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Question: Dear Doctor,
I am a single mother living in Toronto Canada with a seven year old daughter whom I love very much and who needs me so much.
Unfortunately I have been seriously tortured by the constant/non-stop symptoms of great discomfort in throat and esophagus for months. I can’t lead normal life at all. Recent esophageal motility test has shown clearly that I have esophageal spasm, while the reflux is well controlled by PPIs. It was caused by reflux triggered by a stomach flu in Mar 2016.
I used to have a history of reflux and esophgeal spasm, and it was cured by taking valium. The second day after I took valium in March 2015, my intolerable constant/non-stop symptoms in throat and esophagus were immediately well controlled and I can lead normal life again for a whole year and felt very healthy & energetic.
Since esophageal spasm is a very rare disease, although I've been seeing good GI doctors here in Toronto, but the experiences in this specific area is very limited therefore the result is not good.
A remote GI doctor in my home country mentioned a medication named "estazolamum" and asked me to take it 1mg before bedtime. If not working, he asked me to add 1mg in the morning. He said valium is relatively weaker now in my case of reocurrence this time and this medication of "estazolamum" should work for me but it can be dependent. He said it's no big issue if I take it for just 1-2 months. While, I haven't try it yet. And I don't know how to move from valium to estazolamum if I do need to take it.
The priority for me now is really to find a way to try to control the intolerable non-stop/constant symptoms in throat/esophagus due to this rare disease of esophageal spasm, to make life move on.
Can any doctor who has experience in this area help me to give some advice? MY GREATEST GREATEST THANKS!
Yours Sincerely,
XXXXX
I am a single mother living in Toronto Canada with a seven year old daughter whom I love very much and who needs me so much.
Unfortunately I have been seriously tortured by the constant/non-stop symptoms of great discomfort in throat and esophagus for months. I can’t lead normal life at all. Recent esophageal motility test has shown clearly that I have esophageal spasm, while the reflux is well controlled by PPIs. It was caused by reflux triggered by a stomach flu in Mar 2016.
I used to have a history of reflux and esophgeal spasm, and it was cured by taking valium. The second day after I took valium in March 2015, my intolerable constant/non-stop symptoms in throat and esophagus were immediately well controlled and I can lead normal life again for a whole year and felt very healthy & energetic.
Since esophageal spasm is a very rare disease, although I've been seeing good GI doctors here in Toronto, but the experiences in this specific area is very limited therefore the result is not good.
A remote GI doctor in my home country mentioned a medication named "estazolamum" and asked me to take it 1mg before bedtime. If not working, he asked me to add 1mg in the morning. He said valium is relatively weaker now in my case of reocurrence this time and this medication of "estazolamum" should work for me but it can be dependent. He said it's no big issue if I take it for just 1-2 months. While, I haven't try it yet. And I don't know how to move from valium to estazolamum if I do need to take it.
The priority for me now is really to find a way to try to control the intolerable non-stop/constant symptoms in throat/esophagus due to this rare disease of esophageal spasm, to make life move on.
Can any doctor who has experience in this area help me to give some advice? MY GREATEST GREATEST THANKS!
Yours Sincerely,
XXXXX
Brief Answer:
Please follow...
Detailed Answer:
Dear XXXXXXX hi and thank you for asking on HCM!
I read carefully all your concerns and I can say as follows
1. As I have review all your medical reports m you are suffering form esophageal spasms and GERD.
These conditions may be treated with PPI's plus calcium channel blockers like diltiazem and sedatives like Diazepam .
You are using all of them and you have not completed relief.
2.With regards to estazolam, it is a sedative hypnotic drug in the family of benzodiazepine drugs.. It acts on your brain to produce a calming effect. It is used 1 mg at bedtime.
To my opinion you can start using estazolam instead of diazepam.
3. I read that you are using nifedipine , it is a calcium channel blocker too and helps to calm esophageal spasms.
Please consult with your physician about these drugs.
If it doesn't work than you can use diltiazem 60 mg three times per day.
If you have other concerns , please don't hesitate to ask me.
DR.Klerida
Please follow...
Detailed Answer:
Dear XXXXXXX hi and thank you for asking on HCM!
I read carefully all your concerns and I can say as follows
1. As I have review all your medical reports m you are suffering form esophageal spasms and GERD.
These conditions may be treated with PPI's plus calcium channel blockers like diltiazem and sedatives like Diazepam .
