GI pain - Cause or Symptom?

[Elizabeth 4]

After 2 years of utter frustration, I was heartened by the posts I just found from Pete, Wally and Bluebottle. Their symptom descriptions are the closest I've found to my experience, and I'm desperate for answers. I have a history of GI problems and was thrown into the IBS "bucket" many years ago. My first "lurches", or jolts as I call them, were 8 or 9 years ago, but they were rare/isolated events. Two years ago I had an acute onset of diarrhea, jolts, tachycardia, dizziness, GI pain (LUQ/LLQ), and weakness.The acute phase lasted 8 weeks, during which I lost 25 pounds.I've had many tests (colonoscopy, endoscopy, 24hr urine for catecholamines, EKG, holter monitor, CT scans, screens for thyroid, glucose, blah blah blah). While stress certainly doesn't help, I don't believe it

[Elizabeth 4]

Hi Karen & Wally -
Well, aren't we the lucky threesome?  Unfortunately, there are many more of us out there with weird symptoms that can't be diagnosed or treated.  Anyway, I'm thinking we all have some sort of motility problem, and spasms that create various problems - jolts, pain etc.  Like Karen, I've learned over time that this won't kill me, but during some of the attacks all I do is pray and gasp.  I get the intense pain near the bra strap too, and also left upper chest, but heart problems have been ruled out.  I haven't had any motility tests though, so I'll be interested to hear what you find out.  
Lately I've been a little better, and not sure if its just better coping mechanisms or the added B complex and magnesium.  Have either of you tried any suppliments or diet changes that have helped?  
Karen, I've also wondered if there is a hormone element here.  Not as a cause, but perhaps an aggrivating factor.  Do your symptoms worsen before your period?  I'm going through peri-menopause and have major hormone fluctuations that seem to make things worse.  I suspect the dizziness might be connected to hormones, too.
Sorry you're both "sharing my pain", but glad to have company and people to talk to about these charming body habits!
-Elizabeth

[Kevin Pho, MD]

Difficult to say.  It may be possible that the spasm can irritate the vagus nerve - leading to a worsening of symptoms.  

Regarding the random nature of attacks, one option would be to consider a 24-hr pH study with esophageal motility - which may detect abnormalities over a longer period of time.  

With the diarrhea and dizziness, you can consider more uncommon diseases like carcinoid syndrome - which can be tested by a urine sample looking for the metabolic 5-HIAA.

If the tests remain negative, optimizing treatment for IBS can be done.  Antispasmodics are useful.  If there is a constipation-predominant picture, Zelnorm may be helpful as well.  

You can always consider a second GI opinion.  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.
http://www.straightfromthedoc.com

[KarenZ]

Hello:

I just happened upon this site while searching for esophageal spasms.  Going down the list of forum topics I spotted yours.  The timing of your posts has coincided with problems I'm having so I decided to reply to you both, and anyone else who wants to add something here.

I had my gallbladder removed and a hiatus hernia repaired laproscopically last year... both procedures where done in one fell swoop.  Immediately following surgery I began to experience terrible symptoms related to eating and drinking.  I had trouble swallowing for several months even with very soft small bites of food but this got better as time went on.  Worse, I experienced the "dumping" that Wally spoke of complete with horrible stomach distress and pain. I typically get a pretty bad headache while this is happeneing.  This happened with just about every meal I ate, seriously impacting my lifestyle.  Sometimes I would be in the bathroom for 20 - 30 minutes afterward.  After about 7 months, the dumping is now usually limited to the first meal of the day...no matter what time I eat the first meal.  (If I have to go out right after eating I elect to not eat until I get home because of what I know will happen...I know the location of most bathrooms at regular places I frequent)  Sadly, this has continued for me.

About 4 months ago I began to have horrific chest pain just below the braline on my chest.  These attacks come on slowly and build up in intensity over a minute or two, and they last between 5 - 10 minutes.  The feeling is as if someone has a vice grip around this area.  The pain is so intense that if it were closer to my heart I would think I was having a heart attack.  I usually get very warm and sweat profusely, sometime I feel dizzy and I definately am very anxious when this happens.  It's happened enough times now that I know I'll come out of it in 5 to 10 minutes and survive, but while it's  happening the pain is so intense that I am really frightened that I might die.  This has happened several time while I was driving and I had to pull over to the side of the road.  This is interesting to me...my youngest is 19 yo and when I have one of these attacks I immediately go into the Lamaze breathing routine I used during labor pains.  Just like I was back in the labor room 19 years ago!

These attacks can come once a day for two days in a row, or have 1 to 2 weeks in between them.  I wasn't thinking that it had anything to do with eating because sometimes I haven't eaten for hours before an attack.  Essentially, I can't predict when this is going to happen.  If I bend over in pain during an attack it usually feels worse so I try to avoid this while I am writhing in pain.  I am at a loss to help myself when this happens.  I just pray for it to be over.

