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Gastroenterology (Expert Forum)
PVCs, Belching, and Indigestion after eating
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
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.
PVCs, Belching, and Indigestion after eating
by gismatrix, Aug 06, 2006 12:00AM
Hello Doctor,
I am a 33 year old white male living near Pittsburgh, PA. My problems all started in February of this year when I started having episodes of SVT. I was evaluated and put on beta blockers until I had another bad episode in April. These episodes happened either during or within an hour or so of eating (usually dinner). I had an ablation in May, but still noticed that after I would eat I my heart rate would be elevated for up to two hours after eating, but no SVT would occur. (I gave up caffeine, alcohol and sweets at this point). In late June I started getting PVCs and serious indigestion to go along with the elevated heart rate after eating. Some burning like chest pains (left side and back) also occur. Anything with high carbs or sugar would make my symptoms much worse (always have had no trouble with sugar and my fasting sugar is in upper normal range). After about two hours the symptoms would almost diminish completely.
I went my GP and he sent me to a gastro to have an upper endoscopy done. The results were gastric and duodenal ulcers, gastritious and Grade A reflux/espophogitis. No H. Pylori and biopsies were benign. I was put on Protonix. In the next two weeks my SVT returned, so I had to have a second ablation procedure. My stomach problems continued to get worse while waiting to have this procedure, so I was switched to Nexium. The procedure (July 25th) caused a PE which has since resolved and I am on warfarin now for the next few months. Throughout this ordeal I have lost a considerable amount of weight (am 6’4” and went from 270 down to 210 now). I have been eating significantly less, and less carbs/sugars as they seem to exacerbate my symptoms. I also have to belch constantly after eating…sometimes belching will subdue the palpitations and indigestion pain for a short while.
I have had an abdominal CT (June) and ultrasound (a week ago) both which found a 4mm cyst in the upper part of my liver and a larger than normal sigmoid colon. Nothing else remarkable. My heart has been evaluated and tested (echo/MRI/stress test/etc…) and has been deemed normal. I have not had any fecal tests but notice pepper like flakes…assuming this is blood from the ulcers. Bowel movements are not regular, sometimes I cant go for a day or two. I have a fear of eating now and would just like to get this thing figured out so I can get back to a normal life.
1. What additional tests should I have done at this point?
2. Why do you think the sudden onset of these problems? Why does sugar (cake, pie) cause me such problems where it did not used to before?
3. Is there a connection with the PVCs and these ulcers/gastro problems? I sometimes have these PVCs during or after exercise but never the frequency that I have after eating most foods.
4. Is there any other medicine in addition to the Nexium you could recommend that might help alleviate my symptoms?
5. Is it safe to be on the warfarin?
Thank you
I am a 33 year old white male living near Pittsburgh, PA. My problems all started in February of this year when I started having episodes of SVT. I was evaluated and put on beta blockers until I had another bad episode in April. These episodes happened either during or within an hour or so of eating (usually dinner). I had an ablation in May, but still noticed that after I would eat I my heart rate would be elevated for up to two hours after eating, but no SVT would occur. (I gave up caffeine, alcohol and sweets at this point). In late June I started getting PVCs and serious indigestion to go along with the elevated heart rate after eating. Some burning like chest pains (left side and back) also occur. Anything with high carbs or sugar would make my symptoms much worse (always have had no trouble with sugar and my fasting sugar is in upper normal range). After about two hours the symptoms would almost diminish completely.
I went my GP and he sent me to a gastro to have an upper endoscopy done. The results were gastric and duodenal ulcers, gastritious and Grade A reflux/espophogitis. No H. Pylori and biopsies were benign. I was put on Protonix. In the next two weeks my SVT returned, so I had to have a second ablation procedure. My stomach problems continued to get worse while waiting to have this procedure, so I was switched to Nexium. The procedure (July 25th) caused a PE which has since resolved and I am on warfarin now for the next few months. Throughout this ordeal I have lost a considerable amount of weight (am 6’4” and went from 270 down to 210 now). I have been eating significantly less, and less carbs/sugars as they seem to exacerbate my symptoms. I also have to belch constantly after eating…sometimes belching will subdue the palpitations and indigestion pain for a short while.
