Upper esophageal pain

  I began having symptoms in March. The main symptom was a feeling that my turtle necks were too tight at the base of my neck. The feeling was not present in the morning (unlike classic reflux), in fact, I felt great in the mornings. After a month, I went to see my primary care physician. He still suspected some type of reflux and prescribed prilosec for 1 month. The pain did not subside so he ordered another month of prilosec and an upper GI and barium swallow which came back negative. He then referred me to a gastroenterologist which took about 6 weeks to get an appointment. In the meantime, I tried some 'alternative' type treatments recommended by a friend who works in an alternative health care setting (deglyceralized licorace, enzyme replacements, and some solution designed to combat candida). These brought minimal relief. I then read an article that mentioned the beneficial effects of bismuth products on h.pylori. I started taking Pepto-bismal and noticed a dramatic relief in about one week...just in time for my endoscopy. Prior to the endo., the GI guy ordered hyoscyamine 0.125 mg SL to see if it reduced any spasming. The hyoscyamine had no effect. Anyway, the endo. showed only mild chronic inflammation at the distal portion of the esophagus (not at the proximal end where I had been experiencing the pain). Cultures were negative also. But at this time I was feeling pretty good and decided to try drinking coffee again. Big mistake! The pain came back with a fury and I am having a heck of of a time getting it back under control. I now seem to experience more pain in the lower esophagus. However, again, the main relief comes when I lie down and I still feel great in the a.m. I have always been able to eat everything but I now notice that the acidic foods are starting to bother me. I am a nurse and have tried to do all of the right things...eliminated coffee (I only ever had 1c./day), am excercising regularly, am at the bottom normal of the weight scale for my height, drink alcohol very moderately, and do not have a high stressed life style (I have been vegging at my family cabin for 2 months), have been eating organic vegetables, etc. The one test that never was done was a blood or breathing test for h.pylori. I have read that endo results may not be as conclusive as these tests. I'll be returning home in 2 weeks. Any suggestions as to what I should do next? I appreciate any pointers you can give me. Thanks a bunch!!
  JanE.
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Dear JanE,
There is a debate in the medical literature regarding the role of H. pylori in the production of nonulcer dyspepsia.  Some physicians treat H. pylori in anyone who has GI symptoms, whereas others treat only those with ulcers or at increased risk of developing gastric cancer.  In my opinion, your symptoms are not related to H. pylori gastritis and therefore you should not pursue other tests along this line.  With regard to your question of the sensitivity of the tests to diagnose H. pylori, there can be false negatives if patients are taking medications that supress H. pylori replication e.g. Pepto Bismol, certain antibiotics.  The urea breath test is a sensitive test to diagnose infection.  This test is based on the urease enzyme found in H. pylori.  Urea which contains a radioactive marker is eaten.  If H. pylori is presnt in the stomach, the marker is released and collected in the exhaled air.  This test is very sensitive for H. pylori.  
IN your situation., I would consider esophageal causes for the symptoms.  Reflux is one possibility.  You should avoid coffee, alcohol, cigarettes, fatty foods etc.  A second possible explanation for your symptom is esophageal dysmotility.  A cine esophagram or esophageal motility study will exclude this possibility.  Finally, the possibility that your symptoms are related to thyroid inflammation (thyroiditis) or a sinus problem should be evaluated.  This can be done by your primary physician.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: H. pylori, reflux