Persistent Diaphragm Spasms: A 10-Month Struggle for Relief

Persistent diaphragm spasm lasting for 10 months?

Hello Doctor: My symptoms began in March 2017, when I suddenly experienced persistent contractions of the diaphragm.
This is not the typical hiccup; the diaphragm contracts intermittently two to three times, or even more, and can last for 4 to 5 days.
In severe cases, it leads to continuous hiccups and belching, causing nausea and sometimes simultaneous belching and vomiting.
There are episodes where I feel a tightness in my airway, making it difficult to breathe.
This has occurred dozens of times, including while riding a bike or during work hours.
This condition significantly affects my ability to speak smoothly at work, as the diaphragm contractions interrupt my speech.

I do not have any bad habits such as smoking, drinking alcohol, or chewing betel nut.
My routine involves waking up at 7 AM and going to bed at midnight.
My diet is normal and moderate, avoiding fried, gas-producing, and bloating foods.
My bowel movements are regular, and I have no abdominal or gastric pain.
I have undergone endoscopy, X-rays, and ultrasound examinations, all of which showed no abnormalities.

The diaphragm contractions make me feel as if food is accumulating in my chest and abdomen and is not digesting properly.
After eating, I have to induce vomiting every night before bed to relieve discomfort.
I expel a large amount of gastric acid and the food I consumed that day.
I have tried fasting, but there was no improvement; the contractions still occur, leading to excess gastric acid, which causes discomfort in the esophagus and stomach.
Currently, I control my diet by eating small, frequent meals, which has reduced the frequency of episodes, but they can still occur randomly, with a maximum cessation period of three days.
The diaphragm contractions typically stop only when I fall asleep, and sometimes they continue upon waking up the next day.
The onset of these contractions usually occurs shortly after eating, and they can persist until the next day, leading to excessive gastric acid and symptoms of gastroesophageal reflux.

I have taken medications to suppress gastric acid, which alleviated the symptoms of excess gastric acid, but later caused digestive issues.
I still need to induce vomiting before bed to be able to sleep.
I have consulted both traditional Chinese medicine and Western medicine, including gastroenterology and neurology, but no cause has been identified.
The prescriptions I received were mainly for relieving bloating, aiding gastric emptying, muscle relaxants, or antiemetics, but these medications only address the symptoms and have been discontinued.

I would like to ask if you have any recommended methods or suggestions for referral to another specialty.
This issue has been affecting my life for a long time, and I would appreciate any advice or treatment options you could provide.

Mr. Fang, 20~29 year old female. Ask Date: 2018/01/16

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear M.
Fang, based on your condition, you may consider having a physician evaluate the use of antipsychotic medications or mood stabilizers, but these should only be used under a doctor's guidance.
Changhua Hospital cares about your health.

Reply Date: 2018/01/16

More Info

Persistent diaphragm spasms can be a challenging and distressing condition, as you've described. Your symptoms, which began in March 2017, indicate a significant disruption in your daily life, particularly with the episodes of diaphragm spasms leading to hiccups, nausea, and even vomiting. The fact that these spasms can last for several days and are exacerbated by eating is particularly concerning.

From a medical standpoint, diaphragm spasms can be caused by a variety of factors, including irritation of the diaphragm muscle, gastroesophageal reflux disease (GERD), or even neurological issues. Given that you've already undergone extensive testing, including endoscopy, X-rays, and ultrasounds, and that no abnormalities were found, it may be time to consider a multidisciplinary approach to your treatment.

Recommendations:
1. Gastroenterology Follow-Up: Since you have symptoms consistent with GERD, it may be beneficial to revisit a gastroenterologist. They can assess whether your acid reflux is adequately controlled and if further interventions, such as a trial of stronger proton pump inhibitors or even surgical options like fundoplication, might be appropriate.

2. Neurology Consultation: Given the nature of your symptoms, a neurologist may be able to provide insights into whether there is a neurological component contributing to your diaphragm spasms. Conditions such as myoclonus or other movement disorders could potentially be at play.

3. Physical Therapy: A physical therapist specializing in respiratory therapy may help you with diaphragmatic breathing techniques. Strengthening the diaphragm and learning to control your breathing can sometimes alleviate spasms.

4. Dietary Modifications: While you are already controlling your diet, consider working with a nutritionist who specializes in gastrointestinal health. They can help you identify any potential food triggers that may exacerbate your symptoms and suggest a tailored meal plan.

5. Stress Management Techniques: Stress can exacerbate gastrointestinal symptoms and muscle spasms. Techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) may help manage stress levels and reduce the frequency of your symptoms.

6. Medication Review: Since you have tried various medications with limited success, it may be worth discussing with your healthcare provider the possibility of trying different classes of medications. Muscle relaxants, anti-anxiety medications, or even certain anticonvulsants have been used in some cases to help manage muscle spasms.

7. Alternative Therapies: Some patients find relief through acupuncture or chiropractic care. While the evidence is mixed, these therapies may provide symptomatic relief for some individuals.

8. Regular Follow-Up: Given the chronic nature of your symptoms, regular follow-up with your healthcare providers is essential. Keeping a symptom diary may help identify patterns or triggers that could be useful in managing your condition.

Conclusion:
Your situation is complex and requires a comprehensive approach. It’s crucial to communicate openly with your healthcare providers about your ongoing symptoms and the impact they have on your quality of life. By exploring various specialties and treatment modalities, you may find a combination that provides relief. Remember, persistence in seeking care is key, and don’t hesitate to advocate for yourself in the healthcare system.

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