Does lack of appetite indicate esophageal motility disorder?

Question

Hello doctor,

I am a 45-year-old Caucasian male weighing 187 lbs. I am a former smoker with a history of approximately 15 years of smoking. Currently, I am on several medications, including Lansoprazole15 mg twice a day, Famotidine 20 mg twice a day, Gabapentin 300 mg twice a day, Buspirone 5 mg twice a day, Citalopram 60 mg, and Simvastatin 20 mg.

My medical history includes delayed gastric emptying with 20 percent retention at four hours, generalized anxiety disorder (GAD), and gastroesophageal reflux disease (GERD). Recent testing conducted includes an esophagogastroduodenoscopy (EGD), which confirmed GERD, a colonoscopy showing minor inflammation or colitis near the terminal ileum with an inconclusive biopsy for inflammatory bowel disease (IBD), an abdominal CT that was clear, an MRI enteroscopy that was also clear, a chest X-ray that also showed no abnormalities, and blood tests indicating normal results except for glucose (104) and calcium (10.3), with the doctor suspecting an error for the latter and no retest required.

I began experiencing a lack of appetite a few months ago. Initially, I can eat, but I just did not feel hungry. Later, I completely lost my appetite, felt nauseous at times, and felt full after just a few bites of food, resulting in a weight loss of around 10 pounds. Then, I began experiencing severe acid reflux that was not being controlled with up to 30 mg twice a day of Lansoprazole. I added 20 mg of Famotidine and reduced the Lansoprazole to 15 mg twice a day, which has largely controlled the burn, although not completely. However, my primary symptoms now include a constant feeling of regurgitation and food stuck in my throat and chest, chest pain, sometimes a feeling of pain in my esophagus as if it is trying to move something down, and a hoarse voice.

Regarding the need for another esophagogastroduodenoscopy (EGD), is it necessary if the one I underwent 11 months ago showed no evidence of Barrett's esophagus or esophagitis? Additionally, I am concerned about the possibility of esophageal cancer, particularly squamous cell carcinoma due to my history of smoking. Is it possible for this type of cancer to develop and cause symptoms in less than a year? Furthermore, I am wondering if my current symptoms could be attributed to gastroparesis. Lastly, I would appreciate guidance on any other pertinent questions I should be discussing with my doctor regarding my condition.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your case history and you have provided complete details so moving to your questions:

Reflux esophagitis can develop within one year due to persistent acid reflux. Barrett's esophagus will not develop within one year, especially with a normal endoscopy about 11 months ago.
No, tumors take time. It is highly unlikely to develop esophageal cancer, especially squamous cell carcinoma, within one year. Esophageal cancer slowly develops, and the most common symptom is progressive dysphagia (difficulty swallowing food, starting with solids, then semi-solids, and finally liquids).
Gastroparesis can cause prolonged stasis of food within the stomach, leading to reflux symptoms and reflux esophagitis. However, the sensation of acid reaching the throat and the feeling of food being stuck in the throat are relatively uncommon.
Considering your medical history, I would also consider a few other factors, such as esophageal motility disorders, which can cause pain and difficulty swallowing and can be assessed by esophageal manometry. Globus hystericus (the sensation of a lump in the throat or something stuck in the throat when there is nothing there) is a common condition in sensitive individuals and can worsen with anxiety. Functional dyspepsia (when your endoscopic tests and even manometry are normal).
You may need to adjust your antidepressants and anxiety medications because health-related anxiety can trigger such symptoms, and they may respond to the readjustment of these medications.

I hope this helps you.

Thank you.