I went to see a gastroenterolgist yesterday who wants me to have a cardiac stress test to rule out any heart problems first (I don't think I have a heart condition and he doesn't either but this is to make sure I don't as heart symptoms can manifest differently in women).  He thinks I may be having esophageal spasms.  He isn't sure if this is someting that happens after Haitus hernia repair surgery so I have to call my surgeon and inquire. Anyway, after the stress test he would like for me to have an esophageal motility test which I guess will determine if I am having spasms.  I think he said they will put a wire or something down my throat...not looking forward to that.  In the meantime he gave me a script for Colestipol HCL hoping it will help to prevent the "dumping". If I understood it correctly, he said it will bind to the bile that is normally held in the gallbladder (which I don't have anymore).

I can definately sympathize with both of you.  These problems are pretty awful and seriously impact on quality of life.  Going out to eat or eating at friends homes can be a very embarassing experience.  I need to keep a good supply of reading material in the bathroom because I spend so much time in there!  And of course, no one really wants to hear about these kinds of problems. Discussing these problems does not make for interesting or desirable conversation...even among the best of friends!  I sure you can relate to that!!!

[Wally1470]

Hi Karen, I know what you are going through.  I have found that if I lie down, the symptoms go away quicker.  In one of the descriptions of "dumping" I've found, it mentions the need to lie down.  That is me.  It has been almost ten days and I haven't had a major incident.  I temper my eating with drinking and do each one exclusive of the other and it seems to have worked to some extent.  For me, I also have found that if I wait  to eat at least an hour after rising in the morning, things are much better.  Dinner usually is of no consequence because of a couple of beers.  Now the question:  does the alcohol relax the stomach so that no spasm will take place?  My other question is: what value are the numerous tests?  When all is said and done, many of the people here seem to get no relief after diagnosis and medication.  What are we doing?  Is there no hope?  Good luck to you.

[Elizabeth 4]

My symptoms don't seem to be tied to eating at all - I can have them with a completely empty stomach at any time night or day.  In fact, the jolts rarely happen after eating.  I don't really drink, but I'm willing to have a beer if it helps!  :o)
You mentioned that you can go a week without symptoms if you watch what and how you eat.  Aside from the liquids, what else about the eating pattern/foods makes a difference?  Do you ever get dizzy when you have symptoms?  What do your spasms feel like?
Thanks for your help, and I wish you good health too!

[Wally1470]

Hi Elizabeth.  I have maybe gotten dizzy twice during the symptoms with my body experiencing a seeming escalation in heat (temperature).  The type of food seem to matters less than how I eat and what "state" I'm in and I don't mean Oklahoma.(JOKE?)  Gulping seems to have a hand in the symptoms as I swallow too much air.  I went through a spell some 12 years ago when everything I ate (with liquids) would run through my system within 50 minutes after eating.  I was experiencing some turmoil in my life (divorce 7 years). Once that was resolved, the symptoms bascially disappeared unless I eat a large meal on a very empty stomach.  Now I have the opposite, the meal seeming to lay there and build up pressure.  Of course the same causes seem present in this instance also....tension, emotional upset, large meal, gulping, not chewing my food properly and swallowing food that is too large.  I really feel that this is another stage and will eventually disappear.  I do take Primadophilus Bifidus every morning and a natural anti reflux agent called Digest Gold which works well.  I will take Mylanta before bed if I eat something which might cause GERD but on nights when I forgot to take it I experienced no GERD.  My "symptoms" begin with a fullness in my upper stomach and then the spasms begin in cycles with rapid ones then slowing down such as: patpatpatpatpatpatpat....patpat.....patpat.....patpat.....pat.....pat.  A new cycle might or might not start again.  If I walk around or exert myself in some way, the cycle abruplty stops.  Usually after the cycle stops or right before, I feel a need for a BM and then hunger.  That is why I believe that the whole thing relates to "dumping".  I have also found that if I eat and sit in a chair with my torso bent at the waste at a 90 degree angle to the right, I can experience symptoms.  I can bring on the symptoms on my own.  I hope my rambling provides you with some information for comparison.  Be Well!

Wally

[Wally1470]

Hi Elizabeth.  I would like to ask you a question.  How close do your symptoms occur related to eating?  For instance, mine usually take place within 60 minutes of eating.  Yesterday I had an attack 50 minutes after eating.  I find that if I drink something with my meal. the occurance of the "spasms" is much much greater than if I drink something after the meal. I am beginning to think that it has to do with "dumping".  Nonetheless, I can go a week without symptoms and feel great if I watch what and how I eat.  One more point.  I have a few beers with dinner and only once have I had symptoms at dinner.  Do you drink any alcohol at all?  I believe that the alcohol sedates whatever causes the spasms.

Good luck and I wish you good health.