Chest Discomfort with Activity (not Heart Related)

[StRobert]

I have been diagnosed with GERD, sliding hiatal hernia, & esophageal spasms. Blood pressure & heart are fine. I have noticed with heavy lifting, running, or any extended jostling movement, I get serious chest discomfort which feels like a tearing or bruising of the midchest wall which lasts for several days.  My GERD is greatly aggravated during this time as well in spite of Protonix medication.  Current Gastro Dr has no clue & Internist says it is a muscular-skeletal problem but not why.  What is the likely cause of this? Could it be caused by diaphram irritation caused by movement of the hiatal hernia?  If so, it may argue for surgury to repair hernia provided it will likely bring belief. What do you think is most likely causing this problem which limits me from vigorous physical activity?

[Kevin Pho, MD]

If the GERD is aggravated despinte being on Protonix, you may want to consider a 24-hr pH study to determine if the medical therapy is adequate.  If not, then surgical therapy may be considered.

Another consideration would be an upper endoscopy to further evaluate if there is any other esophageal disorder present.  

Given the fact that you are having symptoms on exertion, you may want to rule out a cardiac etiology (i.e. coronary artery disease) if the GI workup is not conclusive.  This can be done via an exercise stress test.  

Surgeon has commented below regarding the effects and indications of repairing hiatal hernias.  

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.

Thanks,
Kevin, M.D.

[tessa0825]

I wonder if the cause of your chest pains arent from the esophageal spasms? They can cause alot of chest pains and discomfort...Most hernias arent symptomatic unless very large...Usually the symptoms you feel with hernias are GERD symptoms...You dont say but what tests have you had done?  Manometry is the best test for esophageal spasms. If you have had an EGD or barium swallow what has your Dr. said about your hernia? Large or small? Also, you might ask to have a 24 hr ph probe test to see how severe your reflux is. I would just ask him if he thinks you are a good candidate for fundoplication surgery? If he says no, ask him why not? If he says yes, ask him how having the hernia repair will effect your activity level post-op? Lifting heavy items (over 10 lbs) will not be an option for many months after this surgery....Im in no way a medical professional just another pt. Good luck to you, Tessa

[nadia]

I am curious about the comment that only large hernias can cause significant chest discomfort.  In my research I have found that size has no relation to the amount of pain one feels.  I have a small hernia but experience significant chest pain.
I'm hoping that surgeon could comment on this.

[TJV]

    Wondering if you were diagnosed with esophageal spasms through manometry-- and if these spasms are primary or secondary to gerd. . If you have diffuse esoghageal spasms a fundo with hernia repair cannot fix these.-- neither can PPIs --  You'd have to try a long acting nitrate, calcium channel blocker , botox injections , etc.  If the protonix doesn't help-- you could consider switching to a different PPI as well.

[surgeon]

Right: the comment by tessa has a few inaccuracies. The size of a hiatal hernia has nothing to do with symptoms. Nor is it true that repairing one would put lifting restrictions on a patient in any way close to what was said. Hiatal hernias are fairly common. They generally are significant only if associated with reflux. Reflux, with a hernia, need not be operated unless non-surgical treatment has failed. People who have hiatal hernias but no reflux need have nothing done. If reflux is treated surgically, it is routine to repair the hernia at the same time, if one exists. It doesn't add to the post op recovery. There is a fairly uncommon type of hiatal hernia, called "paraesophageal" as opposed to "sliding" which has the possibility of causing symptoms and severe problems by trapping part of the stomach in the chest, under pressure. Paraesophagel hiatal hernias are often repaired, with or without symptoms.

[TJV]

  Getting back to StRobert, wondering if you have had sufficent heart investigation, also ph test to see if chest pain correlates with symptoms-- Bernstein test can be useful to evaluate whether chest pain is acid induced--- manometry test to evaluate spasms.

As for hernias, does size matter? I've always said size doesn't matter,..... but a lot of reputable doctors out there actually say it does matter- there is some disagreement there within

Much can't be explained in regards to hernias, such as why half of people have have symptoms with hh and the other half are not affected by the altered geometry.

[tessa0825]

Thank-you for a different view of hernias and recovery time from repair of such......I was basing my comments on my personal experience "and" the medical advise given to me by my  surgeon from CCF and quoted on my "Back to Work" release filled out by him stated "No lifting over 10 lbs. for 6 Months"!...I guess it is just a matter of preference for each surgeon as to whom does what and how soon......Also, there is many reputable articles in print that  argue in favor of the fact that the "majority" of hiatal hernias are not symptomatic, but that the symptoms many times are caused from the GERD.....Chest pains  can be a symptom of HH as can esophageal spasms and GERD and I would think if someone has all 3  (heart problems ruled out) of those things going on, then each one would need evaluated in order to come to a definite cause of symptoms.........Tessa

[TJV]

If you have primary esophageal spasms, a fundo and hernia repair will not cure the chest pain.-- nothing to do with gerd or hiatal hernia.  Of course you need to be evaluated by manometry anyway if deciding to have surgery- and it will be explained to you.