esophageal spasims -- chest pains

[chubnik]

My 14 year old daughter has had chest pains since she could talk to tell me so.  She always said it felt like someone was squeezing her heart.  Years ago her pediatrician said she had "cardiac awareness".  When she was 7, she had two EKGs that were normal.  When she was 11 or 12 she had a stress test--normal.  Last year she had an endoscopy, which showed no damage, but her lower esophagus valve stayed open.  She had a mobility test--ok ( not quite perfect, but in normal range), and a PH test.  She only kept the PH test in for 9 hours when she started to panic and hyperventilate.  It had moved and she thought she was choking. It had to come out, but 95 episodes of reflux were recorded in this 9 hours. She said she only felt pain twice, and will never do this test again. It was considered inconclusive since she didn't finish the test.   She had a barium shallow/upper GI series.  This showed that her lower esophagus valve was open and she had a slight hianal hernia.  Funduplication was suggested, which she had the week before Christmas 2002.  It was attempted laproscopicly; her spleen was tucked too far behind her stomach and there was some bleeding.  It had to be done open, but the doctor was confident and pleased with the job.  The hernia was too small to repair.  Instantly she had no chest pain other than the healing from the surgery.  We were all so pleased.  About a month and a half after the surgery she started having  chest pains again.  At first she said they were slightly different from before the surgery.  Now she says they are the same.  They started only occasionally (she's never had heart "burn", only the pressure and squeezing pain)  They got worse.  They are everyday for most of the day.  Sometimes in school, she just sits with her knees up to chest through a whole class or two.  They even happen in the morning when she wakes up.  When she is empty and when she eats.  She now also has nausea, which she never had before.  She has lost about 40 pounds and looks just right. Most days she doesn't eat since she feels lousy and nausaus.  She is tired and sleeps alot, going to bed early.  She has tried Pepcid, Tums, Previcide, and Nexium.  Nothing has ever helped.  This week she is doing a barium shallow/upper GI series again and some bloodwork.  The doctor mentioned gall stones, but why would she have no pain for 1 1/2 months.  He mention stretching her esophagus during a endoscopy, but I read that is for people whose valve is too tight--hers was open and the surgery was to make it tighter.  She is frustrated and doesn't want to see anymore doctors, medical tests or medications.  I think it is effecting her school work also.  I would appreciate any suggestions. Thanks

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

Studies show a success rate of GERD surgery based on symptom relief in pediatric patients ranges from 57-92%. The most common complications are breakdown of fundoplication, small bowel obstruction, gas-bloat syndrome, infection, atelectasis or pneumonia, perforation, persistent esophageal stricture, and esophageal obstruction.

In general, the Nissen fundoplication, which is a complete 360° wrap, best controls the symptoms of GERD but may lead to more episodes of dysphagia and gas bloat than a partial wrap.  If feasible, you may want to re-evaluate the surgery.  You would have to discuss this with your surgeon.

A diagnosis of functional dyspepsia may also be considered.  Functional dyspepsia is not rigorously defined in children.  In children mature enough to provide an accurate history, the criteria for diagnosis of dyspepsia are: 1) Persistent or recurrent pain or discomfort centered in the upper abdomen, and 2) No evidence (including an upper endoscopy) that organic disease is likely to explain the symptoms, and 3) No evidence that dyspepsia is exclusively relieved by defecation or associated with the onset of a change in stool frequency or stool form. Pain or discomfort in the upper abdomen has to be present at least 12 weeks, which need not be consecutive, within the preceding 12 months.

Studies show that children with functional abdominal pain have more abnormal electrical activity in the stomach with slower movement of stomach contents.  Endoscopy, ultrasound, upper gastrointestinal x-rays with small bowel follow-through, and gastroduodenal manometry are the usual tests ordered for children to look for organic disease.  

If all tests come back negative, then focus should made on symptomatic relief.  You have already tried H2-blockers (pepcid) and nexium/prevacid.  Use of antidepressants, prokinetic agents (i.e. reglan), and biofeedback have had varying success and may be attempted.

Followup with your personal physician is essential.  If a referral has not already been made, I would suggest seeing a pediatric gastroenterologist.

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.

Thanks,
Kevin, M.D.

