Un- explained chest pain

I am a 36 year old female smoker.  I have had chest pain for the past five years.  The pain lasts about 1 to 2 hours and sometimes I can have it twice in one day and sometimes I do not have it for a couple of months.  It is normally when I am a bit stressed. I have been told by my GP that is was a hiatas hernia, then indegestion then told Gall Stones (which I did have) I have my gallbladder removed 18 months ago and am still getting the pains.  The GP then said it was scar tissue, now he is saying it could be chest wall pain.  I have had heart tests which have ruled out problems with my heart..   Nurofen and paracetemol along with antacids do not work the only thing which works occassionaly are hot baths and hot water bottles.  I am in excellant health inbetween these episodes and excersie and watch my diet.  The pain starts with a dull ache/gurguling sensation  on my right hand side of my stomach not chest (roughly where be gallbladder was this pain is quite bearable but i know that within minutes I will get a crushing squeezing pain in the centre of my chest which radiates around my back but still mainly sticking to the right hand side of my body.  Sometimes I find it hard to breath and get a tingling sensation in both my hands and an achey (achy) neck (but not all the time)  the pain on a scale to 1-10 is 9 and i am unable to do anything i can not lie down or bend down as my stomach feels all knotted up and slightly swollen, I have no sympymtons of wind or acid.  I know you will not be able to diagnose over the net, but I would be very grateful if you could reccommend any tests I should have done, (as my GP is offering none) and any over the counter drugs I could take.  I have asked my GP if it could be panic attacks but he thinks this is unlikely as I can not feel my heart racing when it happens.  He has told be to take Buscopan which are muscle spasm tablets but they have not helped either. I have also had an ultra-sound test after the gall-bladder sugery in case some stones were left, this was all clear,  also I have had a blood test which I think was for the same thing. I am sorry if this letter jumps around a bit but I am trying not to miss anything out, I look forward to hearing from you.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note epigastric pain.  Your gall bladder was removed.  Heart tests were normal.  

Causes include chest wall pain (i.e. costochondritis), dyspepsia (inflammation of the esophagus or stomach or peptic ulcer disease), anatomical diseases (i.e. cancer), or pancreatitis.  

If you had your gall bladder removed, then Sphincter of Oddi dysfunction (SOD) should be considered.  Pain from this is amplified after gall bladder removal.

I would consider an upper endoscopy (if not already done).  This can evaluate for ulcers, inflammation or masses in the stomach.  

If negative, then an abdominal CT scan, along with amylase and lipase should be done to evaluate the pancreas.

To evaluate for SOD, you may want to consider a fatty meal ultrasound study or hepatobiliary scintigraphy.  These tests should be coordinated with a gastroenterologist.

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.

[schaeff]

Read about sphincter of oddi dysfunction on the net and see if what is described fits with your experience.

Here's an article to get started:

http://www.joplink.net/prev/200111/04.html

Best wishes.

[samdan]

THANKYOU VERY MUCH FOR THE ADVISE.  ONE MORE QUESTION!  I LIVE IN THE UK WOULD THE SAME TESTS APPLY HERE? I ASK THIS AS THE (SOD) YOU MENTIONED SEEMS QUITE LIKELY AND I AM WONDERING WHY MY DR HAS NOT MENTIONED IT

[LGworried]

If you have chest pain - should you start by seeing a cardiologist or pulmonary doc?

[minnierice]

Hi,
recently I've gone through 4 endoscopy and the first showed hiatal hernia with gastritis,esophagitis, GERD. 2nd one similar findings,3rd crocoidpharyngeal stenosis and had to be dialated at the esophagus area also. Doctor placed a bravo monitor for PH.
5 days post endoscopy I still have pain in epigastric area, at the end of xiphoid process. When I swallow food it feels like someone punched me in the pit of my stomach. Doctor says maybe I'm hypersensitive in that area and will remove the bravo. What is the appropriate time for a person to be on prevacid30 mg twice aday to get rid of these symptoms? Any help wound most appreciated.