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Esophageal Spasm and RLS

Posted: Fri Jan 18, 2019 6:26 pm
by stjohnh
Does anyone have esophageal spasm and RLS?

I ask because I am starting to think that esophageal spasm (currently unknown cause by doctors) may have as it's root abnormal iron metabolism, just like RLS.

I am a 71 year old guy with severe RLS. I started developing chest pains 6-9 months ago. Not particularly related to exercise, and over this period of time they have been steadily increasing in frequency and severity of pain. Pain lasts mostly 1/2-2 minutes, is in the center of my chest, and sometimes goes into my throat. I initially worried about my heart, but the lack of exercise relation, and a seemingly increasing relation to swallowing, made me think I had an esophagus problem. I saw my primary, who said it sounds like an esophagus problem but need to be sure it is not heart. Scheduled heart tests (all fine) and GI consultation (pending in about 10 days). I have noticed as well that the chest pains had been more frequent and severe in the evening and almost non-existent in the morning... just like RLS.

BUT !!! The problem is going away !! AND I had IV Iron infusions 6 weeks ago for RLS, and my RLS symptoms are going away... about the same time as the chest pains.

I did some research and people with iron deficiency anemia have a high incidence of esophageal spasm. Esophageal spasm is twice as frequent in women as men, just like RLS. Completely unknown currently why this association exists. It is not currently known to what extent esophageal spasm is caused by local abnormalities in the esophageal nerves or muscles vs brain control abnormalities of esophageal swallowing mechanisms.

Anyway, it seems possible, even likely, that esophageal spasm (which is what I think my chest pains are due to) have as the underlying problem abnormal iron metabolism. Seems to me an unlikely coincidence that my RLS and esophageal symptoms are resolving at the same time, and both about 4-6 weeks after my IV iron infusions.

Re: Esophageal Spasm and RLS

Posted: Fri Jan 18, 2019 7:57 pm
by Polar Bear
With regard to chest pain I was in A & E twice in the space of two years with suspected heart attack. The chest pain was very severe and lasted approximately 15 minutes and indeed went up into my throat. There was no pain of any sort during the time between these two incidents. Had the camera down etc.Turned out it was stomach/reflux and medication has it under control. Make no mistake the pain of reflux can be extremely severe.
Reflux was what I immediately thought of from your description. I see you are having a GI consultation very soon and it will be interesting to learn the result of any camera investigation.

Very interesting that your symptoms/spasms are resolving at the same time and following your IV iron infusion.

Re: Esophageal Spasm and RLS

Posted: Fri Jan 18, 2019 8:07 pm
by ViewsAskew
ALL THE TIME!!!!!

OK, that was hyperbole, but I do have it. And, now that you mention it, I had not had any in a long time, but in the last month, I've had them almost daily. That coincides with my low iron reading after the last infusion is wearing off.

Interesting...

Re: Esophageal Spasm and RLS

Posted: Fri Jan 18, 2019 8:12 pm
by Rustsmith
Odd you should mention this because I have had one or two episodes in the last few weeks of discomfort beneath the sternum at about the time that I was going to bed. The feeling was only there for about a minute and wasn't the crushing feeling I see described for heart issues and there were no other related sensations. I would have been concerned if it had lasted longer, but heart issues are not a problem in my family and I still run, although not as much as I did for many years.

As for the tie to iron levels, I stopped taking iron sulfate about a year ago because my ferritin levels were so high. I should be getting another test next month. It will be interesting to see where it is now and if it correlates with your theory.

Re: Esophageal Spasm and RLS

Posted: Fri Jan 18, 2019 8:57 pm
by stjohnh
Rustsmith wrote:Odd you should mention this because I have had one or two episodes in the last few weeks of discomfort beneath the sternum at about the time that I was going to bed. The feeling was only there for about a minute and wasn't the crushing feeling I see described for heart issues and there were no other related sensations. I would have been concerned if it had lasted longer, but heart issues are not a problem in my family and I still run, although not as much as I did for many years.

As for the tie to iron levels, I stopped taking iron sulfate about a year ago because my ferritin levels were so high. I should be getting another test next month. It will be interesting to see where it is now and if it correlates with your theory.


Steve,
Betty mentioned reflux, and while reflux has the same location pattern as some heart problems or esophageal spasm, reflux pain always lasts more than a few minutes. Heart pains can last in the range you and I have, but mostly are related to exercise.

As for the iron, I don't recall, did you have an iron workup? Most people with ferritins in the 200-500 range do not have excessive iron, but the ferritin is elevated for other reasons.

Re: Esophageal Spasm and RLS

Posted: Fri Jan 18, 2019 8:59 pm
by stjohnh
ViewsAskew wrote:ALL THE TIME!!!!!

