrowing due to riding in aero? [thomo] [ In reply to ]
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After 5 years of riding only a TT bike I had trouble swallowing. Had a procedure where doc went in with a ballon and opened it back up. Simple outpatient. 2 years later now and I am about ready to have it done again. Highly doubt it’s related to the bike but I still ride 10hrs a week and it is coming back.
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Re: Esophageal Narrowing due to riding in aero? [thomo] [ In reply to ]
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Thank you Thomo, great insights that I had not considered.
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Re: Esophageal Narrowing due to riding in aero? [Joelbob] [ In reply to ]
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JoelBob, thank you for your experience. Has your GI linked the narrowing to cycling or some other underlying condition?
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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JayJuno—
I had the same symptoms as you, and they came about after I entered the AIr Force and started moving every couple years, but the symptoms were worse when riding in aero, so I assumed that might be a contributor. Mine turned out to be eosinophilic esophagitis, aggravated by certain allergens...thus a difference based on location. I had 4 dilations of my esophagus over a decade, but the biggest difference came when a GI sent me to an allergy clinic, and we determined what I was allergic to, airborne and food as well. I had to change my diet significantly. My allergy panels prior to age 40 were also much different than they are now. I’ve been on a mix of Allegra and Nexium or their variants for all this time and haven’t had another dilation in about 5 years. They still scope me every couple of years to rule out Barrett’s, but I’ve remained symptom free.

BL: riding in aero wasn’t the cause, but it did highlight the symptoms.
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Re: Esophageal Narrowing due to riding in aero? [triflorida] [ In reply to ]
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Triflorida,

Thank you for sharing your story. We immediately suspected allergies and while I am waiting for COVID forced closures of outpatient centers to end, I have been working with my allergist (without testing) to adhere to the six food elimination diet. Were your allergens one of the common ones (dairy, soy, nuts, fish, shell fish, gluten, or eggs)?

I have been tested for environmental allergens and control that with various nose sprays. GI said it is very common for folks with environmental allergies to have a higher risk of esophageal disease.
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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As a few others have mentioned, sounds like esophageal dysmotility and/or eosinophilic esophagitis, which I have been diagnosed with. I had a scope, biopsies to confirm eosinophils, rule out Barrett'a, had a barium swallow test so they could image how your esophagus works or not work and after that I had an allergy test done followed by a 2 month elimination diet. This is much bigger version of the 6 food elimination diet. The diet showed I was having issues with dairy, red meat and oats. Also the allergist recommended that I cut back on red wine, coffee, chocolate,tomatoes and high sugar content drinks as they may cause reflux issues. Just two weeks ago my wife was bbq'ing a nice steak and seeing how one bite wouldn't matter, I tried a piece then ended up having an emergency scope to get the piece of meat out of my esophagus, so it can be a pretty serious issue if left untreated. I felt like an ass for taking up emergency services during this time, but where I am there have been almost no COVID cases so the surgery staff were happy to see me as they were pretty bored since electives and non emergency procedures were postponed.
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Re: Esophageal Narrowing due to riding in aero? [Donjek] [ In reply to ]
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Donjek-

Thank you for sharing your story. Amazing on the red meat and oats! These are staples in my diet and I never would have imagined they could be a source. Sorry you had the emergency, but glad you are ok. Thanks again!!
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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It does hurt to not to be able to enjoy some foods. Cheese is the hardest for me to give up. I hope you are able to get some good answers and are able to manage it.
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Re: Esophageal Narrowing due to riding in aero? [Donjek] [ In reply to ]
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Totally agree with you on cheese!! Daiya just isn’t the same!!
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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Yes...mostly the big 6, but not completely. Mine were soy, tomatoes (cooked is fine as it denatures they protein I tested positive for), corn, pecans, and almonds. Mild reaction to wheat, so between that and a conscious effort to eat fewer carbs, the amount of gluten in my diet is much less than before, but I’m not 100% gluten-free.
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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I was tested for everything and did the berrium drink thing. Found nothing they thought was causing it. I do notice when drinking alcohol and eating salty food it does seem to aggravate it.
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Re: Esophageal Narrowing due to riding in aero? [triflorida] [ In reply to ]
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Sounds like eosinophilic esophagitis.

A real quality of life PITA.

If there is any consolation, I don’t think it has much to do with riding in aero. It’s all about the food you eat.
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Re: Esophageal Narrowing due to riding in aero? [Waingro] [ In reply to ]
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Thanks Waingro... if it does end up being due to nutrition, I totally agree with you... PITA!
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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Posted Update to my Diagnosis - See original thread... appreciate any insights y'all might have.

https://rarediseases.org/...-diseases/achalasia/
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Re: Esophageal Narrowing due to riding in aero? [Waingro] [ In reply to ]
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Waingro wrote:
Sounds like eosinophilic esophagitis.

A real quality of life PITA.

