epigastric pain and dyspnea

I am a 51 year old male. Five years ago I started having occasional epigastric pain. The interval between episodes gradually decreased. Occasionally I would wake up gasping. One year ago it was so severe I got a full work-up, I had an coronary angiogram showing no coronary disease. I had a EGD no findings. H. Pylori neg, labs normal. I was put on PPI and the pain resolved. This July the pain returned much more severe. The pain is more associated with eating and there is significant dyspnea. With the pain I get intense ringing in ears, hoarse voice and intense dyspnea. My PCP doubled my PPI dose. Repeat EGD with no findings. CT chest with contrast was normal. Labs normal. Allergy w/u including skin testing was negative. PFTs normal. CXR negative. I have lost 30lbs due to food aviodance. PPI does not help. CCBs did not help. No hx smoking, minimal ETOH, no soda, no junk food, no stress until this. Meds Neurontin, occ Vicodin, Androgel and now PPIs and CCBs. Getting worse. Please help.

[Kevin Pho, MD]

I agree with the testing thus far, and it has been comprehensive.  

If the symptoms are continuing, you may want to consider more specialized testing.  This can include a 24-hr pH study to document the severity of GERD.  And if present, and not response to PPIs, surgical options can be considered.

You can also obtain a gastric emptying scan, which can evaluate for gastroparesis, along with an esophageal motility study to exclude dysmotility.

These options can be discussed with your personal physician or GI consultant.

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.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd