how do I get this under control?

[ccunurse]

I am a 48 year old with a long standing history of GERDS,IBS, Ulcers and have had esophogitis, gastritis, gastroenteritis. I started having severe chest pain about a year ago and underwent a cardiac stress test, cardiac cath, in which the cardiologist feels that I have a nutcracker esophogus along with some leaking valves, hypertension. The stress showed some ischemia and hence the cardiac cath but that was normal. He prescribed nitro for the chest pain along with taking toprol xl, lotrel to control the htn, and he couldn't rule out coronary spasms all together but with my history of esophogitis, gerds,ulcers etc.. he feels that this is the best treatment. I also see a internist who recently did a EGD and found that I did not have Barrett's esophogus but some scarring and inflammation. I go through this every few months with the spasms, the intense reflux, abdominal pain etc.. I wind up off work for several days because I can't get it under control. How do I do this? I am tired of going through this every time I turn around. I have changed my eating habits, my sleep habits, also tried to decrease my stress level which is difficult since I work in critical care. Any suggestions on what else I can do?

[Andy78]

A related discussion, Esophogus problems was started.

[ccunurse]

thank you for your advice. I will take it up with my physician which I see tomorrow. It always helps to get another view of things.

[Kevin Pho, MD]

You have already gone through a pretty comprehensive evaluation. One test that may be helpful would be a 24-hr pH study to document the presence of GERD.  If you continue to have GERD despite the fundoplication, you may want to explore whether a revision is a possibility.  

Some studies have shown that long acting calcium channel blockers (i.e. diltiazem) relieves chest pain associated with nutcracker esophagus.  Other medications that may have some utility would be trazodone and imipramine.  You may want to discuss these 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.

Thanks,
Kevin, M.D.

[ccunurse]

Oops forgot to mention that I also underwent a lap nissen fundalplication back in 1994.