GERD and Esphagus concerns, please advise.. I am suffering

[silverstanger]

I am 27yo.male. I have had a diagnosis of gastritis (few months ago) this year. It was severe pain under my brestbone.. It started with a burning sensation then went to a stabbing pain. Totally the symptoms lasted for about 2-3 weeks. I also had a pain in my back afterwards but that subsided too.

About a half-year before this episode I had an endoscopy done (Apr.2002) (because of some lower abdominal pains) and a hiatel hernia was found. No ulcers or any other problems indicated though.


The gastritis left me after water and nexium for days.

--


It seemed to me that I was having another bout of gastritis and for the last few days I have been suffering with the following:

1st was diareah for days (last week)
2nd was the sharp pains while digesting food. (end of last wk.- started taking nexium and got off soda)
3rd was the constant upset stomach - under pressure feeling that lasted until Today (Friday the 08/01/03). Just when I thought I was rid of the very bothersome upset stomach feeling which was worse after I ate but always there..

**** Today: Pains under my brestbone in the middle and pains in my back (just like the first bout of gastritis) which are alternating mostly. It also starting hurting when I inhaled in and not so much out. The more I inhale the more it hurts in the middle of my back. Why do you think this is? Drinking something seems to help with this..

What do you think the burning is when I inhale? It comes and goes also.
Could I get barrett's in a year since I have had all of these episodes AFTER my endo. Please Advise!! Thanks!!

[Kevin Pho, MD]

I would consider repeating the endoscopy - by a different gastroenterologist if the first one was inconclusive.  It is unlikely that Barrett's would be the cause of your symptoms, especially if it wasn't present in the endoscopy last year.

Regarding the hiatal hernia - 5% of then are paraesophageal (i.e. types II, III, IV).  If this is the case, then repair is indicated since they rarely regress on their own.  You may want to get a surgical opinion on this.  

Other considerations would be an evaluation of the gall bladder if the endoscopy was negative.  Atypical gall bladder disease can present with the discomfort.  

I would also suggest a 24-hr pH study.  There are cases where the reflux cannot be controlled medically - in which case surgical options should then be explored.  

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.

[silverstanger]

Also, The pain in my back seems higher than my brestbone.

It is always there but amplified by me inhaling.

It really seems like drinking some water or something helps with the pain and inhaling discomfort.

Please am I at rist for pnemonia (pneumonia).. It doesn't seem like the pain is in my lungs.. it feels like it is in my esophagus or the wind-pipe due to me breathing making it hurt more.

Could acid have gotten in my wind-pipe??

I am at a loss and can only describe my symptoms and concerns.

[GI.PA]

The symptoms you are describing (pressure at the breastbone usually worse after eating, chronic "sick to stomach", and a history of gastitis symptoms that responded to Nexium) all point to an acid disorder (reflux, gastritis, ulcer ect).  It sounds as if you were off the Nexium for a while and this may be a good time to have a discussion with your doctor about long term Nexium use to prevent these episodes instead of waiting for them to get in full gear before treating.

If your symtoms continue even after two weeks of continuous, daily Nexium use, it would be a good idea to have the gallbladder looked at.  Although your symtoms "sound" acid in origin, an atypical gallbladder presentaion should be considered.


Both acid related conditions and gallbladder disease can give one the sensation of upper abdominal discomfort when taking a deep breath in.  The most likely explaination is that with a deep breath, you diaphram lowers significantly putting pressure on the organs in the upper abdomen  --> Discomfort.

Barrett's is usually a painless condition.  It would be very unlikely that you would develop this in just one year since your endoscopy.  I would reserve repeat endoscopy for if you failed to respond to daily Nexium for two weeks and your gall bladder work-up was negative.

Erin
GI.PA

[silverstanger]

Thank you Erin..

How about Mylanta.. or Pepto.. what is the best over the counter acid reducer since access to Nexium isn't always there for me.

I am taking Mylanta also besides the Nexium between meals and before bedtime..

It kind of seems to help.

Right now the pain isn't so much in my chest but more in my back.

IS the pain in the back the esophagous or the stomach..

My guess is the ESO.

Finally.. about how long of suffering with GERD or other peptic problems would cause barrett's??

I will do what you said and wait another week.

Thanks!!

[GI.PA]

Any OTC is fine.  Gaviscon is a good different choice.  Mylanta, malox, tums ect all work to neutralize the acid.  Pepcid Complete is pepcid (shuts of some of the acid pumps) plus tums (antacid).

With your recurrent symptoms, long term Nexium is indicated.  

Barrets usually results after at least 5 years, usually 10 years of untreated acid reflux disease.

[GI.PA]

Opps forgot.

Pain can be refered to the back with stomach, espohagus or gall bladder pain...It is really non-specific.

[silverstanger]

thanks for the replies.. this relieves me on the barretts..

only.. i wonder how long i have been having it.. I am 27 and they found the hiatel last year. I can recall having heartburn for probably 2 years before that but nothing more than heartburn which happened each day before lunch. After lunch it would go away.. For some reason, with me, food and drink help wash or drive the burning away. I don't think it (GERD,etc) ever really gave me problems before this year.

I hate to ask another question but this makes me wonder:

Can gastritis or esophagitis, a.k.a. for me lots of pain, burning, stabbing, in my chest or back come on as fast as a few months or was it always there and the harsh symptoms just shown up - I am trying to find out if this pain started a few days ago.. or has been building up to this!!

What are the long term damages of these episodes??

