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Gastroenterology (Expert Forum)
reflux, nausea § pain in upper left side (near shoulder)
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.
reflux, nausea § pain in upper left side (near shoulder)
by diamondJ, Sep 05, 2004 12:00AM
For the past 4 years I’ve been going through health troubles. I originally started having heartburn (& feeling nauseous)… this progressed to actual reflux (where I’d vomit, but only a mouthful at a time, never actually throwing up the whole contents of my stomach in one go). Then about a year latter I also started to have constant pain (discomfort) in my upper left quadrant (most notably located between my left shoulder and spine) that has continued also for now almost 3 years.
When I started I was average weight for my height (I’m a 170cm, Caucasian male, 37years old) but as I originally found eating would relieve the heart burn I gained in weight. But as it changed from being like heart burn to this reflux problem, I have been analysing my diet in an attempt to determine if the cause could be food related. Consequently, I now mostly eat a low fat diet (diary & caffeine free) & have brought my weight back down (but am still slightly overweight at 80kg).
Of coarse I tied to seek help from doctors & here are some of the tests I have had to date;
2 separate Gastroscopies, with biopsies. (I think only showed elevated acid levels, the last one being a ear ago)
2Ultrasound of Abdomen (didn’t show anything)
CAT scans of abdomen (which showed only evidence of fatty liver)
Bone Scan (checking spine with nothing apparent).
Xrays of Chest & Spine (with nothing)
Blood Tests (which showed fatty liver which also was a while back. Since then have cut alcohol, smoking & as mentioned before lowered fat content)
For a run down of medications I’ve been given to try, for the Heart burn I was put on Zantac then Pariot. (Which I eventually stopped taking because I really felt wasn’t required any longer as the heartburn sensation rarely happens any more) Then as things developed I was then given Motilium & latter Prepulsid to help food pass through quicker to try to counter the reflux (which I didn’t think had any effect)
So over time things have changed, about last 2 years would say I hardly ever get heartburn sensation any more and over the last year have felt a lot more nauseous & had a lot more of the reflux. Within the last three months though I feel I had a real break though with my diet (changed to a very bland diet consisting basically of Chicken, Baked Potato, Salad or Steamed Vegetables & Cereal for breakfast). This seems to have had the biggest impact on the reflux issue to date but has not completely stopped it & I still basically suffer from the nausea & the pain/ discomfort in my back/shoulder.
About a month ago, I had several times where I was getting excruciating pain/ sick feeling but no reflux & then during that week when I eventually did get the reflux I was bringing up small amounts of blood.
Why I’m writing you is that all the doctors that I’ve seen (including my current specialist) all say that the pain & discomfort that I experience on my left side (shoulder area) is not related to the reflux problem at all. I’ve sought different treatments for the back problem, from therapeutic masseuse & acupuncture (two different style of practitioners, one Traditional Chinese Medicine school & a medical acupuncturist (qualified doctor) all too no avail and all of these partitioners have been surprised that they haven’t gotten a result. To me it really seems that the two are connected. My current Gastro Specialist is still pursuing tests with me, soon I’m to have a 24 hour PH test to test stomach acidity I think. The result of this test he’s told me might lead to keyhole surgery to tighten up something or other to stop the reflux. Something about this doesn’t seem right to me as the reflux it is like little eruptions from my stomach (repeatedly vomiting but only small month fulls), so I feeling a little uncomfortable with this prospect as unlike when I previously had heartburn and could believe this tightening up would be like a capping on a bottle to stop leakage, this action now to me would be closer to trying to cork a volcano to stop the eruptions, which cannot be good. Also the pain/discomfort seems to be worse (something which I feel is somehow connected to the original problem) and this isn’t being address at all. So really looking for clarification of what my current doctors proposing to do & any idea on anything that could be causing the pain/discomfort in my left had side.
Thank You
When I started I was average weight for my height (I’m a 170cm, Caucasian male, 37years old) but as I originally found eating would relieve the heart burn I gained in weight. But as it changed from being like heart burn to this reflux problem, I have been analysing my diet in an attempt to determine if the cause could be food related. Consequently, I now mostly eat a low fat diet (diary & caffeine free) & have brought my weight back down (but am still slightly overweight at 80kg).
