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Gastroenterology (Expert Forum)
Re: chest pains and reflex esophagitis
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Re: chest pains and reflex esophagitis
by HFHSM.D.-mz, Jan 01, 1995 12:00AM
Posted By HFHSM.D.-mz on January 28, 1998 at 07:24:55:
In Reply to: chest pains and reflex esophagitis posted by Greg on January 18, 1998 at 12:28:08:
: Hi, I'm sorry this is so lengthy, I just want to be clear.
2 days ago I was at my computer at work at about 9:30 am and started getting very intense chest pains that would come in waves causing shortness of breath, long story short I ended up in emergency care at the hospital where the doctors performed tests to rule out MI protocol (heart attack?). All tests returned negative and they released me after giving me a GI cockail briefly informing me that I might have some form of relex esophogitis due to acid indigestion. I was given a prescription for over-the-counter Zantac and dismissed. I made an appointment to see a heart specialist and to undergo some tests, earliest appt is mid Feb which I am eagerly awaiting.
I'm confused by the prescription and am trying to obtain more information about this condition. I've never considered myself as having serious heartburn and I can't believe that this is what caused the very sudden and painful chest pains. It's never happened before and it started on a normal day after a normal breakfast of a single, small bowl of ceral (my usual). I'm in pain now (mid chest, upper stomach area) all day long even while taking the medication though it's not nearly as intense as the emergency situation.
I'm concerned that I've somehow damaged my esophogus and want to know how to reapir the damage. I've been healthy all my life and have never taken medication long-term. I don't like it, I'd rather figure out how to get healthy again.
As a side note, I came down with a really bad flu over Christmas (few weeks ago) which lasted for about 4 days. This was different than previous flus as the pain attacked my spine, causing severe aching up and down my back. The spinal pain appears to have returned today and is here as I'm writing this note. I guess these are my questions:
1. Can the esophogus really explode into chest pains in a sudden fashion as I've described? If so, can it really be treated with antacids? This makes no sense to me. If this is caused by acid indigestion, I'd expect the problem to increase over a period of time, not erupt in a massive emergency. In addition, how can Zantac correct the problem? I'd expect I should change my diet or something.
2. Is it possible I've got some kind of infection which causes symptoms similar to a flu with severe spinal pain? If so, is it possible I've still got it and it's partly responsible for my esphogus condition and spinal pain?
3. Is it possible the spinal pain is simply from sleeping (lying down) a lot?
4. Any other ideas?
Thanks for any help.
__
Dear Greg,
Thank you for your letter. I hope that you are feeling better. The sudden onset of chest pain and shortness of breath is often due to heart disease. Therefore, it was appropriate for you to be seen at your Emergency Room and to have an evaluation for cardiac ischemia (angina, infarct). EXCLUDING HEART DISEASE IS THE FIRST PRIORITY OF THE PHYSICIAN. You do not provide your age, history of risk factors for heart disease (high blood pressure, diabetes, high cholesterol etc.) or whether you have other symptoms to suggest heart disease (pain with exertion, shortness of breath, decreased exercise tolerance). This information can influence the nature of your evaluation.
Chest pain can be caused by the reflux of acid into the esophagus (swallowing tube ). The acid causes inflammation and can even cause ulcers of the esophagus. To determine whether your symptoms of pain are due to esophageal reflux could require determination of esophageal inflammation (often by direct visualization i.e. endoscopy), demonstration of acid reflux into the esophagus (24 hr pH study). These tests should not be done unless your cardiologists evaluation does not reveal cardiac disease and you are still having symptoms. You should know that esophageal reflux can present as acute chest pain, although you are correct that often patients have a prolonged history of reflux symptoms.
The esophagus can usually heal itself very quickly and consequently few patients with esophageal reflux have evidence of permanent damage. Zantac is a medication which decreases the secretion of acid. The use of over-the counter Zantac has become one of the initial steps in therapy for esophageal reflux. Antacids are also very effective treatments for reflux. Tums, Rolaids, Maalox are used by many people to control the symptoms of reflux..
In addition to taking over-the-counter medicines, there are a number of lifestyle modifications that are effective:
1)Do not eat within 3-4 hours of lying down.
2)Sleep with the head of your bed elevated approx. 6 inches.
3) Avoid alcohol, fatty foods, chocolate, peppermints. These are foods that can promote esophageal reflux.
4) Limit or eliminate caffeinated beverages e.g. coffee, tea.
5) If you have predominantly daytime symptoms, consider chewing gum or sucking candies. These activities increase the production of saliva. Swallowing saliva (saliva is rich in bicarbonate that can neutralize any refluxed acid) decreases the symptoms of acid reflux.
6) Lose weight if this suggestion is appropriate.
In addition to cardiac disease and esophageal reflux, the symptoms that you describe can be due to other conditions. Esophageal dysmotility (an incoordination of muscle activity in the esophagus) can present with chest pain. Ulcer disease and gallbladder disease can also cause chest pain. Shoulder and spine problems must also be considered. Although possible, I think that it is unlikely that the flu infection per se caused your symptoms, although if you took medications for the flu, the drugs could have caused your problem.
Good luck with your investigation. I hope that your problem resolves.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office, and make an appointment to see Dr. Zonca, one of our experts in the investigation of chest pain and the treatment of esophageal reflux.
