chest pains from reflux

[frank-k]

  I started having a great deal of gurgling, belching and chest pain about a month ago. I am very suseptible to stress. I went to the ER twice, my heart was ok, but I'm cntinously anxious. Is a exercise stress test enough, or should I demand echo, and even catherization. Again, my ekg, enzymes etc. were fine. However, my blood pressure seems lower than before (around 105/78) as opposed to 128/80 before on average. Also, my ability to run has been dimished since the Gerd kicked in. Could I be bleeding from daily aspririn regimen. My hemo was 14.2 i believe. Thank You
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Dear Frank,
GERD is an abbreviation for GastroEsophageal Reflux Disease.  This disease is characterized by reflux of acidic stomach contents into the esophagus causing irritation and, in some patients, pain.  The presentation of this disease is very diverse, and the symptoms you describe could certainly be a result of this disorder.  Before you can say that your condition is GERD, other possibilities need to be considered.  For example, the following problems can present with similar symptoms:  gastritis (or inflammation of the stomach lining); infectious esophagitis; pill esophagitis; peptic ulcer disease; dyspepsia (or recurring pain or discomfort centered in the upper abdomen); biliary tract disease; coronary artery disease; and esophageal motor disorders.  
Your evaluation for coronary artery disease in the ER was appropriate (ECG, exercise stress test).  You should consult with your primary care physician to determine if further studies are necessary (i.e. echo, cardiac catheterization).  Your hemoglobin is normal so I doubt you have significant gastrointestinal bleeding.  A rectal examination to test for microscopic blood in your stool should be done if this is a concern, especially if you use more than 1 adult strength aspirin a day on a regular basis (or aspirin-like products such as Advil, Motrin, etc.).  Aspirin products can cause irritation of the stomach lining and even  ulcers that can result in bleeding.
You should be evaluated by your primary care physician so that a complete history and physical exam can be performed.  Your physician can help determine the cause of your anxiety and suggest methods to help reduce stress.  Stress certainly can aggravate many medical conditions including GERD.  
There are other  measures that you can initiate to reduce the symptoms of GERD.  Elevating the head of your bed 10-15 degrees will prevent stomach contents from refluxing into the esophagus.  Avoid eating at least 2 hours before retiring for the night.  Try to avoid foods that may worsen symptoms such as alcohol, caffeine, chocolate, and peppermint products.  Have you tried any over the counter medications?  If not, you may want to consider this (i.e. antacids, Pepcid AC).  Your doctor can also prescribe medications that may resolve your symptoms.
If your symptoms are severe or the above suggestions are not helpful, your physician may recommend that you be evaluated by a gastroenterologist.  If necessary, an endoscopic exam using a flexible scope can be performed to evaluate your upper gastrointestinal tract (esophagus, stomach and the first portion of small bowel).  If this is negative, an ultrasound of the abdomen to evaluate the biliary tract may be considered.
The gastroenterologist may recommend further studies if necessary.
This information is provided for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-mg
*keywords: reflux disease, esophagitis
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