chest pains and reflex esophagitis

[Greg__0]

Posted By  HFHSM.D.-mz on February 10, 1998 at 07:04:05:

In Reply to: Re: Re: chest pains and reflex esophagitis posted by Greg on February 02, 1998 at 11:03:50:

:
  : : 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.
  :

[HFHSM.D.-mz]

  : 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 cardiologist’s 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
  Thanks for responding!  Yes, the info I provided was probably insufficient.  I'm 40, don't drink, don't smoke, have high cholesterol (last time I checked, 5yrs ago).  However, I've always had good blood pressure and a metabolism which allowed me to eat a lot and never gain much weight (up till a couple years ago at least).  At any rate, in the meantime I went to see a general practice physician 'cause my back pains were getting unbearable and he pretty much said the exact things you did above.  I've been drinking Mtn Dew and Pepsi about 2-3 times a day for the last 5 yrs (it's free at work) and working extremely long hours under much stress.  Turns this is where I got all the huge amounts of caffine.  He gave me a prescription for a bit stronger medication.  I changed my diet completely (don't eat so much,  no pop at all, no chocolate, and leaving work at 4 pm instead of 8-9) and I'm feeling great, not to mention 10 pounds less and 2 belt notches smaller in the gut.
  I'm still scheduled for the heart specialist but I believe I'm on the way to recovery.  I had one more question though.  I searched the internet and found excellent info on my condition and the medication I'm taking.  In every case it listed the symptoms above but nowhere was back pain metioned.  In my case, this was the most painful and serious problem I had (after the initial attack).  It's completely gone now.  Any ideas there?


Dear Greg:
      I was glad to hear that you have made changes in your lifestyle and that you are now asymptomatic.  There are a number of reasons for back pain, some of which I alluded to in my previous communication.    To determine the cause for your problem will require investigation.   A cardiology evaluation, as you have scheduled, is an appropriate starting point.  Further studies to evaluate other organ systems can be initiated after this to see if a cause can be elucidated.  Congratulation and Good luck.
      This response is being provided for general informational purposes only and should not be considered medical advise or consultation.  Always check with your personal physician when you have a question pertaining to your health.
HFHSM.D.-mz
0.15
esophagitis, abdominal pain