[tessa0825]

I'am so sorry you have been through so much and even sorrier for your daughter.....I mainly wanted to tell you that stretching (Dialation) of the esophagus is done for strictures, (better known as narrowing)in the esophagus..Have you seen the same Dr. throughout all this, and is he (she) a pediatric gastroenterologist? If not, I would seriously think about seeing one....My best to you and your daughter.....Tessa

[Valya]

My husband is suffering terribly from reflux - he has had a Barium swallow and we were told it was a narrowing of the esophagus. He is presently booked for a scope and then an appointment with a thoracic surgeon.  He has discomfort swallowing and therefore is reluctant to eat his regular portions.  He has limited his menu to soft food & he has lost weight because he now eats half his usual amount. He is on Ranitidine (zantac) however he is experiencing alot of right shoulder blade pain which he is treating with Advil. I must admit I am very concerned and fear the worst - however I'm trying to be strong & positive.  Any comments re: narrowing of the esophagus?

[tessa0825]

Hello,An esophageal stricture is a narrowing of the esophagus...It is caused by irritation and inflammation, such as chronic acid-reflux, over time it creates scar tissue and forms strictures...I can only tell you this in reference to my personal experience with strictures....I have had mine dilated several times, because of Barrett's esophagus.In my experience this has been a pain free procedure( due to medications that are administered thru IV and spraying of the throat with a numbing medication) and my GI Spec. does it during EGD by inserting a tube and stretching my esophagus open, allowing me to swallow food and liquids much better..I can sympathise with your husband as I have had pain so bad,even trying to swallow water,that I was sure I might be having a heart attacke....However, since I am now aware of what causes the pain I can deal with it much better....Take care...Tessa

[Tomskie]

There was something strikingly familiar about your daughter's cardiac awareness and my own reflux reaction. I have suffered from what I believe is a vagus nerve reaction to any pressure on my small hiatal hernia from both gas and/or reflux (confirmed reflux on 24 pH monitoring). Symptoms include a pounding heart. Mine responds to large dose ibuprofen (600-800mg) which I believe has an anti inflammatory effect on the nerve. I wouldn't suggest this for your young daughter because the dose size/frequency will cause gastritis. You may want to ask your doctor about a night time second dose of prilosec or other PPI, tilting the head of her bed up significantly, slower eating, softer foods and some water therapy. In my case, two quarts throughout the day seems to relieve the hernia pressure/irritation for some reason. I hope she is feeling better soon.

[chubnik]

We saw a different gastroenterologist last year that told us we were "wasting his time", mainly because my daughter couldn't finish the 24 hour PH test.  We live in a somewhat rural area and have to travel about 3-4 hours to a large city to see more doctors and specialists.  Her current gastroenterologist is local, but the sugeon we went to was about 3 hours away.  There are no pediatric gastroenterologists locally.  Thanks for the suggestion, I will look for one, unless the barium swallow/upper GI  that she had this morning shows something obvious.

[chubnik]

Well, the barium shallow was normal--didn't show anything.  She is still very nauseous and avoids eating at times.  Now we are going for a sonogram of her gallblatter next week.  The doctor still wants to do an endoscopy and stretch her esophogas for the spasims.  This stretching thing makes me nervous.  She is looking very pale and sleeps alot.

[scoons]

I was diagnosed with a hiatel hernia when I was 19 having my first child. Two decades have gone by and since then, I have been told I don't have a hiatel hernia, I have esophagus reflux (GERD). Since then, I have been told that the esophagus reflux isn't that bad and shouldn't been giving me the pain I have been experiencing for 23 years. That maybe I have esophagus rings that need to be broken and the esophagus needs to be stretched. This seemed to make sense to me seeing as the pain came on in the form of contractions. It would seem to cramp up for a few minutes, then release for a minute, then would cramp up again. The pain gets so tremendously unbareable, that the older I get the more I feel as though I am not going to be able to handle it. So when my GI said that he was going to give me an upper GI and stretch the esophagus muscle I thought that this would be the cure I was looking for. I had  my upper GI yesterday, but the doctor found no rings and everything looked fine. Seven years ago, my LES had been found to be sticking open, and I thought the least they would found would be the same problem with the LES again. Nothing was found, and yet still the pain worsens each time. I am telling this to you so that for one, you know that this is a larger problem than I thought. There are alot of people suffering from these symptoms, and two, that maybe in someway it will help to know others are going through similar procecures, searching for the cure. If I ever find something that helps, I will post it on this site for all to see. Good luck everyone.

[baseball 4 life]

hello my name is josh and i am 14 years ols..the past couple of days i have had pains in my right side of chest (lung area) when i eat and swallow and sometimes breathing.  When i swallow naything the pain travels through my neck into my chest. i have recently been lifting weights. Could it be muscle problmes?  Or what is happening to me?

[Lynnann]

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[sugar_itch]

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