Aa
esophageal injury - thermal
HPI: 44 yr old male c/o intermittent midline back pain (between T9 & T11) and occasional green stool.
The back pain has been present for 3 years now. It is a 'soreness', and it does not radiate. There is no pattern to the episodes, but it usually manifests late in the day - it has never been present on rising. The frequency of the episodes varies greatly from a few times a month to months without pain.
The green stool was first noticed about two months ago. It started after a course of PPI and H2 blockers (used for the back pain). When the meds were discontinued the frequency and "brightness" of the green stool decreased, but it has not totally resolved. The stool is normal in consistency and odor, and blood has never been reported.
HX: There are no known medical problems. Pt's general health is excellent. Pt runs 6 miles / day, and weight trains in a gym (no heavy weights). T&A was the only surgery (1960s). Pt was a heavy coffee drinker (long time) but gave it up 11 months ago. No street drugs ever - no smoking ever. Height / weight appropriate. NO MEDS currently.
FHX: Both parents are living and healthy. Father has mild HTN, and mother is without medical problems.
Injuries: On three separate occasions (first 3 yrs ago) pt accidently swallowed 'hot' coffee (not boiling but hot / no more than a mouthful). After each incident back pain was appreciated for a few days. GI cocktail and H2 blockers did nothing for the SX, but they did resolve on their own. Current 'back pain' is in same region.
Other: No vomiting or stomach upset has been reported. No change in BM pattern. No change in energy level. No epigastric pain, no painful swallowing, and no unusual 'tastes'.Lab work (CBC, CHEM 20) was normal in Jan 2008.
Questions: How readily can the esophagus / sphincter recover from thermal injury? Is thermal injury a risk factor for other GI disease? What was the likely damage from the injuries? Are there GI specific tumor markers? What is your recommendation?
The back pain has been present for 3 years now. It is a 'soreness', and it does not radiate. There is no pattern to the episodes, but it usually manifests late in the day - it has never been present on rising. The frequency of the episodes varies greatly from a few times a month to months without pain.
The green stool was first noticed about two months ago. It started after a course of PPI and H2 blockers (used for the back pain). When the meds were discontinued the frequency and "brightness" of the green stool decreased, but it has not totally resolved. The stool is normal in consistency and odor, and blood has never been reported.
HX: There are no known medical problems. Pt's general health is excellent. Pt runs 6 miles / day, and weight trains in a gym (no heavy weights). T&A was the only surgery (1960s). Pt was a heavy coffee drinker (long time) but gave it up 11 months ago. No street drugs ever - no smoking ever. Height / weight appropriate. NO MEDS currently.
FHX: Both parents are living and healthy. Father has mild HTN, and mother is without medical problems.
Injuries: On three separate occasions (first 3 yrs ago) pt accidently swallowed 'hot' coffee (not boiling but hot / no more than a mouthful). After each incident back pain was appreciated for a few days. GI cocktail and H2 blockers did nothing for the SX, but they did resolve on their own. Current 'back pain' is in same region.
Other: No vomiting or stomach upset has been reported. No change in BM pattern. No change in energy level. No epigastric pain, no painful swallowing, and no unusual 'tastes'.Lab work (CBC, CHEM 20) was normal in Jan 2008.
Questions: How readily can the esophagus / sphincter recover from thermal injury? Is thermal injury a risk factor for other GI disease? What was the likely damage from the injuries? Are there GI specific tumor markers? What is your recommendation?
In your experience has back pain ever been associated with upper GI issues?
MEDICAL PROFESSIONAL
The recovery time would depend on the extent of the damage.
An upper endoscopy can be performed to determine the severity of the injury, or if there are any other reasons that can be leading to the symptoms.
There are blood tests that can suggest tumors (i.e. tumor markers), but they are generally not used for screening. If there is concern, an upper endoscopy would be the test of choice.
Other tests to evaluate to upper GI tract would be a gastric emptying scan or 24-hr pH study.
These options can be discussed with your personal physician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
www.kevinmd.com
An upper endoscopy can be performed to determine the severity of the injury, or if there are any other reasons that can be leading to the symptoms.
There are blood tests that can suggest tumors (i.e. tumor markers), but they are generally not used for screening. If there is concern, an upper endoscopy would be the test of choice.
Other tests to evaluate to upper GI tract would be a gastric emptying scan or 24-hr pH study.
These options can be discussed with your personal physician.
This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
www.kevinmd.com
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