HFHSM.D.-mz
keywords: chest pain, esophageal reflux,
0.7
In Reply to: chest pains and reflex esophagitis posted by Greg on January 18, 1998 at 12:28:08:
: Hi, I'm sorry this is so lengthy, I just want to be clear.
2 days ago I was at my computer at work at about 9:30 am and started getting very intense chest pains that would come in waves causing shortness of breath, long story short I ended up in emergency care at the hospital where the doctors performed tests to rule out MI protocol (heart attack?). All tests returned negative and they released me after giving me a GI cockail briefly informing me that I might have some form of relex esophogitis due to acid indigestion. I was given a prescription for over-the-counter Zantac and dismissed. I made an appointment to see a heart specialist and to undergo some tests, earliest appt is mid Feb which I am eagerly awaiting.
I'm confused by the prescription and am trying to obtain more information about this condition. I've never considered myself as having serious heartburn and I can't believe that this is what caused the very sudden and painful chest pains. It's never happened before and it started on a normal day after a normal breakfast of a single, small bowl of ceral (my usual). I'm in pain now (mid chest, upper stomach area) all day long even while taking the medication though it's not nearly as intense as the emergency situation.
I'm concerned that I've somehow damaged my esophogus and want to know how to reapir the damage. I've been healthy all my life and have never taken medication long-term. I don't like it, I'd rather figure out how to get healthy again.
As a side note, I came down with a really bad flu over Christmas (few weeks ago) which lasted for about 4 days. This was different than previous flus as the pain attacked my spine, causing severe aching up and down my back. The spinal pain appears to have returned today and is here as I'm writing this note. I guess these are my questions:
1. Can the esophogus really explode into chest pains in a sudden fashion as I've described? If so, can it really be treated with antacids? This makes no sense to me. If this is caused by acid indigestion, I'd expect the problem to increase over a period of time, not erupt in a massive emergency. In addition, how can Zantac correct the problem? I'd expect I should change my diet or something.
2. Is it possible I've got some kind of infection which causes symptoms similar to a flu with severe spinal pain? If so, is it possible I've still got it and it's partly responsible for my esphogus condition and spinal pain?
3. Is it possible the spinal pain is simply from sleeping (lying down) a lot?
4. Any other ideas?
Thanks for any help.
__
Dear Greg,
Thank you for your letter. I hope that you are feeling better. The sudden onset of chest pain and shortness of breath is often due to heart disease. Therefore, it was appropriate for you to be seen at your Emergency Room and to have an evaluation for cardiac ischemia (angina, infarct). EXCLUDING HEART DISEASE IS THE FIRST PRIORITY OF THE PHYSICIAN. You do not provide your age, history of risk factors for heart disease (high blood pressure, diabetes, high cholesterol etc.) or whether you have other symptoms to suggest heart disease (pain with exertion, shortness of breath, decreased exercise tolerance). This information can influence the nature of your evaluation.
Chest pain can be caused by the reflux of acid into the esophagus (swallowing tube ). The acid causes inflammation and can even cause ulcers of the esophagus. To determine whether your symptoms of pain are due to esophageal reflux could require determination of esophageal inflammation (often by direct visualization i.e. endoscopy), demonstration of acid reflux into the esophagus (24 hr pH study). These tests should not be done unless your cardiologists evaluation does not reveal cardiac disease and you are still having symptoms. You should know that esophageal reflux can present as acute chest pain, although you are correct that often patients have a prolonged history of reflux symptoms.
The esophagus can usually heal itself very quickly and consequently few patients with esophageal reflux have evidence of permanent damage. Zantac is a medication which decreases the secretion of acid. The use of over-the counter Zantac has become one of the initial steps in therapy for esophageal reflux. Antacids are also very effective treatments for reflux. Tums, Rolaids, Maalox are used by many people to control the symptoms of reflux..
In addition to taking over-the-counter medicines, there are a number of lifestyle modifications that are effective:
1)Do not eat within 3-4 hours of lying down.
2)Sleep with the head of your bed elevated approx. 6 inches.
3) Avoid alcohol, fatty foods, chocolate, peppermints. These are foods that can promote esophageal reflux.
4) Limit or eliminate caffeinated beverages e.g. coffee, tea.
5) If you have predominantly daytime symptoms, consider chewing gum or sucking candies. These activities increase the production of saliva. Swallowing saliva (saliva is rich in bicarbonate that can neutralize any refluxed acid) decreases the symptoms of acid reflux.
6) Lose weight if this suggestion is appropriate.
In addition to cardiac disease and esophageal reflux, the symptoms that you describe can be due to other conditions. Esophageal dysmotility (an incoordination of muscle activity in the esophagus) can present with chest pain. Ulcer disease and gallbladder disease can also cause chest pain. Shoulder and spine problems must also be considered. Although possible, I think that it is unlikely that the flu infection per se caused your symptoms, although if you took medications for the flu, the drugs could have caused your problem.
Good luck with your investigation. I hope that your problem resolves.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office, and make an appointment to see Dr. Zonca, one of our experts in the investigation of chest pain and the treatment of esophageal reflux.
HFHSM.D.-mz
keywords: chest pain, esophageal reflux,
0.7