Is it how long the episodes last that makes it bad.. or is it letting the episode occur because of non-treatment that makes it bad. Or even many episodes?? Makes it bad to me means like barrett's, cancer, etc.


Thanks I really, really appreciate all of the replies and information.

[tessa0825]

I just wanted to answer your question about "how long with acid before it progresses to barrett's?".....Majority of people never progress to barretts.....Its really unknown why some do and some dont, I guess its about 10-15% of un-controlled reflux people that progress, good news there is that only a small, 5-10% of barretts progresses to esophageal cancer....Barretts is a complication of acid-reflux so the symptoms for it are exactly the same as with GERD, and actually, sometimes the symptoms become less pronounced when you have progressed to barretts, probably because of the cell changes that occur within the lining of the esophagus....I agree that if you were just scoped last yr. and had no ulcers or erosions the chance of you having barretts would be slim....I was just evaluated this past week at one of the best hosp. in the country, Cleveland Clinic, for my barretts and dysplasia.....I next have appt. with several other specialists there to determine my treatment plan but I do know this about reflux....My opinion is that it probably never goes away, and once you are on PPIs you probably need to be on them for the long haul...Think about it, reflux is usually caused from a malfunctioning LES muscle, PPIs only slow or stop the production of acid being made in our stomachs, it does NOTHING to correct our LES, (lower esophageal spinchter muscle)......So, long term lifestyle changes and PPIs or reflux surgery to fix the LES is the two choices with reflux....

[tessa0825]

Erin, could you please explain something to me?....I had always seen the words..."WITH GOBLET CELLS" on all my pathology reports from my barretts biopsies but I never knew what they meant...I did know that the cells take on the same appearance as the cells in our stomache. I asked the Dr. in Cleveland last week what "Goblet Cells" were. It freaked me out when he told me they were cells resembling the ones in my "small bowel"! They have to be there for a true Barretts diagnosis he says...I think I understand why they take on the appearance of our stomach lining cells but what makes them change to look like the small bowel?.....Thank-you for any advise, Tessa

[silverstanger]

Well, the reason I was asking about getting Barrett's only a year after the scope is because I had all of these problems AFTER the endoscopy exam last year.

I got a endoscopy, colonoscopy, CAT scan, MRI of the head last year to try and found out why I was constantly nauseated, elevated creatinine levels, diareah and soft watery green stools, no vomiting, and at times I thought I was going to die do to my heart rate shooting up and me getting flush in the face attacks. Nevertheless all of these tests only turned up a Fatty liver(don't ask me about that one) and a hietal hernia.

The next step they said was to "cut me open" to see what they can find. After all of that my problems had went away by then.. and I said nah, I don't need that because I just started feeling better again.

They had NEVER discussed what the hiatel hernia could bring on.. but here and now I am finding out with all of these pains this year.

So I guess my question EXACTLY is.. Since my endoscopy I have had 2 painful GERD related attacks, and before the endo. I had NONE..
Should I get another endo. done to see if I have developed Barrett's since my last test??

Or- since I had the endo done last year (apr.2002), there is a slim chance of my having developed barrett's EVEN WITH the 2 painful attacks (gastritis/esophagitis) and possibly a years worth of unfelt reflux symptoms in between.

Thanks again.. I am just trying to look at my situation, and go from here.

[tessa0825]

Hi, it must be terrible going through that and not even being told what to do to help your hernia....Barretts develops in some people after MANY yrs of damage to the lining of the esophagus from reflux.....It is  a cell changing process that, according to my Drs., takes a long time to happen....You should be following the GERD diet for your hernia, no caffeine, carbonated beverages, aspirins, NSAIDS, tomato products, mints, pepper, fried foods, citrus fruits, fatty foods...Sleeping on a 6in wedge also helps with reflux....When your Dr. did your EGD if he saw any indication for a need of biopsies he would have made you aware of that....Usually, they can see any change in the lining of the esophagus when they are doing an EGD, however a barretts diagnosis has to be confirmed with biopsy...If you are worried about barretts I would call the Dr that did your test last yr and ask him...."When you were looking in my esophagus, did you see any reason why I should be having follow up surveillance?"....I hope you feel better soon.....Tessa

[tessa0825]

Im wondering if it, GOBLET CELL, is caused from bile? But, how does it get to the esophagus from the small bowel...Does it  reflux into the stomach from my intestines and then refluxes again into the esophagus?..Its so very confusing!! Tessa

[silverstanger]

OK. Today is Sunday and I posted Yesterday.

My esophagal pains are mostly gone but the dreaded sour stomach, pressure, upset stomach thing is back now.

I take mylanta and it does nothing at all.

Could it be the Nexium causing the very irratable stomach sensation that I am getting?? For 2 days it was gone completely and now it is back again.

It is sooooo annoying. It is slightly nauseating and feels like a very upset stomach.. not crampy at all though.. just like a swollen slightly burning feeling.

Would pepto help??

[marlow]

Hi,

Having read all about your problems, I can relate to some of them. I had my gallbladder removed 4 years ago and still now have pains just under my breastbone when I take in deep breaths.  The worst is when i yawn - that is agonising. I am due an ultrasound scan in two days because I have been vomitting alot as well.  since the operation 4 years ago, I have had constant diarhea (diarrhea) - every single day, sometimes 12-13 times a day. Believe it or not, I have gained 2 stone in weight - how's that work????

I hope you and all of us eventually find some cure or comfort.

Good Luck