Chest pain with no diagnosis

I am a 43-yr old female. 5 years ago I was diagnosed with GERD (w gastroscopy). I take Aciphex twice a day.15 months ago I had an extreme attach that took me to the ER with chest pains right in area of my diaphram, but radiating up through my shoulder and also my back. Battery of tests over the next 2 months (blood,stress,ultrasound,Gluten,Gastroscopy,Hepabiality with CCK,torso CTScan with contrast). All were neg except reconfirming I had GERD, some bile in esophagus, & inflammation. On the CCK injection I experienced the same intense pain but thruput was 90%. Although my GP was convinced it was gall bladder, surgeon said pain on CCK injection was normal. After another month, pain finally was tolerable. Last 3 months attacks have been much more consistent and moderate to intense. Additional symptoms are nausea, dry mouth, back pain is now more intense and regular. After a major attack, everything in the area is sore to the touch. Pain does elevate after I eat 10-15minutes, but also in the morning before I eat. GP has ordered blood work again and I am scheduled for another hepa with CCK test. 1. Is it possible that severe GERD could be causing this pain?If so, what else can be done? 2. Even if throughput of the gall bladder is within range, can it still be the culprit? Is pain on the CCK injection normal? 3. Are there any other tests that could help in diagnosis? 4. Finally, the other test my GP was going to send me for is a colonoscopy, is this suggested?

[Kevin Pho, MD]

You have had a comprehensive evaluation for your symptoms, ruling out many of the GI disorders.  

The CCK stimulation test would make delayed gallbladder emptying less likely.  

To answer your questions:
1) Yes, GERD is still possible.  A 24-hr pH study can quantify the severity of GERD.  If medications are not helpful, you can consider surgical options such as a fundoplication.

2) Possibly, but less likely given the negative imaging studies.  Biliary duct stones can be evaluated with an MRCP, and Sphincter of Oddi dysfunction can be evaluated with Sphincter of Oddi manometry.

3) The aforementioned tests can be considered.

4) A colonoscopy is not unreasonable, however, it will only evaluate the lower GI tract, and not visualize the upper GI tract where the symptoms seem to be concentrated.

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.
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