Burning for 2 weeks

For the record: I'm a 29 y/o male. I'm 5'10" and weigh 200lbs.

Back in february, I visited my dr. for chest pain. After some tests, he thought it could be acid related. He gave a four week supply of nexium. I took, maybe, a 10 day supply.

In March, I had a follow up visit. He suggested an upper gi. Test was complete. The diagnosis was "slight reflux". No ulcers or hernias. I was afraid of being constipated by the barium so I was constantly trying to "go". This led to a few strenuous sessions.

Just recently, I was straining on toilet and felt a strange sensation in mid abdomen. And it seems like ever since, I've had a terrible burning in my throat and upper chest. It's bothersome during the day. And, it wakes me up at night. I wake every 2 hours or so. It's relieved to a certain degree by taking pepcid ac.

Here are my questions: Could my recent bout of straining caused this burning episode?

Or, is this some kind of rebound effect caused by the nexium?

Can nexium harm someone who doesn't really need it?

I visited my dr. yesterday. He ordered another upper gi. Which I had performed today. Last night since I couldn't eat or drink, I suffered from some terrible burning. Unable to take it, I took 2 tablespoons of maalox at 4:30 a.m. My test was at 8:30. Do you think the maalox may interfere w/ my test? The Dr., who administered the test, didn't seem too concerned.



thanks.

[Kevin Pho, MD]

It is possible but less likely that the straining may be caused by the burning episode.  It is also possible that when stopping the Nexium, there is a rebound GERD effect.  Sometimes taking an H2 blocker (i.e. Pepcid or Zantac) in conjunction with the Nexium can reduce this.  

In general, Nexium is a safe medications and that class of medications (the PPIs - proton pump inhibitors) have a good long-term safety record.  

I would suggest an upper endoscopy to evaluate for inflammation or ulcers, as well as a blood test for H Pylori.  If GERD continues to be a possibility, I would consider a 24-hr pH study to further define this.  

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.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[yoshi]

if you have problem at nite,try not to eat before bedtime,like 2-3 hours before bedtime.
pay attention to what you eat,some will make things worse for you-caffeine,soda,chocolate,nuts,spices,fat,greasy fried food,tomato,dairy products etc

[TJV]

  It is IMPOSSIBLE for a rebound effect to occur 4 months after stopping a medication that was only taken for 10 days.

[JD10]

Guys, thanks for the reponses.

Yoshi, I can't really pinpoint any food or drink that may cause it. This has just come on suddenly. This sounds strange. But, I felt so much better BEFORE I went to the doctor. I've been miserable ever since. I've had upper abdominal pain off and on for a few months. In fact, I posted a question about it a month or so ago under the user name "jd10". I couldn't remeber my password, so I created a new account.

TJV, yeah I didn't think it was the nexium.

At 29, this stinks.

Do either of you suffer from reflux?

[yoshi]

yes,i have acid reflux.
if pepcid and maalox etc make you feel better,it is possible you have a reflux problem.
These over the counter drug will provide temporary relief,if you read the label,some of them just neutralise the gas already in the system,it does not prevent your stomach from producing more gas,only the prilosev,prevacid and nexium of the world shut down this capacity for a period of time.
also read the label,magnesium (as in milk of magnesium) can cause diarhea (diarrhea),but alumium cause constipation.
some of these medication do contain aluminium.
there is a site which described side effects of nexium,i will find it later for you.

[yoshi]

half digested food passed from stomach to the intestines interact with the bacteria ,ferment and create more gas.

[JD10]

You know, I never had these problems until I visited the doctor. I had occasional chest pain. Once in a while, I experienced reflux. It's just been these past few weeks that I've really been suffering. There's isn't a day that goes by that I don't wish I didn't see the doctor.

PPI's scare the hell out of me. I suppose it's because I have a distrust for the pharmaceutical industry. I'm afraid if I begin taking these, my problems, once I stop, will escalate 10 fold.

Also, I truly believe my problems are from the straining. That's the only thing I can attribute it to. That's the only thing I've done differently in the past months.

[JD10]

Also, do you think taking the maalox 4 hours before my upper gi will have an affect on the outcome?

[yoshi]

you have to check with your doc,i thought they always tell you how to prepare for the test like dont do this and dont do that.

