Baffled Doctors

Hello, I am a 22 yr old female, who is generally in good health, weighing about 85 pounds.  Last June, I started developing chest pains.  I went to the ER, they ruled out anything w/ my heart and lungs and said I just pulled a muscle and gave me 800mg Ibuprofen.  Did not get better, went to see my general doctor and he thought that it sounded as though I had a stomach ulcer.  He put me on omeprazole and carafate.  Neither of those helped, so I was then scheduled for an upper GI.  They found gastritis and esophagitis and a weakened LES, no hernia, nothing too significant.  From there, I had an ultrasound of my gall bladder and that was negative.  All the biopsies from the scope was also negative.  Medications were not working, I was getting more sick, throwing up, getting nauseated after I ate, losing weight.  I was put on Reglan, and in the meantime I had a HIDA scan, a small bowel follow through, stomach emptying test, a CT scan of the pelvis, abdomen and chest.  All tests were negative.  I am currently now on Nexium once a day and 2 Zantac before bed.  I've been on these meds for about 2 months now, and nothing is working.  I had a second upper GI scope done, and I have a severe grade 1 esophagitis of the entire esophagus and the LES does not close at all and also I have now a sliding hital hernia.  GI doctor said can't have acid reflux b/c I'm not responding to medication but I'm refluxing.  General doctor thinks maybe I should get a fundoplication surgery to fix the LES, but it's not his call to make, it's the GI doctor.  GI doctor will not fix that and he admits he has no clue what's going on.  I have a 24 hr PH test scheduled but he fears that will show nothing and will need to refer me to a different specialist. I've done everything such as changing my diet, sleeping elevated, I don't smoke or drink.  Nothing is helping and I'm in so much pain!!  Do you have any suggestions on what else could be done?

[Kevin Pho, MD]

This certainly sounds like a difficult scenario and there has been a comprehensive workup done already.

I agree with the 24-hr pH test, as this is the definitive test for reflux.  If this is present despite the use of Nexium, then indeed a surgical procedure may be considered.

I would also consider a gastric emptying scan to exclude gastroparesis - which would be an uncommon cause of your symptoms.

Obtaining another GI consult at an academic medical center can also 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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com