OK, that was hyperbole, but I do have it. And, now that you mention it, I had not had any in a long time, but in the last month, I've had them almost daily. That coincides with my low iron reading after the last infusion is wearing off.

Interesting...


Ann, did you get a GI workup and definite diagnosis of esophageal spasm?

Re: Esophageal Spasm and RLS

Posted: Sat Jan 19, 2019 10:41 pm
by ViewsAskew
No - I never figured it mattered to get it diagnosed as I didn't think they could do anything about it. I have had them since my late twenties. Sometimes it is worse than others. Does anything else make your chest feel that way? Never occurred to me that it was something else. It isn't GERD - as I work through my fifties, I do get some reflux now, but never did until relatively recently. The spasms - heavens, the first time I was sure I was having a heart attack at age 26! Over the years it was relatively clear it was my esophagus doing it; I can usually get mine to relax with something very cold.

Re: Esophageal Spasm and RLS

Posted: Sat Jan 19, 2019 10:56 pm
by stjohnh
ViewsAskew wrote:No - I never figured it mattered to get it diagnosed as I didn't think they could do anything about it.


Mostly true, though if my theory is correct it could be treated with IV Iron.

ViewsAskew wrote: I have had them since my late twenties. Sometimes it is worse than others. Does anything else make your chest feel that way? Never occurred to me that it was something else.


Not much else in your case, since you have had it for years. If of short duration, could be various tumors affecting the esophagus. When I see the GI doc I will discuss all this with her. If my pains have continued to improve, I probably will not get the upper endoscopy and possible manometry she will likely recommend.

When will you be getting your next iron infusion? And which type of iron are you getting?

Re: Esophageal Spasm and RLS

Posted: Sun Jan 20, 2019 9:14 pm
by ViewsAskew
I have to make the appointment with the hematologist - I just receive the authorization in the mail yesterday, so I'll make the appointment tomorrow - hopefully they can see me soon. I think Buchfuhrer wrote Injectafer on the order. I don't have the results from the most recent blood tests - just had them Friday.

I recently have had some odd things going on. I have NEVER had low iron, though my ferritin has been very low. In the last year, I have low total iron, am bruising easily, I have widespread pain diagnosed as fibro (doesn't quite seem right to me), became hypothyroid, and have had a high SED rate, an ANA Screen that was positive (but negative antibodies for the common autoimmunes), and an ANA titer of 1:80. Serum ferritin actually went up 40 points from a few months prior- likely due to the sinus infection I had at the time.

Will be interesting to see what shows up this time!

Re: Esophageal Spasm and RLS

Posted: Sun Jan 20, 2019 9:41 pm
by stjohnh
ViewsAskew wrote:I have to make the appointment with the hematologist - I just receive the authorization in the mail yesterday, so I'll make the appointment tomorrow - hopefully they can see me soon. I think Buchfuhrer wrote Injectafer on the order. I don't have the results from the most recent blood tests - just had them Friday.

I recently have had some odd things going on. I have NEVER had low iron, though my ferritin has been very low. In the last year, I have low total iron, am bruising easily, I have widespread pain diagnosed as fibro (doesn't quite seem right to me), became hypothyroid, and have had a high SED rate, an ANA Screen that was positive (but negative antibodies for the common autoimmunes), and an ANA titer of 1:80. Serum ferritin actually went up 40 points from a few months prior- likely due to the sinus infection I had at the time.

Will be interesting to see what shows up this time!


Sounds like a head scratcher. Probably not a serious combination, but will need some other tests to be sure.

Re: Esophageal Spasm and RLS

Posted: Wed Jan 30, 2019 12:17 am
by leggo_my_legs
I get esophageal spasm. One trigger is eating too much ice cream too fast. Another trigger is taking an opioid without a significant amount of food with it! Now I know the feeling, but it's very painful, and every time it happens, it still makes me wonder if I'm having a heart attack even though I'm pretty sure I'm not, I'm always a little on guard when it happens. It radiates around my sternum and down my right arm.

If I catch it in time, I can stop it by eating some food quick. Before I learned that, it used to just get worse and worse, and go into my stomach, and last for around 15-20 min. I would be literally sweating and rolling around on the ground in severe pain. I would be in so much pain I wouldn't be able to stand up. It was awful. The first time that happened, and even a few other times, it got me an ambulance ride to the ER.

Re: Esophageal Spasm and RLS

Posted: Wed Jan 30, 2019 1:54 pm
by stjohnh
leggo,
Is there any relation to RLS? I.E. did you have esophageal spasm before you developed RLS? After RLS? How long? If your RLS is worsening, is the spasm worsening as well?

Is your iron status related to the spasm?