GERD and Chest Pain

I am a 24 y/o male who began having chest pain about a year ago.  The pain was sharp in nature and was located on my right sternal border around my 3rd and 4th ribs.  My primary care doctor first thought it was a pleural bleb, but after a few months of it getting worse, I went to see him again.  The pain had started moving to the same location on the left sternal border and sometimes substernally.  He now suspected GERD.  He started me on 80mg of Protonix for 2 weeks, and then a follow up.  On the follow up my chest pains had reduced dramatically in both duration and severity, but they were still present.  He took this as all he needed to diagnose me with GERD and give me a prescription for Protonix for another 6 weeks, 40mg.  Then I could decide whether I wanted to get off of it or now on my own.  I'm just finishing my 6th week.  He wasn't concerned at all with the breakthrough chest pains.

I have a few questions:  

1.  Are these symptoms typical of GERD?

2.  Is it normal to still have chest pains even after taking the proton pump inhibitor?  I am still in the same state as having sharp chest pains, just not as long and not as painful as before the medication.  

3.  Do the breakthrough chest pains indicate that some GERD is still occurring, thus putting me at risk for developing esophageal cancer?  

4.  Should I switch medications to see if the pain stops?

5.  Do my symptoms justify having an upper endoscopy to assess any possible damage?

Obviously, I am concerned about predisposing myself to esophageal cancer.  I just want to make sure that I cover all my bases for the risk factors.

Sorry for the laundry list of questions.

Thanks,

Zach

[Kevin Pho, MD]

To answer your questions:

1) Those symptoms can be caused by GERD.

2) If the chest pains continue despite being on medication, you may want to consider other causes.  This can include heart or lung conditions.  An echocardiogram as well as chest imaging can be done to exclude these causes.

3) If esophageal cancer is of concern, the test of choice would be an upper endoscopy.

4) If the pain is caused by GERD, changing medications may help.

5) An upper endoscopy is not unreasonable in the setting of chronic GERD.

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

[zoomistic]

upper endoscopy would get the best results, if its stomach related,