Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: abdominal pain, nausea, fainting

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Digestive


I've been suffering from epigastric pain, awakening at night
short of breath, extreme dizziness and extreme nausea. Sometimes I have no pain, only the shortness of breath, nausea and dizziness. I fainted for the first time the other night after an episode.

Last night I awakened with the squeezing epigastric pain and extreme shortness of breath. I also felt very weak. It finally passed and I went back to sleep. I find that I awaken extremely nauseated in the mornings after these episodes, but the nausea subsides after I get up and move around a little.

I've had a normal upper GI and normal ultrasound. I just started taking prevacid in the past two weeks for heartburn and it's not helping. The other night it was so bad I thought I was having a heart attack. The pain was going into my left shoulder, down my arm and my left hand was tingling. I've also been having squeezing sensations in my back and a pressure sensation in my chest, throat; however, I went to the ER and had a normal EKG, but the symptoms were gone at the time. Today I hurt all over. Sore muscles. The nausea in the mornings is so extreme that I dread waking up in the mornings. I feel so weak and shaky for the first 15 minutes I'm awake. Just feel kind of under the weather constantly.

I take a beta blocker for brady-tachy syndrome, am having sleep apnea, just recently diagnosed, but I do not snore and am actually under weight, also, I have abnormal EEGs, but different physicians make different diagnoses. I really need to get a grip on what's happening to me. Any ideas?

I'm willing to travel anywhere to get to the bottom of this.


_

Dear Brooke,
I read your letter with interest. I wonder how long you have had these symptoms and whether they have changed in severity. My initial thought was that you had esopahgeal reflux and possibly aspiration as the cause of your epigastric pain, shortness of breath,and nausea. If you have reflux, the beta blocker may be contributing to your symptoms. Also, the possibility of concurrent gastroparesis must be considered.

I suggest that the next step be an esophageal motility study with 24 hr pH probe test. You should also have a gastric emptying study.

While you await the tests, I would suggest that you consider lifestyle modifications to reduce the presumed esophageal reflux.
These changes include
1) eating 3 meals, no snacks
2) stop smoking, avoid alcohol, coffee, tea, fatty foods, cola, peppermint, chocolate
3) do not lie down for three hours after eating
4) sleep with the head of your bed elevated approx 6 inches
5) try over the counter H2 receptor antagonists e.g. Tagamet HB, pepcid AC before going to sleep.

This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.

If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of complex gastrointestinal disease by calling the Henry Ford Physician Referral Line at (800)653-6568.
HFHSM.D.-rf
*keywords: esophageal reflux, gastroparesis, chest pain
0.3


 

[The Gastroenterology and Liver Diseases Forum]      [The Gastroenterology and Liver Diseases Forum Archives]