Are my symptoms consistent?

[JLAMB]

I am a 33 year old male with a history of stress.  I use alcohol less than moderately and quit a light/moderate smoking habit about 2 years ago.  I have been taking Paxil for about 2 years.  I rarely supplement with Xanax.  Three days ago, while eating lunch, I experienced pain, not difficulty, in swallowing behind my sternum.  The pain applies to solids as well as liquids of all temperatures.  I also experienced the same localized pain when belching.  The pain has since remained constant during those activities.  When not eating, the chest/back pain has varied, from nonexistent while sleeping and relaxing, to significant during times of stress.  I saw my primary care physician yesterday.  She prescribed a fecal occult test for ulcers, an upper GI series, and Protonix, which I have taken once.  I have experienced heartburn prior to this, maybe a dozen times in my life.  It was very painful.  This current pain feels like a low grade version of heartburn.  My family has a history of gastric issues: hemmorhiods, haital hernia, polyps and ulcers.  I've had a sigmoidoscopy, keep a high fiber diet and remain very vigilant.  Bottom line, this latest issue is very new and came on very suddenly.  I fully expect to be told that I have GERD, esophagitis or some other inflammation.  I know that anything is possible.  Given my age and the above information, does esophageal cancer sound probable?  Thanks.

[Kevin Pho, MD]

Hello - thanks for asking your question.

The symptom that you are describing is dyspepsia.  There are many causes other than GERD that can cause this.  You should definitely follow this up with your primary care physician.

Dyspepsia was defined as pain or discomfort centered in the upper abdomen (mainly in or around the midline as opposed to the right or left hypochondrium). Discomfort is a negative feeling that the patient does not interpret as pain, which can be characterized by or associated with fullness, early satiety, bloating, or nausea. Dyspepsia can be intermittent or continuous, and may or may not be related to meals.

Here are some diagnoses to consider:
Peptic ulcer disease — A peptic ulcer refers to a well defined raw area or sore where the mucous membrane of the stomach, the upper region of the small intestine (duodenum), or esophagus has been eroded or damaged by stomach acid and digestive juices. Some individuals with peptic ulcers have no apparent symptoms, while others may have severe symptoms. Depending upon the form of ulcer present or other factors, patients with symptomatic disease may experience burning, "gnawing," or "hunger-like" pain or discomfort, primarily in the upper middle region of the abdomen, that may worsen when the stomach is empty. Less commonly, pain or discomfort may be located in other abdominal regions, such as the upper left or upper right side of the abdomen.

Medication-induced dyspepsia — Dyspepsia can be associated with or aggravated by the use of certain medications (eg, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs]). Thus, clinical evaluation typically includes a complete medication history.

Gastroesophageal reflux disease — Gastroesophageal reflux disease (GERD) is a disorder in which acid from the stomach flows back (refluxes) into the esophagus, causing irritation and sometimes damage to the lining of the esophagus. The most common symptom is frequent heartburn. Some patients have heartburn in combination with upper abdominal discomfort.

Biliary pain — Biliary pain (pain from the gallbladder or associated structures) is characterized by attacks of sudden, intense pain in the upper right or upper middle region of the abdomen that may last for one to several hours or more. Pain may extend to the back or between the shoulder blades and may be associated with vomiting, sweating, and restlessness. Episodes are usually separated by weeks or months.

Irritable bowel syndrome — Irritable bowel syndrome (IBS) is a chronic condition of the gastrointestinal tract. Its cardinal symptoms are abdominal pain and altered bowel habits, but these symptoms have no identifiable cause.

Stomach cancer — Although malignant or cancerous tumors of the stomach are an uncommon cause of chronic dyspepsia in the United States and other Western countries, the disease should be considered, particularly in patients over age 45 to 50 or those who have certain symptoms (known as "alarm symptoms"). These include unexplained weight loss; repeated vomiting; difficulty swallowing (dysphagia); anemia, and/or bleeding from the stomach; and the presence of an abdominal mass or swelling of the lymph nodes (lymphadenopathy). Some patients with early gastric cancer may also have dyspepsia, although associated abdominal pain tends to be mild early in the course of the disease.

I would strongly suggest that you follow this up with your personal physician or gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Links:
http://familydoctor.org/handouts/474.html

[mainebound2014]

I had chest pain radiating to the middle of my back that kind of sounds like yours. After having every test done that could be done and having my gall bladder removed to no avail, I finally had a motility test done of the stomach and esophagus on Monday.  I was found to have nutcracker esophagus--finally an answer for my pain--!  I take a nitro tab when pain is bad and it really seems to be helping me.  I have actually gone a couple of days without pain now, a miracle for me.  Good luck to you.

[tech443]

I am a 34 male plagued by stress as well. I have had bad heartburn and irregular shaped and odd colored stool. Just recently had endoscopy and colonoscopy. They found nothing wrong with the colon, but found that my esophagus was pretty badly inflamed. They even told me that they were testing to determined if any cancer cells were present.