You are using all of them and you have not completed relief.
2.With regards to estazolam, it is a sedative hypnotic drug in the family of benzodiazepine drugs.. It acts on your brain to produce a calming effect. It is used 1 mg at bedtime.
To my opinion you can start using estazolam instead of diazepam.
3. I read that you are using nifedipine , it is a calcium channel blocker too and helps to calm esophageal spasms.
Please consult with your physician about these drugs.
If it doesn't work than you can use diltiazem 60 mg three times per day.
If you have other concerns , please don't hesitate to ask me.
DR.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
DR.Klerida,
Thanks your so much for your careful study, your understanding and professional answer.
I would appreciate if you can answer me a couple of more questions following your advice:
1. How to transfer from diazepam to estazolam? As diazepam is no longing working for me now although I've been taking it for 3 months, can I suddenly stop taking diazepam and start taking estazolam?
2. You mentioned that I should take 1mg estazolam at bedtime. How long should I expect it to take effect to start relief my throat/esophagus symptoms? If not working well, can I add 1mg in the morning of estazolam, i.e. 1mg in the morning and 1mg at bedtime?
3. If estazolam works to relief my symptoms, how long should I take it? And I should I quit it? If it still doesn't work, do you have any other alternative medication advice?
4. I've been taking nifedipine for 10 weeks and it's not working well obviously. You mean I can try another medication "diltiazam". Should I change diazepam to estazolam, and nifedipine to diltiazam in the meanwhile, or I should change diazepam to estazolam first and keep on taking nifedipine to see the result?
5. Regarding "diltiazam", I want to confirm that the dosage you mentioned is 60mg x 3 per day, is that correct? And at what time of the day should I take this medication.
6. As I've been taking double dosage PPIs 30 min before meal for four months, and 24hr PH study has shown that my GERD is now well controlled. Do you think I should keep on taking double dosage PPIs or I can change to take single dosage? If you think I can change to single dosage, it should be in the morning or in the evening?
Sorry that I have so many questions, since I'm really suffering so much and I have no choice but to try my best to cope with it, for the sake of my daughter.
THANKS A LOT AND MY BEST WISHES!
XXXX
Thanks your so much for your careful study, your understanding and professional answer.
I would appreciate if you can answer me a couple of more questions following your advice:
1. How to transfer from diazepam to estazolam? As diazepam is no longing working for me now although I've been taking it for 3 months, can I suddenly stop taking diazepam and start taking estazolam?
2. You mentioned that I should take 1mg estazolam at bedtime. How long should I expect it to take effect to start relief my throat/esophagus symptoms? If not working well, can I add 1mg in the morning of estazolam, i.e. 1mg in the morning and 1mg at bedtime?
3. If estazolam works to relief my symptoms, how long should I take it? And I should I quit it? If it still doesn't work, do you have any other alternative medication advice?
4. I've been taking nifedipine for 10 weeks and it's not working well obviously. You mean I can try another medication "diltiazam". Should I change diazepam to estazolam, and nifedipine to diltiazam in the meanwhile, or I should change diazepam to estazolam first and keep on taking nifedipine to see the result?
5. Regarding "diltiazam", I want to confirm that the dosage you mentioned is 60mg x 3 per day, is that correct? And at what time of the day should I take this medication.
6. As I've been taking double dosage PPIs 30 min before meal for four months, and 24hr PH study has shown that my GERD is now well controlled. Do you think I should keep on taking double dosage PPIs or I can change to take single dosage? If you think I can change to single dosage, it should be in the morning or in the evening?
Sorry that I have so many questions, since I'm really suffering so much and I have no choice but to try my best to cope with it, for the sake of my daughter.
THANKS A LOT AND MY BEST WISHES!
XXXX
Brief Answer:
Please follow...
Detailed Answer:
Hi back,
Let me answer your questions:
1- 2. You are using diazepam 2X10 mg per day. 10 mg of diazepam is equivalent to 1 mg of estazolam. Since the average time of estazolam to reach the effect is 1-2 hours, You can use valium in the morning 10 mg and in the bedtimes you should start estazolam 1 mg.
Diazepam has a long half life elimination so the next day you will use 10 mg again in teh morning and 1 mg estazolam in bedtime. after these two days you don't need to use more diazepam because estazolam has reached the desired concentration on blood.
