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I am a 23 year old female and was recently diagnosed with GERD and diffuse esophageal spasm after having an x-ray, barium swallow, schazki ring removal and balloon stent, endoscopy, and an esophageal manometry. I am now on medication for the esophageal spasms that lower my blood pressure but my blood pressure is low from genetics. Sometimes I get very dizzy and it has gotten to the point that I don’t feel comfortable driving. From my research and speaking to relatives in the medical field, being hospitalized and speaking to the hospital doctors, and meeting with my gastroenterologist, it seems that this might be the best case scenario, and that it might never get better. I have read about antidepressants helping rather than heart pressure medication, but my doctor said he doesn’t think it would help and if the heart medication is helping the spasms that I should stick with it. I’d like a second opinion.

It appears you are suffering from diffuse esophageal spasms but also have low blood pressure. Calcium channel blocks and nitrates (both heart medications) have been proven to effectively decrease the amplitude of diffuse esophageal spasms. These medications are generally well tolerated but may lower the blood pressure of patients. Unfortunately, it appears that you have low blood pressure and these medications are giving you symptomatic hypotension. If you feel uncomfortable driving because of dizziness, it may be necessary to explore alternative treatment options.

The antidepressant you are referring to, imipramine (a tricyclic antidepressants) is not indicated for treating diffuse esophageal spasm. Instead, it may be used as a last resort to treat unexplained chest pain. Your best alternative if calcium channel blockers and nitrates are intolerable is botulism injection above the lower esophageal sphincter.