If you have symptoms of dysmotility and GERD and are not getting better with cisapride alone or in combination with other drugs, that's alarming. In this case, your doctor should investigate why you are not getting better by doing further diagnostic tests.
An upper G.I. series can shed some light on what;s going on in your esophagus with swallowing, as well as how well your stomach is emptying. The scrambled egg test can also help to document the time it takes for the esophsgus to clear the tracer out, which will help your doctor to understand a little more about esophageal clearing. This test may also provide information on how quickly your stomach empties both solids and liquids.
This test is done using nuclear medicine. A nuclear medicine technician will play "chef," and sit down in the laboratory with a frying pan and make you scrambled eggs with technetium as a tracer. You will eat the eggs, then a gamma counter will be placed over your stomach after you've swallowed to follow the eggs on their journey through your G.I. tract. The test will determine how quickly the eggs leave your stomach. This test should only be done once ulcers, esophagitis, or tumors have been ruled out through endoscopy.
Many gastroenterologists believe, however, that there are no good tests to check gastric emptying or motility. If your gastroenterologist comes from this school, then she may decide to try a combination of drugs to see how well you respond. Atypical symptoms may warrant pH testing or manometry.
Certain tests need to be done properly to extract any useful information. For example, people who have difficulty swallowing need to be investigated for some sort of obstacle or obstruction in the esophagus. In this case, imaging tests need to be performed while you're in various positions, when the most stress is placed on the esophagus. Imaging tests should be done while you are upright as well as lying down. It's alsouseful to have an imaging test after you've had a soft drink, so your doctor can have a good look at the stomach when it's ballooning out.
If your symptoms persist despite treatment, and all other serious diseases, such as cancer, have been completely ruled out, then you may require surgery. In the case, a procedure known as fundoplication can be done to physically increase the pressure in your LES. This is definitely a last resort that shouldn't be attempted unless all treatment options have been tried.