After these two days you will continue with 1 mg estazolam in bed time. If you have no improvement you can use up to 2 mg per day( 1mg in the morning and 1 mg in bedtime) Please avoid driving during these time.
3. you can use estazolam for 4-6 weeks . If is still doesn't work than you should consult psychiatrist to start another antidepressant only after physical examination.
4-5. To my opinion you should firstly change diazepam to estazolam and after 2 weeks if you have no improvement you should start to use diltiazem instead of nifedipine with the above dosage. Please control your blood pressure during these time.
6.With regards to PPI's use To my opinion you should continue with double dosage in the morning and in bedtime up to 6 months from the first day of treatment.
After that time you will use single of PPI's dosage in the evening.
It is really important to avoid stress during these time because stress trigger you symptoms.
Hope it was helpful to you!
Dr.Klerida
Please follow...
Detailed Answer:
Hi back,
Let me answer your questions:
1- 2. You are using diazepam 2X10 mg per day. 10 mg of diazepam is equivalent to 1 mg of estazolam. Since the average time of estazolam to reach the effect is 1-2 hours, You can use valium in the morning 10 mg and in the bedtimes you should start estazolam 1 mg.
Diazepam has a long half life elimination so the next day you will use 10 mg again in teh morning and 1 mg estazolam in bedtime. after these two days you don't need to use more diazepam because estazolam has reached the desired concentration on blood.
After these two days you will continue with 1 mg estazolam in bed time. If you have no improvement you can use up to 2 mg per day( 1mg in the morning and 1 mg in bedtime) Please avoid driving during these time.
3. you can use estazolam for 4-6 weeks . If is still doesn't work than you should consult psychiatrist to start another antidepressant only after physical examination.
4-5. To my opinion you should firstly change diazepam to estazolam and after 2 weeks if you have no improvement you should start to use diltiazem instead of nifedipine with the above dosage. Please control your blood pressure during these time.
6.With regards to PPI's use To my opinion you should continue with double dosage in the morning and in bedtime up to 6 months from the first day of treatment.
After that time you will use single of PPI's dosage in the evening.
It is really important to avoid stress during these time because stress trigger you symptoms.
Hope it was helpful to you!
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr.Klerida,
Your answers are so clear and complete. It is is really really very helpful!
May I ask one more question? If all these medication adjustments don't work, do you know there is a kind of treatment called "Botox Injection". It directly injects Botox into the muscle of esophagus to make it relax. Do you think it applies for my situation?
MY greatest thanks!
Have a nice weekend.
XXXX
Your answers are so clear and complete. It is is really really very helpful!
May I ask one more question? If all these medication adjustments don't work, do you know there is a kind of treatment called "Botox Injection". It directly injects Botox into the muscle of esophagus to make it relax. Do you think it applies for my situation?
MY greatest thanks!
Have a nice weekend.
XXXX
Brief Answer:
Please follow,,,
Detailed Answer:
Hi back,
Botulinum toxin or botox injection is use is spasctic muscles of teh esophagus.
In clinical practice it is used often in cases like Achalasia of the esophagus. In this cases the spastic muscles of the esophagus can be treated with botox injection.
However toxinum botulinum in cases such your is reserved for patients who have delayed transit of the food or incomplete lower esophageal sphincter relaxing.
Usually it is applied in patients which have dysphagia.
So if you will not have improvement after medical therapy and dysphagia will start than you can use Botox injection.
Hope it was helpful to you.
Dr.Klerida
Please follow,,,
Detailed Answer:
Hi back,
Botulinum toxin or botox injection is use is spasctic muscles of teh esophagus.
In clinical practice it is used often in cases like Achalasia of the esophagus. In this cases the spastic muscles of the esophagus can be treated with botox injection.
However toxinum botulinum in cases such your is reserved for patients who have delayed transit of the food or incomplete lower esophageal sphincter relaxing.
Usually it is applied in patients which have dysphagia.
So if you will not have improvement after medical therapy and dysphagia will start than you can use Botox injection.
Hope it was helpful to you.
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Klerida,
Your explanations are very clear and helpful as always!
