Correct GERD Diagnosis?

[arboricola]

I had a URI back in Feb/Mar.  As it went away, I had intense abdominal gas -- relieved by flatulence -- and intense heartburn.  At a physical in May, doc diagnosed it as GERD and prescribed omeprazole.

I'm wondering if this is the right diagnosis.  Symptom lists I see for GERD do not seem to include gassiness.  Is it?

Second, the heartburn presents with what also feels like muscle pain, located directly behind the sternum.  The apparent muscle pain is made worse with exercise, but goes away or reduces with omeprazole.  Could the GERD be causing neighboring inflammation of some kind?  Only very specific chest wall motions cause this pain; doc has diagnosed it as chest muscle strain.  I went off omeprazole for a few days to check; this still occurs.

Third, when I don't take the omeprazole, my intestines get gassy, and feel "beat up" like they do after a stomach flu.  They feel far worse than my throat.

Fourth, isn't GERD supposed to have bad heartburn, or is that a stereotype?  When I stopped taking omeprazole as an experiment, I had very mild (1-2 second) heartburn while swallowing, and only mild heartburn (30 second at a time) between meals.

Fifth, what caused this?  I never had GERD before the URI.  Hiatal hernia from percussive coughing during the infection?  Will it ever "heal" to the point that I can get off medication?

[Kevin Pho, MD]

GERD can lead to gassiness and heartburn, but to be sure, further tests can be considered.  

These options would include an upper GI series.  However, the 24-hr pH study is the definitive test and should be considered if the diagnosis is in question.

If the symptoms continue, an upper endoscopy can be done to rule out other causes.  Normally chronic PPI's like omeprazole should suffice.  Further testing should be done if the symptoms continue despite PPI therapy.

These options can be discussed with your personal physician.

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.
kevinmd_

[Soonerdean]

I had the same problem...BAD!  I began taking Apple Cider Vinegar and in 2 weeks sypmtoms were gone.  Do a search on this stuff and find out for your self.  This stuff is NASTY tasting but it worked for me.  It is cheap too but you will have to purhcase it at a health food store.  GOOD LUCK!

[SHIDKDNE]

Hello,

I have a gastroenterological problem and it’s now affecting my quality of life and it is really getting me down and I don’t know why I have it. My problems first started about 4 years ago, I used to get wind, constipation etc. After lots of tests, scans, bowel training etc they put it down to IBS, although they have found my bowel is looped in 2 places, which I don’t think can be helping my symptoms very much but it seems there is nothing that can be done about this. Everyday I have trapped wind, which only comes out when I lay in different positions, I have bloating after every meal, I can only go to the toilet if I drink Chinese Herbal Tea, if I don’t drink one every night I will be constipated the next day.

For the past year and a half my symptoms have now got worse and my main symptom at the moment is constant burping. It’s driving me mad and ruining every day life for me. It used to happen after I’d eaten something but gradually over the past year and a half it’s happening all the time. It doesn’t matter what I eat, when I eat or even if I eat at all, as within 5 minutes of waking up in the morning I am needing to burp. At the moment I am burping all day until I go to bed! My stomach feels constantly gassy and it sounds weird but it feels like there is a lot of gas in my chest….Most of the time the burps come up OK but sometimes (which is also becoming more frequent) I have trouble getting the burps up and they feel like they get stuck ( I know it sounds strange but this is what it feels like) and then the gas goes to my stomach and I end up having wind in my stomach. I cannot understand why I have soooooo much gas in my body! People say if you have a lot of gas it’s because you are swallowing too much air – well sorry but I’m 25 years old and haven’t started breathing any differently in the past few years! I also have Acid Reflux now and once I’ve eaten and I burp, the food comes back in to my mouth. It’s disgusting. I have to take Nexium every day to control the burning pain of the acid, otherwise it feels like someone is cutting my throat and chest, it’s that painful!
After many tests to see if they could find a cause I had to have a gastroscopy (camera down my throat) which showed I have a hiatus hernia, which could be attributing to my problems. I also have a lot of Bile in my stomach, which shouldn’t be there.
My consultant, on many occasions has called me a medical mystery as he isn’t sure what’s causing the problem or how to fix it and he hasn’t come across anyone else who has this. A few months back he told me that he thinks I have 2 problems going on. 1. I have a motility problem, whereby food isn’t reaching my stomach quick enough, so therefore it’s getting stuck and causing a build up of air, hence why I burp continuously. 2. I have IBS and a dysfunctional bowel, which isn’t working properly. He doesn’t know how to fix each problem without making one of them worse!

He suggested having Botox injected in to my gullet to paralyse that area in order to let the foot drop in to my stomach easier and quicker and hopefully reducing the amount of burping – however he said it may make the reflux worse as there will be nothing to push the food down if it’s all paralysed! I had the 1st botox injection done in March 2007 – The results were immediate and although it didn’t get rid of the burps completely, it really did help and it was bearable and I was much happier. I was warned that eventually the botox will wear off and my symptoms would come back. My consultant said some people get the symptoms again after 6 months to a year and will need another injection. I was happy to have the injection this often if it meant I felt better. The injection also helped with the reflux – which was strange as it wasn’t meant to! Anyway within 2 weeks I noticed I was burping more often and I had the burning, after 1 month it was becoming a lot more often. My consultant said I could have 1 more botox injection but I couldn’t start having them once a month, that would be ridiculous! Anyway I had the second one at the beginning of May and this time it did not help at all! The very next day I was still burping. I was so upset and miserable that it hadn’t worked and felt like giving up hope.

I saw my consultant 2 weeks after the 2nd botox injection and he suggested we try Colofac and Motilium tablets (both IBS tablets, which I’d taken before and they hadn’t helped, so I didn’t hold out much hope!) As I thought they have done nothing!

My burps are terrible every day now and I feel they are getting worse. What’s more because I am constantly burping and my breathing pattern changes I am finding I am becoming light headed every day also….do you experience this aswell?

I went back to see my consultant last week and I am now booked in for an operation to see if that helps, am having it done on 2nd August. Basically they will stitch up my hiatus hernia and wrap my stomach. They are going to be tightening everything up. My consultant said hopefully it will relieve some of my symptoms but may give me a lot more wind coming out the other end, as opposed to burping. I am pessimistic about the whole thing now as I have tried to stay positive for so long but it’s so hard…..I pray this operation helps me.  

In terms or stress, yeah I have been very stress the past few months…..it’s been one thing after another really but not knowing what’s causing my problems is only making me stress even more!

If I go back to when my IBS symptoms first started it was about 2 months after my Dad was diagnosed with skin cancer. He had surgery and is fine now, thank God, but at the time it devastated me. So, I’m not sure if this could be linked to when my problems began. I am also a born worrier and worry about everything – even things that might never happen. I do feel on edge a lot of the time, so I’m not sure if this could be making it worse. However there is definite proof that my insides aren’t working as they should be.

I can cope with some wind, some bloating etc…but it’s the constant burping that is making my life hell, it’s so embarrassing and is stopping me from leading a normal life. I get so frustrated and can’t see a light at the end of the tunnel.

Can you relate to what I’m saying?
Thanks