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What Causes Esophageal Spasms After Transesophageal Echocardiography?
Question: Hello, I had a TEE 7 days ago to check on my mitral valve prolapse. This is the first time I have had the procedure. I am 5'5" and 115 lbs. Ever since the procedure, I have been dealing with burning in my esophagus and sometime dull pain that comes and goes. I also have nausea, especially when trying to sleep at night. It is worse if I change sides. I wake up with terrible nausea. I went back to see my cardiologist yesterday to tell him about this and he does not think it is an infection. He thinks he irritated my esophagus and gave me Zantac to take. He said if it is not better in a couple of days then to call him. What else could be going on? The nausea is terrible and I did not have this prior to the procedure. It's worse when lying down. I did not have reflux prior to this procedure either. There was no blood on the probe when it was removed but my esophagus does not feel right and the nausea is preventing me from eating well.
Any ideas? Thanks.
Any ideas? Thanks.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through you recent medical history and would explain that an esophageal injury during the TEE procedure is very likely to be the cause of your current clinical symptomatology.
Although, REE is considered almost a safe procedure, some rare complications do occur:
- dysphagia (discomfort or difficulty in swallowing) around 1.8%;
- severe odynophagia (painful feeling while swallowing in esophagus) around 0.1%;
- minor pharyngeal bleeding around 0.01%-0.2%;
- esophageal perforation <0.01%
Whether, a minor esophageal mucosa erosion or a more severe laceration has occurred, it will depend on the probe manipulation, level of sedation during the procedure, level of examiner expertise and some patient predisposing factors.
In general, the symptoms will definitely resolve after a couple of days.
Now, as your unpleasant feelings (relapsing esophageal pain and nausea) persist, the most important issue to exclude is a possible severe esophageal laceration or perforation, as it is the most serious complication.
If a laceration has occurred at the lower portion of esophagus, some degree of acid reflux may be present. In such case, Zantac and other gastric anti-secretor drugs such as Pantoprazole, Omeprazole, are highly recommended to relieve the symptoms.
In addition, other antiemetic drugs (for nausea) are recommended, like Metoclopramide 10 mg 2-3 times daily.
But, if the chest pain keeps returning repeatedly, especially if other associated symptoms persist or appear (fever, difficulty of breathing, tachycardia, etc), then it is recommended to consult immediately your doctor after 24 hours as a more serious mechanical injury (laceration) may be present (esophageal perforation is a serious health condition warranting prompt medical intervention and as such should be timely excluded/confirmed).
Meanwhile, try to take soft or liquid foods in small proportions and monitor your overall body status (temperature, BP, heart rate).
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through you recent medical history and would explain that an esophageal injury during the TEE procedure is very likely to be the cause of your current clinical symptomatology.
Although, REE is considered almost a safe procedure, some rare complications do occur:
- dysphagia (discomfort or difficulty in swallowing) around 1.8%;
- severe odynophagia (painful feeling while swallowing in esophagus) around 0.1%;
- minor pharyngeal bleeding around 0.01%-0.2%;
- esophageal perforation <0.01%
Whether, a minor esophageal mucosa erosion or a more severe laceration has occurred, it will depend on the probe manipulation, level of sedation during the procedure, level of examiner expertise and some patient predisposing factors.
In general, the symptoms will definitely resolve after a couple of days.
Now, as your unpleasant feelings (relapsing esophageal pain and nausea) persist, the most important issue to exclude is a possible severe esophageal laceration or perforation, as it is the most serious complication.
If a laceration has occurred at the lower portion of esophagus, some degree of acid reflux may be present. In such case, Zantac and other gastric anti-secretor drugs such as Pantoprazole, Omeprazole, are highly recommended to relieve the symptoms.
In addition, other antiemetic drugs (for nausea) are recommended, like Metoclopramide 10 mg 2-3 times daily.
But, if the chest pain keeps returning repeatedly, especially if other associated symptoms persist or appear (fever, difficulty of breathing, tachycardia, etc), then it is recommended to consult immediately your doctor after 24 hours as a more serious mechanical injury (laceration) may be present (esophageal perforation is a serious health condition warranting prompt medical intervention and as such should be timely excluded/confirmed).
Meanwhile, try to take soft or liquid foods in small proportions and monitor your overall body status (temperature, BP, heart rate).
Hope to have been helpful to you!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. The chest pain is not really there and when I had it was only mild. I feel a little discomfort in the center of my chest when I take a deep breath or my esophagus is. The most concerning symptoms are the nausea, esophageal discomfort and burning, and diarrhea ( I forgot to mention the diarrhea earlier. It is usually first thing in the morning after being nauseous at night while laying down). The nausea is pretty consistent all day, even with taking the Zantac. But it is worse when I lay down especially at night and first thing in the morning. I have been given a referral to a G.I. specialist so hopefully this will give me some answers. If there's anything else you would like to provide face on this please let me know.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello again!
I understand your concern and would recommend taking omeprazole or pantoprazole to help you with gastro-esophageal reflux. These drugs are more potent compared to Zantac and I would recommend to switch from Zantac to one of these drugs.
Regarding diarrhea, I would recommend performing a stool bacterial culture, to exclude an infection.
Another diagnosis to take into consideration would be irritable bowel syndrome.
Anyway, Imodium (loperamide) can help against diarrhea. I would recommend taking 4 mg initially, then 2 mg after each loose stool until controlled, and then 4-8 mg/day in divided doses.
