Re: GERD

Posted By HFHSM.D.-rf on May 03, 1998 at 09:50:10:

In Reply to: GERD posted by Tom on May 01, 1998 at 10:05:26:






I have a couple of questions about GERD.
I was diagnosed with GERD after going to the hospital one month ago with
chest and arm pain (plus nausea and a racing heart) I was given a stress
echo test on my heart which came up negative. My EKG and blood enzymes were normal, so
a heart attack was ruled out.
My doctor believes my pain was due to a spasm in my esophagus. He said
the nitro which reduced my chest pain could have relaxed the esophagus.
He thinks I might have a lot of acid reflux, so he has me taking antacid
for any chest pains. I have had some pains below the breast bone
approximately where the esophagus meets the stomach, which are reduced
with the antacid. But I have also had some pains on the left front of
my chest (usually lasting less than 1 minute so the effect of antacid is
hard to judge). My doctor said reflux can back up into the lung. Both
of these pains occur when sitting/laying as often (or may be even more
often) than as when standing.
Can GERD present itself solely as jaw pain, without any
chest pain?
The jaw pain usually occurs after a meal, and usually last less than 5 minutes.
Sometimes, though, it occurs soon after I stand up and start walking --
and then typically goes away within a few minutes (standing still or
sitting down seems to make it go away quicker).  Sometimes it seems
like it may occur more often when I am stressed.
Any thoughts or insights appreciatted. My doctor was reasonably
informative, but I wanted confirm what he had told me.
Tom
______


Dear Tom,
Sometimes, physicians can have great difficulty deciding if chest pain is due to a cardiac or esophageal cause.  The initial approach must be to rule out the more life threatening cardiac cause, as was done in your case.
Esophageal spasm and esophageal reflux (either alone or with a secondary change in motility) can cause chest pain that simulates angina.  Usually, the pain is located behind the breast bone but radiation to the jaw, left arm and neck can occur.  It would be unusual to have only jaw pain but this presentation could occur in some people.  
I am uncertain what is meant by the statement " reflux can back up into the lung. Acid reflux into the esophagus can initiate a neural reflex that causes bronchospasm (wheezing) that resembles asthma.  Some people with reflux can aspirate acid ( acid refluxes from the stomach into the mouth and enters the breathing tube) initiating a chemical inflammation. Neither of these conditions cause the chest pain of which you complain.   Acid reflux can cause chest pain when lying or standing due to acid-induced irritation of the esophageal mucosa.  One does not need to postulate a lung problem to explain the left chest pain..
Because you have been to the hospital with this pain, a definitive diagnosis of the cause is warranted.  In order to determine the specific esophageal cause of your chest pain, you should have an esophageal motility study ( to measure pressures and coordination of the esophageal muscles; this test will confirm if you have esophageal spasm) and a 24 hour pH probe study ( to confirm that you have acid reflux and to quantify the severity).  Additional tests to rule out structural problems of the esophagus (i.e. UGI x-ray or endoscopy) may be necessary depending on your symptoms. A specific diagnosis is needed because the medical treatment of reflux esophagitis is completely different from that of esophageal spasm.  Initiaitng the wrong treatment may exacerbate symptoms.  
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.

If you wish to be seen at our institution, Henry Ford Hospital, please call our PHYSICIAN REFERRAL LINE at(313) 876-2393 and request consultation with Dr.Zonca. one of our experts in the diagnosis and treatment of esophageal disorders.  He can arrange for a quick and thorough evalaution and start you on the appropriate medical  treatments.
HFHSM.D.-rf
*keywords: chest pain, angina, esophageal spasm, esopahgeal reflux
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