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[DYSPHAGIA] patient with chronic belching


  • Subject: [DYSPHAGIA] patient with chronic belching
  • From: eripley@yahoo.com (Irene Campbell-Taylor)
  • Date: Sun, 12 Mar 2000 10:20:22 -0800 (PST)

Dear Karen,
Two possibilities come tomind:
1: Has anyone checked her gallbladder for alcalculous
cholcystitis?
2: She may have diaphragmatic flutter See following:
Lancet 1992 Feb 1;339(8788):265-7 
High-frequency diaphragmatic flutter: symptoms and
treatment by
carbamazepine.
Vantrappen G, Decramer M, Harlet R
Classic diaphragmatic flutter, a rare disorder
associated with dyspnea, thoracic or abdominal wall
pain, and epigastric
pulsations, is caused by involuntary contractions of
the diaphragm with a frequency of 0.5-8.0 Hz. The
authors describe three patients
with diaphragmatic flutter of higher frequency not
associated with respiratory disease. They presented
with longstanding
esophageal belching, hiccups, and retching,
respectively. The diagnosis was established by the
presence on electromyography
of the diaphragm and scalene and parasternal
intercostal muscles of repetitive discharges of 9-15
Hz. Spirographic tracings,
especially those of volume or flow vs time, showed
similar high-frequency oscillations superimposed on
tidal respiratory
movements. Treatment with carbamazepine 200-400 mg
three times daily led to disappearance or great
improvement of flutter
and clinical symptoms in all three patients. The
phenomenon was not seen in other patients with chronic
hiccups or esophageal
belching or in patients without these symptoms who had
undergone electromyography or spirography for other
reasons. Thus,
high-frequency diaphragmatic flutter seems to be a new
disease entity. The response to carbamazepine suggests
that the
flutter causes the symptoms. 
 
Irene.




--- "Myers, Karen" <Karen.Myers@59MDW.WHMC.AF.MIL>
wrote:
> Please help with this most interesting patient. 
> Patient is a 39 year old
> female with approx 9 month history of chronic
> belching at all times except
> during speech.  Noted approx 25 per 5 minute
> interval during rest and is
> able to decrease that number to approx 5 with
> concentrated slow breathing.
> She cannot maintain this concentrated breathing
> pattern.  No significant
> history.  
> 	She has been treated with different medications - a
> 4 week trial of
> Zantac and a short trial of Thorazine with no
> relief.  No presently on no
> medications.  
> 	Normal UGI and video swallow.  Both oral and
> pharyngeal stages were
> completely normal.  Does not appear to be swallowing
> air.  Normal chest CT
> with no evidence of abdominal or diaphragmatic mass.
>  
> 	HELP
> Karen Myers
>
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