Barrett's Esophagus?

[betty27]

I am a 27y/o female in good general health with a slender build and, up until about 5 mo. ago, I exercised regularly.  At that time, the day after a 10 mile race, I experienced an abrupt episode of severe upper-abdominal pain with mild nausea which lasted under 1 hr, followed by a similar episode the next day.  I saw my GP who prescribed Prevacid and Bentyl and had an upper GI series and ultrasound done which were interpreted as normal, other than a small polyp in gallbladder.  I remained on meds with episodic bouts of discomfort (pressure as if band wrapped around chest,more severe when I attempted to run) until an episode of extreme chest pain compelled me to go to ER 3 months ago, where I had an EKG, chest x-ray, bloodwork and CT scan done, all of which were normal.  The ER doc prescribed Protonix and Lidocaine/Maalox for pain, and I followed up with a gastroenterologist.  At this appt, the doc thought my Sx sounded like GERD and prescribed Reglan in addition to Protonix. Since the symptoms were not subsiding, and were becoming more frequent and troublesome, I went for an upper endoscopy 2 wks ago from which the preliminary results indicate a likely dx of Barrett's Esophagus as well as stomach inflamation (inflammation) (results of biopsies not in yet).  Since the endoscopy, I have experienced unrelenting pressure in my chest/upper abdomen, but have noticed the pressure only occurs when I am sitting down, and it feels as though there is something pressing into my rib cage.  This pressure is alleviated when I stand or lie completely flat on my back, but is present if I lie with my head elevated.  None of the medications which have been prescribed thus far have ever appeared to have an effect on my Sx, including Lidocaine or Bentyl. While the Sx subside when I am standing, they become much worse when I have tried to jog or run.  I personally have not observed any connection b/w my diet and the symptoms, as they are present at all times of the day even when I stick to a bland diet and avoid acidic foods.  Other than the pain and discomfort while sitting (to the point where it effects any seated activity, including the ability to concentrate at work), I have not noticed any other symptoms.  The most notable thing to me is that while the pain used to be 45-60 min episodes of feeling as though a band were wrapped too tight around my chest which would occur while seated or standing and would become more severe with exercise, the pain has evolved to this continuous discomfort while seated which can be alleviated if I lay flat. My question is whether this sounds consistent with Barretts and, if so, is there any tx regimen which may help the symptoms subside?

[Kevin Pho, MD]

With chronic reflux symptoms, Barretts esophagus may be possible.  However, the diagnosis of this is solely by biopsy - so you need to wait for the biopsy results.  

To help with this, the Protonix is an appropriate treatment to help with reflux.  You can consider a 24-hr pH study to quantify the degree of reflux, and if the medication isn't controlling the symptoms, you may want to inquire about surgical options.  

Another consideration would be a cardiac cause of the pain (with its relation to exercise).  If the GI tests were non-revealing, you can consider a stress test to ensure the heart isn't causing the symptoms.  

Followup with your personal physician is essential.

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, M.D.
Medical Weblog:
kevinmd_b