Discomfort in the chest, non-cardiac pain, H-Pylori, and Gastritis

[hpanandy]

This is my problem.  I am a 36 year old male, 5’11”, 188 lb.  I visited the doctor because of excessive burping problems throughout the day (approx 40-50 times), slight palpitations, and shortness of breath, and pain.  The pain if I can describe was:  In the left breast area in and around the nipple, sometimes on the upper side of the left breast, sometimes in the middle and between the two breasts.  It is more like a discomfort and maybe I could describe it as a pulling/tightness/mild pressure.  In other words, I am not able to say with certainty that the pain is localized to one area.  I have also noticed that there is a slight pricking/tingling/pinching sensation in the area of the shoulder blades sometimes.  I have controlled my diet, I exercise almost daily.  I still feel that my stomach is a little tight.  The pain would go away when I slept at night. In other words I could sleep well at night.  It would take about an hour for the pain/discomfort to subside when I slept.

A blood test was done and tested positive only for Hpylori.  Went on Prevpac triple therapy.  After the Prevpac, the burping reduced (less than 3-5 a day), shortness of breath was gone, palpitations were not there.  At the same time also had an EKG, Stress test, and Thallium test performed.  All were OK.  Doctor therefore ruled out more heart related tests.  Thereafter, visited a gastroent. when pain related symptoms in the breast areas/center of chest seemed to be returning along with a little more burping again (not like before but definitely not  normal). An endoscopy and colonoscopy was performed.  Only a mild inflammation of the stomach was found in the endoscopy.  Biopsy during endoscopy revealed that Hpylori did not exist any longer.  I have been on Prevacid, 30 mg since. It has been approx. 5 months since the Prevpac treatment was completed and approx. 4 weeks since the endoscopy/colonoscopy was performed.  
  
Now my problem is that the initial pain type symptoms have returned (no excessive burping, no palpitations, or shortness of breath though).  The pain stays the whole day (not continuously but is intermittent).  Starts in the morning right about half an hour after I wake up in the morning till I go to bed.  My stomach does feel bloated.  I can thank god still sleep well at night.  In the last 7-8 months since this started, I can recall maybe 3 times that I was awaken by a little pain in the center/left breast area.  I am so confused and troubled on how to proceed now.  Are these symptoms related to the inflammation of the stomach? I do not smoke or drink.  Please let me know what the alternatives are, what is the best course for the next evaluation (with no idea at all, I think it could be the gall bladder, the pancreas, stomach, heart, etc., and that is very distressing), and how should I proceed from here.  I am totally at a loss on what to do from here especially when it is so difficult to even describe the pain.  I really appreciate your guidance.

[Kevin Pho, MD]

You have had a good evaluated for your epigastric pain, including treatment for H Pylori and upper and lower endoscopy.  One consideration would be GERD which can certainly contribute to your symptoms.  The definitive test for this would be a 24-hr pH study.  An upper endoscopy would be able to see ulcers or inflammation if that would be causing your pain.  

Other tests to consider would be an abdominal ultrasound which can evaluate the liver and gall bladder system or an abdominal CT scan to evaluate for any masses.

If the GI tests are completely negative, you may want to consider a non-GI source - such as a cardiac stress test to evaluate for heart-related pain, or a chest CT/chest X ray to evaluate for pulmonary causes of your discomfort.  

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.

[yoshi]

i just completed the prev pac regime which lasted 14 days,after 7 days,i started to suffer from diarhea (diarrhea),it got so bad i have to go to bathroom in the middle of the nite.
then i start taking yogurt and the diarhea (diarrhea) went away.
just curious,how was your 14 days ordeal with prevpac??
the 2 antibiotics could wipe out a lot of bacteria ,good or bad in your system,have you considered replenishing the good ones by taking yogurt??
you mentioned taking 30 mg prevacid after prev pac.i did that too,and found out prevacid has a bad side effect for me-constipation.
i switched to OTC prilosev 20 mg and then eventually i stop taking either prevacid or prilosev.
i elimintae soft drink from my diet,i also avoid dairy product such as cheese and cream,chocolate and tomato sauce/juice.
i take alka selzer /mylanta if i have .
i am not home free,but i am hoping  by watching my diet ,i can avoid those prescription drug,they all have side effects.

