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Gastroenterology (Expert Forum)
pain in the upper chest
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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.
pain in the upper chest
by toonces, Mar 31, 2003 12:00AM
Hello:
I have had a hiatal hernia for about 11 years now, and have been taking Prilosec or Nexium most of this time. It does help me alot. I am 34 years old, 6'3 and 286 pounds. I could stand to lose some weight.
My symptoms have alway been chest pain, tighness in the chest, or the burning effect associated with the hernia. I have had the upper Gi about 8 years ago, and most recently a Endoscopy. The doc says no Barrets, but some apparant burning away of the Sphincter area that covers the Esophogus. It seems it the acid has done a job on that area.
Anyway, I occasional get chest pain when I forget to take the Nexium and eat acidic or fatty fried foods, but they are quick pains that come and go quickly. Sometimes they may last more than a few seconds. However, I mostly get the burning reflux associated with the reflux disease.
The other day, I had just eaten some yogurt on an empty stomach and soon after got this sharp pain in the chest area. I usually don't get it that constant or painful. It wained a little after a minute, and seemed to go away. I then was fooling with a friend and ran up my stairs and fell at the top due to wet shoes. I went down pretty hard on my right side and believe I tried to reach out to stop myself from falling, but no use I came down hard, and quickly got up, and paid no attention to the fall. Then about an hour later the pain in the chest, while a little different from the pain earlier came on hard. The pain seems to be exactely 3 inches above my right nipple, and three inches in towards the center of the chest. I could push on that area and it would hurt to the touch. I am confused because this is the same area I occasionaly get this quick sharp pain when my hernia is acting up. So I do not know if it's from the fall or I affected the hernia from the fall, or something altogether different. The pain does come and go depending on how I position my body so it seems somewhat muscular, but I always have seemed to affect the reflux pain depending on the stretches I do as well. This is also strange because I did not know a hiatal hernia can be affected by body position. However, I do know that body position when sleeping can affect the reflux. So when I do get reflux at night I keep my head and chest elevated.
I was diagnosed with a small duodenal ulcer when I had the upper GI some years ago, but the Doc make no mention of it at the last Endoscopy.
I am hoping you can give me an idea how to proceed and if the fall could have affected the Hernia, and what steps I should take to recover from this, or should I seek out my Doc.
Could you also quickly tell me if there are any long term negative effects associated with long term use of Nexium.
Thank you
toonces
I have had a hiatal hernia for about 11 years now, and have been taking Prilosec or Nexium most of this time. It does help me alot. I am 34 years old, 6'3 and 286 pounds. I could stand to lose some weight.
My symptoms have alway been chest pain, tighness in the chest, or the burning effect associated with the hernia. I have had the upper Gi about 8 years ago, and most recently a Endoscopy. The doc says no Barrets, but some apparant burning away of the Sphincter area that covers the Esophogus. It seems it the acid has done a job on that area.
Anyway, I occasional get chest pain when I forget to take the Nexium and eat acidic or fatty fried foods, but they are quick pains that come and go quickly. Sometimes they may last more than a few seconds. However, I mostly get the burning reflux associated with the reflux disease.
The other day, I had just eaten some yogurt on an empty stomach and soon after got this sharp pain in the chest area. I usually don't get it that constant or painful. It wained a little after a minute, and seemed to go away. I then was fooling with a friend and ran up my stairs and fell at the top due to wet shoes. I went down pretty hard on my right side and believe I tried to reach out to stop myself from falling, but no use I came down hard, and quickly got up, and paid no attention to the fall. Then about an hour later the pain in the chest, while a little different from the pain earlier came on hard. The pain seems to be exactely 3 inches above my right nipple, and three inches in towards the center of the chest. I could push on that area and it would hurt to the touch. I am confused because this is the same area I occasionaly get this quick sharp pain when my hernia is acting up. So I do not know if it's from the fall or I affected the hernia from the fall, or something altogether different. The pain does come and go depending on how I position my body so it seems somewhat muscular, but I always have seemed to affect the reflux pain depending on the stretches I do as well. This is also strange because I did not know a hiatal hernia can be affected by body position. However, I do know that body position when sleeping can affect the reflux. So when I do get reflux at night I keep my head and chest elevated.
I was diagnosed with a small duodenal ulcer when I had the upper GI some years ago, but the Doc make no mention of it at the last Endoscopy.
I am hoping you can give me an idea how to proceed and if the fall could have affected the Hernia, and what steps I should take to recover from this, or should I seek out my Doc.
Could you also quickly tell me if there are any long term negative effects associated with long term use of Nexium.
Thank you
toonces
Doctor's Answer
by Kevin Pho, MD, Mar 31, 2003 12:00AM
, Mar 31, 2003 12:00AM
Hello - thanks for asking your question.
The pain that worsens after you press on it is characteristic of musculoskeletal pain. An X-ray looking for anything broken would be a reasonable next step. Treatment with pain medications +/- physical therapy would help musculoskeletal-based chest wall pain.
However, if the pain continues past several weeks, then you would have to start looking for other causes. You already have a documented hiatal hernia. Depending on the type (they range from type I-IV - ask your physician which one you have), then surgery may be an option. Enlarging type II, III, and IV hiatal hernias never regress and continue to enlarge. If this is the case, then surgical repair may be considered. If you continue to have heartburn symptoms despite nexium, surgery would again be the next step.
You may also want to consider an ultrasound to evaluate for any gall bladder disease since they can also cause epigastric pain.
Studies have been performed with omeprazole (prilosec) - which is in the same class as nexium. Over 15 years, there have not been any clinically significant side effects.
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.
Thanks,
Kevin, M.D.
The pain that worsens after you press on it is characteristic of musculoskeletal pain. An X-ray looking for anything broken would be a reasonable next step. Treatment with pain medications +/- physical therapy would help musculoskeletal-based chest wall pain.
However, if the pain continues past several weeks, then you would have to start looking for other causes. You already have a documented hiatal hernia. Depending on the type (they range from type I-IV - ask your physician which one you have), then surgery may be an option. Enlarging type II, III, and IV hiatal hernias never regress and continue to enlarge. If this is the case, then surgical repair may be considered. If you continue to have heartburn symptoms despite nexium, surgery would again be the next step.
You may also want to consider an ultrasound to evaluate for any gall bladder disease since they can also cause epigastric pain.
Studies have been performed with omeprazole (prilosec) - which is in the same class as nexium. Over 15 years, there have not been any clinically significant side effects.
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.
Thanks,
Kevin, M.D.
Member Comments (1)
by nadia, Apr 10, 2003 12:00AM
To: surgeon
I just wanted to hear from anyone who has had their hiatus hernias surgically repaired. Does it need to be a large hernia to warrant the surgery? Mine is small but causes alot of chest pain. Cardiac problems have been ruled out. I do get occasional heartburn, but the most debilitating symptom is the chest pain and I am ready to pursue the surgical option.
by nadia, Apr 10, 2003 12:00AM
To: surgeon
I should also mention, the surgeon who did the gastroscopy told me that there is only one type of hernia. I have read that there are different types on here, but shouldn't he know what type it is?