But, careful, because if you take it unnecessarily it can lead to constipation.
Another drug which can help against reflux and nausea is metoclopramide (Reglan). You can take a low dose like 10mg when feeling nausea.
But the possible adverse effect of this drug is that it can exacerbate diarrhea, because it has a pro-kinetic effect (which means that it stimulates the bowel movements). That is why I would recommend taking it only when pantoprazole or omeprazole are not helpful to relieve these symptoms.
Some other tips to improve your situation would be:
- eat frequently and in small portions
- avoid large meals
- avoid spicy food and caffeine.
Hope you will find this answer helpful!
Let me know about everything!
Wishing good health,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello again!
I understand your concern and would recommend taking omeprazole or pantoprazole to help you with gastro-esophageal reflux. These drugs are more potent compared to Zantac and I would recommend to switch from Zantac to one of these drugs.
Regarding diarrhea, I would recommend performing a stool bacterial culture, to exclude an infection.
Another diagnosis to take into consideration would be irritable bowel syndrome.
Anyway, Imodium (loperamide) can help against diarrhea. I would recommend taking 4 mg initially, then 2 mg after each loose stool until controlled, and then 4-8 mg/day in divided doses.
But, careful, because if you take it unnecessarily it can lead to constipation.
Another drug which can help against reflux and nausea is metoclopramide (Reglan). You can take a low dose like 10mg when feeling nausea.
But the possible adverse effect of this drug is that it can exacerbate diarrhea, because it has a pro-kinetic effect (which means that it stimulates the bowel movements). That is why I would recommend taking it only when pantoprazole or omeprazole are not helpful to relieve these symptoms.
Some other tips to improve your situation would be:
- eat frequently and in small portions
- avoid large meals
- avoid spicy food and caffeine.
Hope you will find this answer helpful!
Let me know about everything!
Wishing good health,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Last question- I have been having some annoying upper back pain today. Could this all be related? My dr is checking my electrolytes again because my potassium was a little low last week, 3.3. But I just feel unwell overall. It's really frustrating because I didn't feel like this prior to the TEE. If I had a tear or rupture in my esophagus, wouldn't I be in bad shape at this point, 7 days out? I can't get into a gastroenterologist for 3 more days so I'm thinking of going to the ER tomorrow morning to have this all evaluated. Thanks again.
Brief Answer:
My answer as follows:
Detailed Answer:
Hello again!
The upper back pain could be related to a wrong posture during the day. It may also be related to irradiating pain from esophagitis or gastro-esophageal reflux.
But, it does not seem to be related to any serious medical condition.
The low potassium levels, are just borderline. They can lead to fatigue and muscle weakness. I would recommend taking potassium supplements and food rich in potassium (bananas, plumes, potatoes, etc.) during these days.
Regarding the tear in esophagus, it may need more than 7 days to heal. I do not think it is any rupture, because in such case you would not be in this clinical situation (but in a much more severe clinical situation).
Anyway, as you are feeling so anxious, I would recommend going to the ER to check your electrolytes (especially considering the fact that you have repeated episodes of diarrhea), perform a complete blood count for infection, a stool bacterial culture and a chest X ray study.
Hope to have been helpful!
If you have any other questions, please do not hesitate to ask me again!
Best wishes,
Dr. Iliri
My answer as follows:
Detailed Answer:
Hello again!
The upper back pain could be related to a wrong posture during the day. It may also be related to irradiating pain from esophagitis or gastro-esophageal reflux.
But, it does not seem to be related to any serious medical condition.
The low potassium levels, are just borderline. They can lead to fatigue and muscle weakness. I would recommend taking potassium supplements and food rich in potassium (bananas, plumes, potatoes, etc.) during these days.
Regarding the tear in esophagus, it may need more than 7 days to heal. I do not think it is any rupture, because in such case you would not be in this clinical situation (but in a much more severe clinical situation).
Anyway, as you are feeling so anxious, I would recommend going to the ER to check your electrolytes (especially considering the fact that you have repeated episodes of diarrhea), perform a complete blood count for infection, a stool bacterial culture and a chest X ray study.
Hope to have been helpful!
If you have any other questions, please do not hesitate to ask me again!
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Had a chest X-ray and an X-ray drink and barium X-ray. No tear was found in my esophagus during the testing. They anticipate some sort of irritation of the esophagus has occurred from the TEE. Gave me GI medicine and Pepcid. White blood cell count was normal so no signs of infection. Following up with a GI specialist in 12 days since they have no idea why I am having nausea and diarrhea. They gave me prescriptions to help with both. Just wanted to give you the update. Thanks for your help!
Brief Answer:
I am glad that your tests have resulted normal.
Detailed Answer:
Hello again!
Thank you for the information!
I am glad that nothing serious seems to be going on with you!
I recommend continue taking the therapy given by the doctors, in order to help you relieve your symptoms.
I would also recommend avoiding spice food and caffeine in the next days!
Regards,
Dr. Iliri
I am glad that your tests have resulted normal.
Detailed Answer:
Hello again!
Thank you for the information!
I am glad that nothing serious seems to be going on with you!
I recommend continue taking the therapy given by the doctors, in order to help you relieve your symptoms.
I would also recommend avoiding spice food and caffeine in the next days!
Regards,
Dr. Iliri
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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