[hpanandy]

I fortunately did very well handling the Prevpac treatment. A biopsy was also done during the endoscopy to check if the H-Pylori was eradicated.  Thanksfully, I am free from H-Pylori now.  I am still having those weird symptoms though.  an EKG was done again today and was normal.  Yes, I did include Yogurt in my diet as a routine on an almost daily basis.  Today I visited the Gastoenterologist again and we changes the treatment to Nexium and increased the dosage to 2 tabs/day.  One in the morning and other in the night before meals.  Hopefully, will feel better.  Yes, all citric related stuff is almost eliminated from my diet except the chocolates :)) - my weak point!!  Hope this is of help to you.  Please keep us posted on your progress.  Best Wishes!

Did yo or do you also have the same pain related symptoms?  
Thanks!

[yoshi]

no,i do not share the similar symptoms.
it started out as chest pain in the middle of the nite which i mistook as angina,for years i took aspirin and bumex and garlic and cod liver oil thinking i have a heart problem.
then i went to see a cardiologist and he gave me a resting EKG ,echoscan,bloodtests ect and he said i am the last person to have heart problem and if this were angina for 7 years,i would have been dead a long time ago.
the echoscan did show some heart muscle stiffening due to age.
but i am not sure my heart is flawless,but anyway i move on to see a GI doctor .
since then i have taken nexxium.prilosev,prevacid,alka selzer,mylanta,gravscon,zantac etc.
now i am trying to wean myself away from any of these medication by watching what i eat,esp before i retire to bed.
during the period i was on medication,i did wake up one morning with a pain size of a quarter on the right side of my shoulder blade and i use tigerbalm oil and rub against it for several days and now it is gone.
prevacid makes me constipated and i do not react well to zantac.
alka selzer is loaded with sodium,and gas x makes me tired.
so today i found out if i stay away from soda,dairy products and chocolate,i need little medication.time will tell.
on the bright side,my grocery bill has been cut in half,i eat 1/3 of what i use to eat.

[hpanandy]

Thanks for the update.  I do have some good advise to heed there...especially dietary.  Take care and Best Wishes!

[uncomfy in nyc]

On Dec 30th 2003 I awoke with a massive burning sensation directly behind breastbone. The night before I drank champagne, sangria and had lobster, shrimp, oysters and mussels. Topped off with more sangria and dessert. (It was an anniersary celebration -- I'm not a glutton usually!). Stayed with the daily, consistent pain until Feb when I could see a doctor. Tests concluded I had the dreaded H PYLORI bacteria. I'm on PREV PAC until the 14th day which will be FEB 19, 2004. DUring this time I have had pain in my stomach, (what appears to be my esophagus) and the back of my throat. At times I thought my shortness of breath meant I was going to have a heart attack. But even turning 40 in JAN and stopping working out 5 years ago (I'm an IDIOT) I am still 5'5" and 125 lbs. and I have a really good diet, except I drink (or should I say I USED TO DRINK a good amount with socializing). I ate tons of garlic, ginger, wasabi and sushi, drank tons of water, also began having decaf coffee 2 years ago every day (out of the blue) never had coffee before in my life. Also ate loads of spicy foods, cayenne, black pepper, and a lot of sauces: i.e. soy sauce all over the meats, sushi, etc. I guess I burned out my stoamch with it but I don't understand this. If I hurt my stomach with the wrong food/drink, how did I get the H PYLORI? Will this F-----G pain in my breastbone eventually go away because I rushed to my doctors thinking I was having a stroke last week and also had extreme anxiety which these pains seem to cause for people. Will I be able to eat and drink whatever I did before or do I have to live my life like this always watching what I eat and being afraid of having pains? I am already freaked out that I may have to live with this pain in my esophaugs and throat forever. The doc did a sonogram to rule out gallstones which can cause pain in the breastbone. G-d, I cannot stand the annoying, relentless, pain and discomfort. Anybody have what I have and now are they FINE? PLEASE SHARE YOUR STORY if its similar. I'm losing my marbles in NYC; (well at least living here, no one will notice :>). THANKS!