LPRD and Gallstones and Apnea (oh my!)

Hi,

I'm a 36 yr old female, 165 lbs, 5'2".  Gained 80 lbs due to 4 months pregnancy bedrest (placenta previa), lost 50 of it over a year, so 30lb overweight.  Quit smoking (after starting back after pregnancy) in April.   Began to diet in August, walking 30 minutes/day, lost another 10 lbs.  Quit caffiene in August.

Family history - father died 55 (heart failure/emphysema), sister blood clotting disorder (heart attack at 31, bypass at 40), mother died at 65 (amyotrophic lateral sclerosis, type 1 diabetes, hypothyroid), brother type 1 diabetes, 9  year old son born with imperforate anus

In October, I began waking several times with a choking feeling, blacking out and tachycardia.   Also had excessive thirst/urination at night, headache on awakening. Also had daytime shortness of breath, dizziness and backpain. Spent two nights in hospital (caught tachycardia on monitors).    Had normal echo, stress test, chest xray.  Abnormal ECG.  Tried Calcium Channel blockers and Beta blockers which made  symptoms worse.

Had normal EP study, so sent home with event monitor.  After proceedure I had some crazy things happening with my blood pressure (very low, then very high, going higher laying down)

GP suspected reflux, even without heartburn or sore throat, started me on Aciphex 20mg 1x and tachycardia improved as did nighttime choking events.   ENT confirmed I had damage in throat, prescribed sleeping wedge, and sent me for a sleep study.  That showed RDI 19 (mild-moderate apnea), CPAP is prescribed, but haven't been fitted yet.  

I have not had any more tachycardia (but some palpitations) since starting the Aciphex, but my chest and mid back pains are worse.  So had ultrasound and they found gallstones.  Have surgical consult next week

Finally, GP is concerned that I developed a heart murmur in the past 6 months, and it is getting more pronounced.

Okay, here are my questions -

1. I've been reading about reflux and apnea and heart stuff maybe being linked.  But gallstones?  Could this be from weight loss or  quitting coffee? Or do PPIs cause them?

2.  Are there any more tests I should mention, any other specialist I should see?  Had no idea GI could cause this much pain!!!  I thought I was having heart failure or embolism, esp not being able to breathe supine.   My concern is some overall disease causing all of this.

3.  Which of my symptoms are reflux, which would be gallstones?  Is it normal to feel better when standing up with either gallstones or reflux? My symptoms seem to follow eating, but not fatty foods, dairy, etc.  Big triggers seem to be corn, tomatoes, sausage.  (Tomatoes and corn also give me Ani Pruritis)   So would it help to maybe do an elimination diet for food sensitiivty?)

4.   I'm having a lot of confusion.  Some days I feel myself, and others I feel like I'm in a fog all day - esp when my symptoms are worse.  Is this normal?

Thanks for your help,

36 year old mom, feeling 63

[Kevin Pho, MD]

To answer your questions:

1) It has been shown that rapid weight loss is a risk factor for gallstones.  The reasons why this happens is not completely understood.  I am unaware of coffee increasing the risk of gallstones.  According to the PDR, Aciphex does not have gallstones as a side effect.

2) I would await the surgical consult before considering further tests.  If there is an opinion that the gallstones are not causing your symptoms, an upper GI series or 24-hr pH study can be considered to look for other upper GI conditions that may be causing your symptoms.

3) There are certainly some overlapping symptoms.  Typically reflux can present with heartburn, regurgitation, and dysphagia (problems swallowing).  Gallstones can present with right upper quadrant pain, periodic nausea and vomiting and intolerance to fatty foods.  Tomatoes in particular can exacerbate GERD symptoms.  

4) Regarding your confusion - this may or may not be related.  If the GI workup is not revealing, you may want to consider a neurology referral for evaluation of these symptoms.  A good start would be a blood count, thyroid tests, sedimentation rate, and chemistry panel.  These tests should be discussed with your regular 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 patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.