Now what really confounds me is that I have been taking Alkaseltzer heartburn relief and over the counter medicine to relieve the symptoms. I also have changed my diet as best as possible to prevent further attacks. The doc says this medicine is not good for me.

I have since tried Protronix... was on it 3 days and started suffering gut pain and a weird bubbly sensation on my right side.

Next was Nexium.... lasted 3 days... gave me bad gas and made my heartburn worse!!!

Then Prevacid... it works but I have to use more than the recommended amount... 1 pill every 8hrs. and even then I still experience pain usually after eating something or drinking something. {Which is exceeding the recommended daily dose by 2 pills}

Last but not least is Aciphex. Which almost seems like it may be the best of the 3 but I still feel a little discomfort and still must take one every 8 hours or there abouts. {Which is exceeding the recommended daily dose by 2 pills}

Why can't they make one that works???

Or is it like how many licks does it take to get to the center of a lollipop?  "The world may never know!"

Overall the Alakaseltzer worked the best for me as usually my heartburn flares up the worst at night. Taking the other meds I just have to keep taking them all the time. What gives? Anyone?

Good luck and God Bless you all.

[nadia]

Although Alka Seltzer seems to really work for some people(my mom swears by it) it does contain aspirin.  This would irritate the delicate lining of the esophagus. I have chronic gastritis and a hiatus hernia and would never use it. I have tried all kinds of meds for my problem and the only one that seems to work is Pariet.  It is a proton pump inhibitor. You might want to ask your doctor about it.  Let us know if you find something that works.

[tech443]

Are you sure the alkaseltzer contains aspirin? I have looked at the ingredient list and can not find aspirin as an ingredient.

To clarify again I am talking about Alkaseltzer Heart Burn Relief Lemon Lime tablets. {not the cold fighting products} It says nothing about containing aspirin.

Yes the Pariet that you talk of is the same as aciphex that I am currently taking. Pariet is the Canadian name. I think I will probably go with this one and supplement with Gaviscon as so far that's what I've been instructed per my doc. The thing is I still have to take at least 2 of the Aciphex a day and I really can't afford that.

Thanks for your post

[nadia]

You are correct.  I have not seen this product.  Having looked into it on the net, the product is aspirin free. I will look for it next time I am out shopping.  I hope it is available in western BC.

[tech443]

What is Gastritis?  I have just been diagnosed with Gerd with the strong possibility of beginning Barrett's esophagus. No cancer just badly inflamed.... although it feels very much like I need a new something or other. ;)

The nurse so far is the only one talking to me as I guess the doc is too busy. It seems one minute she tells me one thing and the next minute she's telling me not to do that. The nurse tells me that I will be on the meds the rest of my life. mmmm just what I wanted to hear! Right now it feels like a really bad valentine's day accident... {Got shot in the heart by cupid}

I think this has got to be the slowest death any one could die. If it wasn't for my extreme patience and high tollerance for PAIN I would have been done a long time ago.

Hopefully, the cycle I am currently on will pass quickly... please God you know I can't handle much more of this!

From what I hear Barrett's is surgically treatable? How successful is it? and what are all the pro's and cons of the procedure? If anyone is listening to me babble....

Thank you and God bless you all......

[nadia]

From what I know about gastritis, it is a chronic inflammation of the stomach lining.  It is quite common in people who have had their gallbladders removed.  In my case it is quite intrusive into my lifestyle.  I have constant pain which may be due to the hiatus hernia or the chronic gastritis. I have been told to live with it but I refuse to do that.  I am learning  that many chronic disorders such as this are as a result of allergies.  They could be environmental or food related. Since my entire upper body is sore and I now have heart related issues I would tend to agree with this analogy.

[tech443]

yes I can very well imagine. My lifestyle has changed as well. Most days I feel like doing nothing and if not in pain then just uncomfortable which after awhile of being like that is depressing.

You can't exercise as more often that makes it worse, but yet they tell you to lose weight to reduce the pressure on the stomach.

I work a job that is very hard on the body anyway so I don't know maybe that's what caused it. It just seems I am in a trap with no way out... "well other than death" ~ and I mean that sarcastically.

Then I seem to take certain meds and they work a little or they work great for 10min and I have to retake them over and over. Like the gaviscon tablets... what a gimmick. The companies making these things are making good money... no worries for them.

I just wish there was something better for all of us. I'm only 34 and I shouldn't have this so young. It sounds like an old mans disease. Not that I am wishing it on the old either. So much for the perfect world theory.

Good Luck to you I hope you feel better soon.

[nadia]

I can sympathize completely.  I am only 40, but I feel worse than some 70 year olds.  It's good to hear that you are still working.  I have been on Long term disability since March of last year.  My hope is to find some miracle cure and get my life back.
       Good luck and I hope you can find some resolution to your pain as well!