Hiatal Hernia/GERDS/ which one, nothing is helping!

[mt__0]

  Over a year ago, I was lifting weights (pulling weights down from over head, basically working the upper body).  I felt like I had injured my chest muscles/ligaments that go between my ribs from where the ribs meet at bottom to mid-way up my chest.  I rested and stopped lifting weights.  It was painful to sleep on my side because it scrunched my shoulders together.  Then a few months later, it felt better, but all of a sudden, they were back with new and different chest pains.  I had shooting pains (lasting just a second) many times per day for many, days.  So, I went to an interest.  I went through all the chest pain tests, i.e. ekg, stress test, ultrasound, heart monitor etc.  Everything was perfect and my BP was great.  He perscribed a steroid for me to take for 12 days (where you gradually increase then decrease the dosage).  The last day or so, it seemed to help.  He thought that I had a hiatal hernia.  Then, probably a month later, I began feeling nauseous.  He thought that I had GERDS.  My upper stomach is very, very sore at all times.  So, I several days of 30 mg Prevacid then 15 mg.  I had taken this for several months.  It seemed to be better at first, but then worse and my pain in my stomach has not been alieviated.  I also feel that this area pokes out some.  My chest pains have wained, except for about one per week.  I then became more nauseated and he increased the dosage to 30 mg.  I had and upper GI and H Plor test.  Everything was great.  I had my gall bladder checked, fine.  I am still nauseated.  I have been on a special diet for a couple of months (little amounts, no caffine, no cocoa, low fat, etc.)  I have no relief.  Should I go to another doctor or what?
  Thanks for your time, this has been a long story, just think how I feel!
  mt
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Dear mt,
It is relatively easy to determine if your pains are the result of acid or gastric contents refluxing into your chest.  An esophageal motility study with 24 hr pH probe test is needed.  This study will allow for 1) the measurement of the pressure in the lower esophageal sphincter (the barrier that prevents gastric contents from refluxing into your chest), 2) the coordination of esophageal muscles during swallowing and 3) whether there is abnormal reflux of gastric contents into the chest (everybody has some reflux).  I assume that the upper Gi study that you had was an x-ray test.  An endoscopic study to look for superficial inflammation of the esophagus is needed, if it has not yet been done.  The endoscopy test, which is more sensitive than a barium x-ray, will also exclude superficial inflammation of the stomach and duodenum.
If yout doctor believes that your problem is definitely due to reflux and the two of you decide that there is no value in additional tests , then you may consider adding a prokinetic agent, such as Propulsid, to your medications.  This drug promotes emptying of the stomach and increases the lower esophageal sphincter pressure. These two actions reduce the frequency of acid reflux.  
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and investigate your symptoms.  You can arrange an appointment with Dr. Fogel, one of our experts in the treatment of esophageal disease.  He can be reached by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: wsophageal reflux. GERD, therapy
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