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Gastroenterology (Expert Forum)
Are my symptoms consistent?
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Are my symptoms consistent?
by JLAMB, Feb 14, 2003 12:00AM
I am a 33 year old male with a history of stress. I use alcohol less than moderately and quit a light/moderate smoking habit about 2 years ago. I have been taking Paxil for about 2 years. I rarely supplement with Xanax. Three days ago, while eating lunch, I experienced pain, not difficulty, in swallowing behind my sternum. The pain applies to solids as well as liquids of all temperatures. I also experienced the same localized pain when belching. The pain has since remained constant during those activities. When not eating, the chest/back pain has varied, from nonexistent while sleeping and relaxing, to significant during times of stress. I saw my primary care physician yesterday. She prescribed a fecal occult test for ulcers, an upper GI series, and Protonix, which I have taken once. I have experienced heartburn prior to this, maybe a dozen times in my life. It was very painful. This current pain feels like a low grade version of heartburn. My family has a history of gastric issues: hemmorhiods, haital hernia, polyps and ulcers. I've had a sigmoidoscopy, keep a high fiber diet and remain very vigilant. Bottom line, this latest issue is very new and came on very suddenly. I fully expect to be told that I have GERD, esophagitis or some other inflammation. I know that anything is possible. Given my age and the above information, does esophageal cancer sound probable? Thanks.
Doctor's Answer
by Kevin Pho, MD, Feb 14, 2003 12:00AM
, Feb 14, 2003 12:00AM
Hello - thanks for asking your question.
The symptom that you are describing is dyspepsia. There are many causes other than GERD that can cause this. You should definitely follow this up with your primary care physician.
Dyspepsia was defined as pain or discomfort centered in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium). Discomfort is a negative feeling that the patient does not interpret as pain, which can be characterized by or associated with fullness, early satiety, bloating, or nausea. Dyspepsia can be intermittent or continuous, and may or may not be related to meals.
Here are some diagnoses to consider:
Peptic ulcer disease — A peptic ulcer refers to a well defined raw area or sore where the mucous membrane of the stomach, the upper region of the small intestine (duodenum), or esophagus has been eroded or damaged by stomach acid and digestive juices. Some individuals with peptic ulcers have no apparent symptoms, while others may have severe symptoms. Depending upon the form of ulcer present or other factors, patients with symptomatic disease may experience burning, "gnawing," or "hunger-like" pain or discomfort, primarily in the upper middle region of the abdomen, that may worsen when the stomach is empty. Less commonly, pain or discomfort may be located in other abdominal regions, such as the upper left or upper right side of the abdomen.
Medication-induced dyspepsia — Dyspepsia can be associated with or aggravated by the use of certain medications (eg, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]). Thus, clinical evaluation typically includes a complete medication history.
Gastroesophageal reflux disease — Gastroesophageal reflux disease (GERD) is a disorder in which acid from the stomach flows back (refluxes) into the esophagus, causing irritation and sometimes damage to the lining of the esophagus. The most common symptom is frequent heartburn. Some patients have heartburn in combination with upper abdominal discomfort.
Biliary pain — Biliary pain (pain from the gallbladder or associated structures) is characterized by attacks of sudden, intense pain in the upper right or upper middle region of the abdomen that may last for one to several hours or more. Pain may extend to the back or between the shoulder blades and may be associated with vomiting, sweating, and restlessness. Episodes are usually separated by weeks or months.
Irritable bowel syndrome — Irritable bowel syndrome (IBS) is a chronic condition of the gastrointestinal tract. Its cardinal symptoms are abdominal pain and altered bowel habits, but these symptoms have no identifiable cause.
Stomach cancer — Although malignant or cancerous tumors of the stomach are an uncommon cause of chronic dyspepsia in the United States and other Western countries, the disease should be considered, particularly in patients over age 45 to 50 or those who have certain symptoms (known as "alarm symptoms"). These include unexplained weight loss; repeated vomiting; difficulty swallowing (dysphagia); anemia, and/or bleeding from the stomach; and the presence of an abdominal mass or swelling of the lymph nodes (
The symptom that you are describing is dyspepsia. There are many causes other than GERD that can cause this. You should definitely follow this up with your primary care physician.
Dyspepsia was defined as pain or discomfort centered in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium). Discomfort is a negative feeling that the patient does not interpret as pain, which can be characterized by or associated with fullness, early satiety, bloating, or nausea. Dyspepsia can be intermittent or continuous, and may or may not be related to meals.
Here are some diagnoses to consider:
Peptic ulcer disease — A peptic ulcer refers to a well defined raw area or sore where the mucous membrane of the stomach, the upper region of the small intestine (duodenum), or esophagus has been eroded or damaged by stomach acid and digestive juices. Some individuals with peptic ulcers have no apparent symptoms, while others may have severe symptoms. Depending upon the form of ulcer present or other factors, patients with symptomatic disease may experience burning, "gnawing," or "hunger-like" pain or discomfort, primarily in the upper middle region of the abdomen, that may worsen when the stomach is empty. Less commonly, pain or discomfort may be located in other abdominal regions, such as the upper left or upper right side of the abdomen.
Medication-induced dyspepsia — Dyspepsia can be associated with or aggravated by the use of certain medications (eg, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]). Thus, clinical evaluation typically includes a complete medication history.
Gastroesophageal reflux disease — Gastroesophageal reflux disease (GERD) is a disorder in which acid from the stomach flows back (refluxes) into the esophagus, causing irritation and sometimes damage to the lining of the esophagus. The most common symptom is frequent heartburn. Some patients have heartburn in combination with upper abdominal discomfort.
Biliary pain — Biliary pain (pain from the gallbladder or associated structures) is characterized by attacks of sudden, intense pain in the upper right or upper middle region of the abdomen that may last for one to several hours or more. Pain may extend to the back or between the shoulder blades and may be associated with vomiting, sweating, and restlessness. Episodes are usually separated by weeks or months.
Irritable bowel syndrome — Irritable bowel syndrome (IBS) is a chronic condition of the gastrointestinal tract. Its cardinal symptoms are abdominal pain and altered bowel habits, but these symptoms have no identifiable cause.
Stomach cancer — Although malignant or cancerous tumors of the stomach are an uncommon cause of chronic dyspepsia in the United States and other Western countries, the disease should be considered, particularly in patients over age 45 to 50 or those who have certain symptoms (known as "alarm symptoms"). These include unexplained weight loss; repeated vomiting; difficulty swallowing (dysphagia); anemia, and/or bleeding from the stomach; and the presence of an abdominal mass or swelling of the lymph nodes (