I have had an abdominal CT (June) and ultrasound (a week ago) both which found a 4mm cyst in the upper part of my liver and a larger than normal sigmoid colon. Nothing else remarkable. My heart has been evaluated and tested (echo/MRI/stress test/etc…) and has been deemed normal. I have not had any fecal tests but notice pepper like flakes…assuming this is blood from the ulcers. Bowel movements are not regular, sometimes I cant go for a day or two. I have a fear of eating now and would just like to get this thing figured out so I can get back to a normal life.
1. What additional tests should I have done at this point?
2. Why do you think the sudden onset of these problems? Why does sugar (cake, pie) cause me such problems where it did not used to before?
3. Is there a connection with the PVCs and these ulcers/gastro problems? I sometimes have these PVCs during or after exercise but never the frequency that I have after eating most foods.
4. Is there any other medicine in addition to the Nexium you could recommend that might help alleviate my symptoms?
5. Is it safe to be on the warfarin?
Thank you
Doctor's Answer
by Kevin Pho, MD, Aug 07, 2006 12:00AM
, Aug 07, 2006 12:00AM
To answer your questions:
1) You have had a pretty comprehensive workup already. To further evaluate the stomach issues, a 24-hr pH study or gastric emptying scan can be considered to further evaluate for GERD or gastroparesis. I cannot recommend any further testing for your heart symptoms. If it recurs, another cardiology opinion can be obtained.
2) Difficult to say. I am not aware of a clear disease that would connect these two symptoms.
3) I am not aware of a specific disease that links PVCs with ulcers.
4) If GERD or an ulcer continues to cause symptoms, adding an H2 blocker like Zantac or Pepcid may help.
5) This is a risk/benefit question. You have had a PE as well as ulcers. The coumadin will increase the risk of bleed from the ulcers. Stopping the coumadin will increase further PE risk. If your doctor feels it is safe to continue on coumadin, you need to be aware of this increased bleeding risk. If this risk becomes too high, an IVC filter placement can be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
1) You have had a pretty comprehensive workup already. To further evaluate the stomach issues, a 24-hr pH study or gastric emptying scan can be considered to further evaluate for GERD or gastroparesis. I cannot recommend any further testing for your heart symptoms. If it recurs, another cardiology opinion can be obtained.
2) Difficult to say. I am not aware of a clear disease that would connect these two symptoms.
3) I am not aware of a specific disease that links PVCs with ulcers.
4) If GERD or an ulcer continues to cause symptoms, adding an H2 blocker like Zantac or Pepcid may help.
5) This is a risk/benefit question. You have had a PE as well as ulcers. The coumadin will increase the risk of bleed from the ulcers. Stopping the coumadin will increase further PE risk. If your doctor feels it is safe to continue on coumadin, you need to be aware of this increased bleeding risk. If this risk becomes too high, an IVC filter placement can be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Google and find a list of acidic food versus alkaline food,and food you should avoid if acid reflux is a problem for you.
You can also take note of what you eat,when you eat and the consequences of such so you can finetune your lifetstle and diet to avoid discomfort.
Nexium and Protonix of the world could shut down too much of the stomach acid production to the extent when you eat again,you suffer from too little acid to digest your food and poorly digested food would be passed on to the intestines and mingle with bacteria to form gas,and cause infatulence.
Also medication containing MG would cause diarhea while medication containing AL would cause constipation and without moving your bowel,harmful bacteria could built up in your body causing more gas,this catch 22 situation just goes on and on.
Ideally we should avoid alcohol,spicy,oily,greasy food and dairy product and caffeine and soda ,chocolate ,nuts etc etc and leave a spartan life of boiled rice,water,boil lean meat and fish ,veggies and wonder WHERE IS THE FUN OF EATING?
I can't imagine that the PVCs are connected to my eating, but perhaps you are right about the bacteria... I was tested for H. Pylori so I assume you mean the normally "good" bacteria as potentially being in too high a number.
I have this pain that is in the left side of my chest and radiates through to my back... along with the PVCs. I just wish there was something I could do to alleviate these symptoms.
Thanks
I still have pvcs and belching/stomach pain after eating.
I wonder if the Nexium is causing too little acid like you said...
I am still losing weight unintentionally and that scares me.