To be honest, the difficulty I'm facing is that I can't find a physician who knows much about esophageal spasm here in Canada. Last year when my symptoms were suddenly unexpected well controlled by taking diazepam, it was because an open-minded psychiatrist prescribed me with this medication according to the information I searched on the internet. Before that I've seen several good GI and ENT doctcors but they have little experience in esophageal spasm. I was tortured so much by the symptoms all the time and can't get solutions, so I started having suicidal thoughts and was therefore sent to the hospital by my family doctor to be daily treated by a psychiatrist. He tried me with several kinds of anti-depressants without any effect. His conclusion is that my mental problem was actually due to my intolerable physical symptoms. Although he has little experience in esophageal spasm too, but he is so kind and open-minded and prescribed me diazepam according to the information I searched. The magic happened. My symptoms were immediately well controlled the second day after taking diazepam and I can do all the normal things - taking classes, working, travelling, and lead a happy life with my daughter for a whole year, until it reoccurred again triggered by the stomach flu I caught in this March.
Sorry I bothered you with such a long story. I think myself very fortunate to reach a doctor like you who really knows about esophageal spasm and GERD.
With the above situation, may I ask you one more question? If estazolam and diltiazem still fail, what other medications do you think I can try to treat my esophageal spasm? And what about their dosage? Then I can consult with my physician about them to have a try.
I think myself really have bothered you with too many questions. But you're just so professional, helpful and kind, and you don't know how thankful I am to you!
XXXX
Your explanations are very clear and helpful as always!
To be honest, the difficulty I'm facing is that I can't find a physician who knows much about esophageal spasm here in Canada. Last year when my symptoms were suddenly unexpected well controlled by taking diazepam, it was because an open-minded psychiatrist prescribed me with this medication according to the information I searched on the internet. Before that I've seen several good GI and ENT doctcors but they have little experience in esophageal spasm. I was tortured so much by the symptoms all the time and can't get solutions, so I started having suicidal thoughts and was therefore sent to the hospital by my family doctor to be daily treated by a psychiatrist. He tried me with several kinds of anti-depressants without any effect. His conclusion is that my mental problem was actually due to my intolerable physical symptoms. Although he has little experience in esophageal spasm too, but he is so kind and open-minded and prescribed me diazepam according to the information I searched. The magic happened. My symptoms were immediately well controlled the second day after taking diazepam and I can do all the normal things - taking classes, working, travelling, and lead a happy life with my daughter for a whole year, until it reoccurred again triggered by the stomach flu I caught in this March.
Sorry I bothered you with such a long story. I think myself very fortunate to reach a doctor like you who really knows about esophageal spasm and GERD.
With the above situation, may I ask you one more question? If estazolam and diltiazem still fail, what other medications do you think I can try to treat my esophageal spasm? And what about their dosage? Then I can consult with my physician about them to have a try.
I think myself really have bothered you with too many questions. But you're just so professional, helpful and kind, and you don't know how thankful I am to you!
XXXX
Brief Answer:
Please follow. ..
Detailed Answer:
Dear XXXXXXX
I feel sorry about all your history and the problems with medical services that you are facing.
Firts of all I belive and hope too that your symptoms will improve after medical treatment.
Otherwise if your symptoms will not improve after estazolam and diltiazemi plus PPIs drugs ,you can perform botulinum toxin.
But in this case you should find an experienced endoscopyst gastroenterologist to do Botox injection.
Wish you fast recovery. Remember to avoid stress and enjoy your life.
Dr.Klerida
Please follow. ..
Detailed Answer:
Dear XXXXXXX
I feel sorry about all your history and the problems with medical services that you are facing.
Firts of all I belive and hope too that your symptoms will improve after medical treatment.
Otherwise if your symptoms will not improve after estazolam and diltiazemi plus PPIs drugs ,you can perform botulinum toxin.
But in this case you should find an experienced endoscopyst gastroenterologist to do Botox injection.
Wish you fast recovery. Remember to avoid stress and enjoy your life.
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr.Klerida,
No words can express my thanks to you - your sympathy and professionalism.
I would follow the instructions and avoid stress as you mentioned several times.
My best best wishes to you!
XXXXX
No words can express my thanks to you - your sympathy and professionalism.
I would follow the instructions and avoid stress as you mentioned several times.
My best best wishes to you!
XXXXX
Brief Answer:
Please follow...
Detailed Answer:
Dear XXXXXXX
I am happy to know that it was helpful to you.
