Is this GERD, or something else?

[ColinJ]

I am 34 year old male, slim build, prone to occasional anxiety bouts but generally have good health.  I gave up smoking (3 per day) a few months ago, and have cut back on drinking as well (used to drink 14-21 units per week), now down to 4-7 units per week. I dont exercise as much as I should and have had trouble eating enough vegetables but working on that too.  I was treated for dyspepsia with proton pump inhibitors late 2001 for 12 weeks and my low grade upper left quadrant abdominal discomfort disappeared. I have always belched alot, like I swallow alot of air and this has seems to have increased over the past couple of months, and I've noticed that I get more nauseous, more easily.  I have noticed that I have had mobile upper quadrant abdominal discomfort, borborygmi, occasional diarrhoea or gassiness, and a bit of a mild burning sensation centre chest and up to my neck (mild and infrequent).  My main concern is that when I swallow foods and occasional liquids I get a pain sensation in my lower right chest, about level with my xiphisternum, lateral to the costochondral junction by a couple of inches.  This pain sensation is mild but recognisable each time I swallow a bolus of food, or fizzy drink or hot beverage, but water seems to be ok.  My work has been very busy over the last few weeks and I haven't been eating properly - missing lunch, small breakfast so only large evening meal and snacks at home at night. My blood pressure is normally 120-130/70-80.  I had a full chest x-ray April 2002 which was unremarkable according to the raiologist, and in 2003 my bloods and urines were all normal, cholesterol was about 4 although my ratios were a bit out - trying to eat more fish.
My question - does this sound like GERD? I can't find any reference to the right displaced chest pain on swallowing, and heartburn doesn;t seem really bad or consistent however, and I wouldn;t say it feels bad in the morning or on an empty stomach.
However given the belching, occasional vomiting of empty stomach contents associated with nausea and now the slight pain that I attribute to lower esophagus or cardia of stomach I cant help but include carcinoma in the differential. Do the clinical signs described fit potentially with that? I know I need to go see my doctor but another opinion along the way would be great.

Thanks

[Kevin Pho, MD]

I would evaluate the gallbladder.  Something like a gallstone can cause your symptoms - especially with relation to eating.  The best test to evaluate this would be an abdominal ultrasound.  

If negative, tests to evaluate the various causes of dyspepsia (i.e. GERD, ulcers, or inflammation of the upper digestive tract) should be considered.  The most comprehensive test is an upper endoscopy.  

If that test is negative, you may want to consider a 24-hr pH study - which would be the definitive test for GERD.

A GI referral should be obtain to discuss these possibilities.

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