chest/back pain

  i am a 37 year old, healthy mom.  I have had confusing chest/back pain for several months.  My doctor doesn't think it's my heart and suspected esophagitis, but prilosec seemed to make it worse.  She wondered about some type of esophagael spasm, but the pain is always relieved by lying down, which wasn't consistent with a GERD problem.  Can this still possibly be an esophagus problem? The doctor is having x-rays done to check for problems in my back(and put me on relafen which does seem to ease the pain a bit, but it is such an odd pain that i am still worried that it is something with my esophagus. Any info would be helpful.
Dear confused,
Chest or back pain can be atypical manifestations of gastroesophageal reflux disease, symptoms of an esophageal motility disorder (such as diffuse esophageal spasm) or symptoms associated with disorders outside of the gastrointestinal tract (such as coronary heart disease or musculoskeletal disorders). To further suggest that the chest pain that you are experiencing is esophageal in origin you might want to see if your pain is related to food intake. Are you getting symptoms with any particular type of foods? Is your chest pain associated with other typical and atypical symptoms of gastroesophageal reflux such as heartburn, nausea, abdominal bloating, belching, burping, difficulty swallowing, hoarseness, dental problems, choking sensation or asthma? Do your symptoms improve on an anti-reflux diet? Are you taking any medications that could worsen acid reflux? Relafen tends to worsen gastroesophageal reflux. The fact that Relafen eases the pain may suggest a musculoskeletal origin for the pain.
Although omeperazole (Prilosec) is an excellent treatment for gastroesophageal reflux, it does not work in every patient. Treatment should be individualized. There are other medications that could be tried. The initial treatment for esophageal spasm is to try treatment for gastroesophageal reflux. If that doesn't work then other medicines have been tried with variable results.
Ask your doctor to help find the best medical regimen for you.
Finally, if your pain persists despite treatment, it may be necessary to perform a diagnostic evaluation. A number of tests provide important information about your gastrointestinal tract and can help confirm the diagnosis of gastroesophageal reflux or esophageal dysmotility. These include barium x-rays, upper GI endoscopy, ambulatory pH monitoring and esophageal manometry. You can consult your doctor to decide whether it is time for you to have any of these tests. I hope you find this information helpful. Good luck to you. If you are seen at our institution I look forward to meeting with you personally.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
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Keywords: gastroesophageal reflux, chest pain, esophageal motility disorder

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