Severe Esophageal Spasm

  I am having a lot of discomfort which I will discribe after I give you my history.  Healthy 45 year old male, normal blood chemistries, normal upper GI CAT scan, barium swallow, lower sig.  14 months ago, Lap Chole 3 months ago with pathology of chronic inflamation (inflammation) without stones- healed up fine, regular daily BM's, hemacult negative, recent history of burning stomach pain that is relieved by Prevacid. My current complaint is severe upper GI pain midline just below the breast bone.  I notice the pain will frequently occur when I just wake up in the morning although I have had it occasionally in the PM.  It feels like a cramp that gets very intense, then will subside and when it decreases it will be occampanied by gurgling sounds in the same area.  If the pain gets extreme enough I will feel the pain in my back as well.  I find that if this comes on when I first awake in the morning it will continue to be very intense unless I get up and move around at which time I notice less pain accompanied by gurgling in my stomach area.  I also find that if I drink a large warm glass of H2O the pain will reduce quickly.  I do notice whenever I have had one of these "spasms" that while the acute pain may be gone I still feel a uncomfortable for a number of hours kind of like when you get a calf spasm and it still hurts after you have rubbed out the cramp.  I have scheduled an appointment in 2 weeks with my Gastro DOC and am considering asking for an Endoscopy.  However, I would like to hear what other tests you might recommend.  I have thought that this might be a Pancrreas issue but I don't drink and the pain comes and goes within minutes which is not how I understand Pancreatitis operates. I am baffled?  Can you actually get sort of a chronic esophageal or stomach spasm syndrome? Are there medications that will help?  Your thoughts on this are appreciated.  Thank you.  Jim
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Dear Jim,
I agree with you that your symptoms are not representatve for pancreatitis which has a more prolonged pain.  Possibilities suggested by thr description of symptoms are esophageal reflux and esophageal dysmotility.  Prior to having an endoascopy, your physician may suggest a trial with an acid suppressing drug e.g. proton pump inhibitor ( prevacid or pilosec) or an H2 receptor antagonist.  IF symptoms persist after several weeks of treatment, then an endoscopy is warranted.  The other test that may be needed is an esopahgeal motility study (to measure esopahgeal contractions) and 24 hour pH probe (to assess the extent of acid reflux).
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: gall bladder surgery, esophageal reflux, esophageal spasm
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