If you have other concerns in the future please write me.
I would also like to know how is going your symptoms in the future.
Wish you fast recovery.
Dr.Klerida
Please follow...
Detailed Answer:
Dear XXXXXXX
I am happy to know that it was helpful to you.
If you have other concerns in the future please write me.
I would also like to know how is going your symptoms in the future.
Wish you fast recovery.
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Klerida,
I am so much touched. You are really so responsible and a doctor who would like to spend time to accumulate professional experiences, besides your great sympathy towards patients.
Sure I'd keep you updated about my progress. My email is YYYY@YYYY . How can I reach you in the future after this on-line consultation is closed?
FYI. I've also tele consulted with an experienced GI doctor who have seen many cases of reflux in my home country. The medical equipments and medications are not so good there, but there are more similar cases he has seen due to the larger population in my home country.
Therefore, I'd like to share some of his opinion just for your reference:
1. Basically he has the same suggestion for me as you to change from Diazepam to Estazolam, and the importance to avoid stress.
2. He mentioned another medication named "Pinaverium" which is also a calcium channel blocker that I can try.
3. He said dilitiazem may have similar effect as nifedipine. Since nifedipine doesn't work for me, he said that it is possible that dilitiazem may not work for me too.
4. He mentioned a medication "Deanxit". He said it's a very safe medication and can be a good supplement when taking together with other effective medications.
5. Regarding Botox injection, he said it would produce anti-body and may not be a long-term solution.
I hope you won't feel offensive for me to write to you about another doctor's opinion, basically I believe open-communications between good doctors can help each other to improve their skills. I've also told him your advice to me.
Again, my email address is YYYY@YYYY and I would for sure to keep you updated about my progress. Could you give me your email so that I can write to you in the future.
Under this desperate situation, you give me more confidence and hope alghough you are far away in Europe and we've never known each other.
My greatest thanks and best wishes for you.
XXXX
I am so much touched. You are really so responsible and a doctor who would like to spend time to accumulate professional experiences, besides your great sympathy towards patients.
Sure I'd keep you updated about my progress. My email is YYYY@YYYY . How can I reach you in the future after this on-line consultation is closed?
FYI. I've also tele consulted with an experienced GI doctor who have seen many cases of reflux in my home country. The medical equipments and medications are not so good there, but there are more similar cases he has seen due to the larger population in my home country.
Therefore, I'd like to share some of his opinion just for your reference:
1. Basically he has the same suggestion for me as you to change from Diazepam to Estazolam, and the importance to avoid stress.
2. He mentioned another medication named "Pinaverium" which is also a calcium channel blocker that I can try.
3. He said dilitiazem may have similar effect as nifedipine. Since nifedipine doesn't work for me, he said that it is possible that dilitiazem may not work for me too.
4. He mentioned a medication "Deanxit". He said it's a very safe medication and can be a good supplement when taking together with other effective medications.
5. Regarding Botox injection, he said it would produce anti-body and may not be a long-term solution.
I hope you won't feel offensive for me to write to you about another doctor's opinion, basically I believe open-communications between good doctors can help each other to improve their skills. I've also told him your advice to me.
Again, my email address is YYYY@YYYY and I would for sure to keep you updated about my progress. Could you give me your email so that I can write to you in the future.
Under this desperate situation, you give me more confidence and hope alghough you are far away in Europe and we've never known each other.
My greatest thanks and best wishes for you.
XXXX
Brief Answer:
Please follow. .
Detailed Answer:
Hi back,
It is not a problem for discussing your issues with another doctor.
In my clinical practice I prefer to work on group and discuss rare cases with my colleague.
My email adress is YYYY@YYYY . You can write me or send me a direct queries on HCM.
With regards to the medication that the other doctor has mentioned , they may be really useful but I don't have experience with them this is why I didn't mentioned it to you.
Hope it was helpful to you.
Dr.Klerida
Please follow. .
Detailed Answer:
Hi back,
It is not a problem for discussing your issues with another doctor.
In my clinical practice I prefer to work on group and discuss rare cases with my colleague.
My email adress is YYYY@YYYY . You can write me or send me a direct queries on HCM.
With regards to the medication that the other doctor has mentioned , they may be really useful but I don't have experience with them this is why I didn't mentioned it to you.
Hope it was helpful to you.
Dr.Klerida
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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