[yoshi]

i would be candid to admit i dont really know what PPI would do in the long run.
Eversince i start taking PPI,i go from day to day trying to figure what goes wrong.
My problem usually occurs at nite,after not eating after 6 pm and taking 40mg nexium before bedtime,i still have problem in the middle of the nite when i have to get up and drink some water and may be take a zantac 75.
During the day,i may have eaten something wrong or i just dont feel right,and what do you know,a fruit flavored popsicle can bring relief ,which if i understand right,it is a quick way of raising stomach acid level,which means the PPI may just be working too well??
If you search the web,you will find some articels on side effects of nexium and what too little stomach acid can cause half digested food fermenting in the intestines creating a different kind of gas,and that most people are wrong in thinking their problem is too much acid while in fact it is too little acid.
So,i tend to agree with you,PPI somehow just dont solve the problem??
Or may be we should just stop eating!!after all ,in this modern world,it is hard to find food which is not tainted with chemical,or laden with stuff which makes our situation worse.

[JD10]

I actually have a book called "why stomach acid is good for you". It's premise is, exactly that, too little stomach acid. While I think that may be true for older people. At 29, I doubt that that is my case.

Fruit flavored popsicle, huh? I may try that. These last three weeks have terrible. I'll either pop a pepcid or drink 2-3 bottles of water.

Regarding the upper gi instructions, I wasn't supposed to eat or drink anything past midnight. I had some taco bell at precisely 11:45. Around 4:30 I woke up on fire. There was no way I getting back to sleep w/out taking something. So I figured maalox is the better of two evils.

So, what kinds of things do you eat and drink during the day. I usually have fast food during the day. And some kind of home cooked meal in the evening. I've been chugging pepsi and coke for 10+ years. But, now I try not to keep any of that around. I drink alot of gatorade and water.

[yoshi]

that does it-taco bell tacos before bedtime.
from what i understand,if the problem is not treated,it just gets worse and worse.
Fast food is bad news,so is soda.
i agree,older people has less stomach acid,but not younger folks,you may just been eating too much fast food.
from what i read,the symptoms of too much and too little acid are similar,but if you feel it right away after you eat something,it is too little.
if you feel it hours later,it is too much acid.

[JD10]

That's interesting. I usually feel pain hours after a meal. Rarely, does it come immediately.

I'm learning alot from you yoshi.

thanks.

[TJV]

  Remember though , Gerd doesn't usually involve too much acid in the stomach , it involves a weak or dysfunctional sphincter letting stomach contents in the esophagus where it's not supposed to go.

  The LES s the root problem, not acid.

[JD10]

TJV: do have reflux? do take acid reducers? how do you control your reflux?

yoshi: here's a link i found: http://www.diet-and-health.net/Diseases/Hypochlorhydria.html

[yoshi]

good point,i feel much better during the day as most of the time i am either standing or sitting or moving around.
At nite while asleep in bed,thats when i have the acid reflux.
does anyone use a wedge pillow,does it work??

[JD10]

I have a wedge pillow. I doesn't really help me. However, I still use it. I bought it here: www.medslant.com

[tessa0825]

I used a wedge for awhile but keeping sliding off. My husband has built some kind of lift that raises the head of our bed about 7 inches..You can also buy a wedge from almost all medical supply stores..Prices can vary greatly, any where from about 25.00 on up..

[yoshi]

tessa,
TJV brought up a good point,GERD is about loose sphlincter,not so much acid reflux.
i have been thinking,i can do fine all day,quit eating at 6-7 pm and take 40mg nexium before i go to bed,i still have reflux at nite,which prompts me to drink water and take zantac 75 to make it till morning.
So now i just ordered a wedge pillow which is 12 inches tall and 27 by 27 inches wide and long,i am hoping that this will keep the acid in my stomach ,not up my esophagus.
how long is your wedge pillow if you keep sliding off??
i think my problem actually gets worse after taking different PPI.That vagas pinch is something which happens at nite after i start using PPI.

[tessa0825]

Yoshi, have you ever considered the fundoplication surgery? Yes, reflux is almost always about a weakened or non-functioning LES. Fundoplication creates a new one. I know several people who have had really good results from fundoplication surgery and have remained symptom and medication free for years. I haven't been quite that lucky since my surgery, but the majority of people respond well to it if they have a good surgeon who has done many of them. I know you don't like taking the PPIs so you might to check into surgery as an option. However, fundoplication requires alot of pre-surgery testing because they have to make certain that reflux is the reason for your symptoms and that your esophagus has enough motility to allow surgery.  

My wedge was pretty long but it was only 8 inches high and I slid off every nite. I could have never stayed up on one 12 inches high..It has taken some getting use to having the bed raised but now I'm use to it and it certainly works against gravity to keep reflux from happening during sleep.

good luck, Tessa

[yoshi]

i figure if 12 inches is too high for me,i just slide down to 10 inches,8 inches and so forth,as it is 27 inches long.
Thanks for the surgery suggestion,i will look into it.