If there is any consolation, I don’t think it has much to do with riding in aero. It’s all about the food you eat.

im thankful for the posting of this thread, as i have been suffering through this recently. I just ride aero once a week, so its not that. I think I only have this reaction when I eat raw onions or cabbage. Its scary cause I am so hungry and chomping down my food fast , that when it does happen it feels like I need the heimlich maneuver done on me
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Re: Esophageal Narrowing due to riding in aero? [synthetic] [ In reply to ]
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I have to really consciously slow down when eating to the point that the bites of food are small and I count to thirty bites. Even then, if my esophagus decides to seize, the food just gets stuck and sits there until I vomit it out. After that, generally good to go for the rest of the meal! Eating out is a big gamble and forget about eating at my desk at work, could be a really bad scene!

If it is getting stuck, get checked out. One of the three GI checks will pin point the problem... there just may not be much they can do.
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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I feel your pain - but not quite to the extent that you do.

Two or three times a year I'll have an "episode" when I sit down to eat. Certain foods, white rice with butter for instance, can cause such sudden and massive heartburn that I can't swallow or burp. I usually have to excuse myself from the table, rinse my mouth out and drool copious amounts of saliva into the bathroom sink. It sometimes takes 10 -15 minutes to get things back to normal and then I can sit down and finish the meal. Very weird. I've taken to eating very slowly which seems to help avoid the onset.

A somewhat unrelated difficulty in swallowing occurred about ten years ago, got it checked out and then went away not to return.

"They know f_ck-all over at Slowtwitch"
- Lionel Sanders
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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Jayjuno wrote:
I have to really consciously slow down when eating to the point that the bites of food are small and I count to thirty bites. Even then, if my esophagus decides to seize, the food just gets stuck and sits there until I vomit it out. After that, generally good to go for the rest of the meal! Eating out is a big gamble and forget about eating at my desk at work, could be a really bad scene!

If it is getting stuck, get checked out. One of the three GI checks will pin point the problem... there just may not be much they can do.

let us know which you foods you think is triggering it. during this covid19 i have been having a lot of retarded issues (acid reflux as one) probably all stress related
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Re: Esophageal Narrowing due to riding in aero? [synthetic] [ In reply to ]
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Ate much slower today with more chews, onions much thinner and less in quantity. No attack. Guess I am not winning an onion eating contest anytime soon
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Re: Esophageal Narrowing due to riding in aero? [synthetic] [ In reply to ]
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I had the procedure done where they stick a device down there to stretch out your esophagus. Later that night when I was eating it was shocking how easy it was to swallow food. Even big chunks were going down easy. Doc said some people need it done every few years.
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Re: Esophageal Narrowing due to riding in aero? [Joelbob] [ In reply to ]
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Thanks JoelBob! I am awaiting the final written report but stretching and elongation is definitely on my radar as a possible solution. If you don't mind me asking, was it determined what might have caused the need for stretching? Did you have reflux or some other impact? No one can determine or tell me yet what exactly is causing my problem after all the testing I listed in my updated original post.
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Re: Esophageal Narrowing due to riding in aero? [Jayjuno] [ In reply to ]
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Like others in this thread I was diagnosed years ago with eosinophilic esophagitis.

I first started getting symptoms over 10 years ago, while eating an overcooked steak and the horrible sounds of trying to cough it up in the bathroom with a full dining room listening.

Finally had a endoscopy done and there was no issues found except for some minor acid reflux damage. Doctor said I had eosinophilic esophagitis. He diagnosed me with prescription prilosec, which is 100% different from over the counter and a asthma inhaler but I don't inhale the medicine into my lungs but instead swallow the medicine to "numb" my esophagus. Both worked great but not recommended for long term use.

Now I learned how to live with it, and yes quality of life can suck. I know the exact moment food gets "stuck" and now its a routine process. Only once I had to go to the emergency room when getting a buffalo wing stuck.

The scary part is when food is stuck in your esophagus is how your saliva now gets backed up in your esophagus and eventually you start to choke on your saliva. This only happens in bad cases and consists of a horrible "coughing up". Most times I am spitting a lot in the sink and waiting the 5 minutes for the food to go down. I know the exact moment when the food finally goes down.

For me I no longer can swallow pills, I have to eat very slow and chew a lot more. Any food like meat, rice, etc I know I have to take it easy. 90% of the time my food gets stuck on the first bite. So I either have to drink something to moisten my throat and stop digging right into the food. The other times is due to distraction or I stop focusing on chewing or talking and eating at the same time.
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Re: Esophageal Narrowing due to riding in aero? [ChrisC42780] [ In reply to ]
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Thank you so much for sharing your experience and in many ways you described exactly what it is like to live with it. Especially being distracted during eating as that is probably the only consistent thing that will cause the food getting stuck.

I was not aware of the Prilosec option, what were the long term concerns of that course of treatment?
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