Of coarse I tied to seek help from doctors & here are some of the tests I have had to date;
2 separate Gastroscopies, with biopsies. (I think only showed elevated acid levels, the last one being a ear ago)
2Ultrasound of Abdomen (didn’t show anything)
CAT scans of abdomen (which showed only evidence of fatty liver)
Bone Scan (checking spine with nothing apparent).
Xrays of Chest & Spine (with nothing)
Blood Tests (which showed fatty liver which also was a while back. Since then have cut alcohol, smoking & as mentioned before lowered fat content)
For a run down of medications I’ve been given to try, for the Heart burn I was put on Zantac then Pariot. (Which I eventually stopped taking because I really felt wasn’t required any longer as the heartburn sensation rarely happens any more) Then as things developed I was then given Motilium & latter Prepulsid to help food pass through quicker to try to counter the reflux (which I didn’t think had any effect)
So over time things have changed, about last 2 years would say I hardly ever get heartburn sensation any more and over the last year have felt a lot more nauseous & had a lot more of the reflux. Within the last three months though I feel I had a real break though with my diet (changed to a very bland diet consisting basically of Chicken, Baked Potato, Salad or Steamed Vegetables & Cereal for breakfast). This seems to have had the biggest impact on the reflux issue to date but has not completely stopped it & I still basically suffer from the nausea & the pain/ discomfort in my back/shoulder.
About a month ago, I had several times where I was getting excruciating pain/ sick feeling but no reflux & then during that week when I eventually did get the reflux I was bringing up small amounts of blood.
Why I’m writing you is that all the doctors that I’ve seen (including my current specialist) all say that the pain & discomfort that I experience on my left side (shoulder area) is not related to the reflux problem at all. I’ve sought different treatments for the back problem, from therapeutic masseuse & acupuncture (two different style of practitioners, one Traditional Chinese Medicine school & a medical acupuncturist (qualified doctor) all too no avail and all of these partitioners have been surprised that they haven’t gotten a result. To me it really seems that the two are connected. My current Gastro Specialist is still pursuing tests with me, soon I’m to have a 24 hour PH test to test stomach acidity I think. The result of this test he’s told me might lead to keyhole surgery to tighten up something or other to stop the reflux. Something about this doesn’t seem right to me as the reflux it is like little eruptions from my stomach (repeatedly vomiting but only small month fulls), so I feeling a little uncomfortable with this prospect as unlike when I previously had heartburn and could believe this tightening up would be like a capping on a bottle to stop leakage, this action now to me would be closer to trying to cork a volcano to stop the eruptions, which cannot be good. Also the pain/discomfort seems to be worse (something which I feel is somehow connected to the original problem) and this isn’t being address at all. So really looking for clarification of what my current doctors proposing to do & any idea on anything that could be causing the pain/discomfort in my left had side.
Thank You
Doctor's Answer
by Kevin Pho, MD, Sep 06, 2004 12:00AM
, Sep 06, 2004 12:00AM
What the 24-hr pH study would do is to determine whether reflux is present despite the medication. If it is, and medication isn't controlling the symptoms, then the surgery that would be considered is a Nissen fundoplication - which is the surgical treatment for GERD. This approach is certainly reasonable as a next step.
I would also ensure that you are tested for H Pylori - a bacteria associated with ulcers and inflammation. If present, antibiotics can be used to treat this condition.
I would also consider a gastric emptying scan to evaluate for gastroparesis.
If every GI test is negative, then you may want to consider other diagnoses - such as a musculoskeletal origin. An MRI of the thoracic spine can be considered to ensure a disc problem is not causing the symptoms.
You may want to discuss these options with your personal physician.
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.
Kevin, M.D.
Medical Weblog:
kevinmd_b
I would also ensure that you are tested for H Pylori - a bacteria associated with ulcers and inflammation. If present, antibiotics can be used to treat this condition.
I would also consider a gastric emptying scan to evaluate for gastroparesis.
If every GI test is negative, then you may want to consider other diagnoses - such as a musculoskeletal origin. An MRI of the thoracic spine can be considered to ensure a disc problem is not causing the symptoms.
You may want to discuss these options with your personal physician.
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.
Kevin, M.D.
Medical Weblog:
kevinmd_b
