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F/U on Esophageal Spasm

  You have responded before to an inquiry of mine and I appreciate the feedback.  I have received authorization from my HMO to see a Gastro Doc in 1 week and would like to have some ideas on what to ask for.  The following is my medical history as well as a relatively detailed discropiton of symptoms that may or may not have any clinical significance.  Thanks for reading through this.  Healthy mid 40's male, 6 foot, 185 lbs, Clinical Biochemist.  Recent GI workup included 16 months ago, Normal upper GI barium series, Normal Lower Sig, Normal Upper GI CAT scan, Hemacult Neg, Regular formed daily BM's, 5 year ago repair of anal fissure with internal spincterotomy. Removal of Gallbladder 4 months ago revealed chronic inflamation and upper right pain has resolved.  My current complaint is pain and spasm about 1 inch below the sternum which when it becomes severe will radiate up to my jaw and to my back.( No cardiac Problems!!)  These spasms are short lived - 2-3 minutes but leaves me with a "real tight feelingof pressure " in the solar plexus area. I also notice less gurgling somach sounds after an episode, like everything is uptight.   I find myself trying to burp to relieve the pressure and it only helps a little.  The sensation that I am sometimes left with for most of the day is like pressure in the solar plexus area that while not being extremely uncomfortable except during an episode of spasm it sometimes feels like my troat and haed are going to pop ( Normal Blood Pressure!!).  I find that it creates some level of nausea and loss of appetite but not to bad - it is just more uncomfortablle like you want to shake your insides to "loosen up".  I find that it is also sensitive to posture in that I will sometimes awake in the early AM lying on my back ( I keep my bed raised up 6 inches for any reflux issues )and go into a strong spasm.  If I get up quickly and walk around I do not experience the extreme spasm but I notice that my belly area feels "tight".  An interesting note is that I find that speaking can be uncomfortable when I am feeling this pressure.  I have even noticed that area below the sternum becoming hard as a rock when I am trying to speak with a client on the phone and I find that I have had to stop and let it subside or not "speak from my solar plexus area".   When all this discomfort started about 2 years ago, I gave up singing opera and doing public speaking engagements because the use of the diaphragm would elicit spasm and discomfort as discribed above. I also find that doing situps or doing yardwork can bring on this tight feeling and sometimes the spasms. Yes, this is pretty bizarre sounding to me and I am clueless.  I wonder about the connection between speaking and singing and the diapragm and a postural relationship between this discomfort and the area just below my sternum. I am planning to ask for an upper endoscopy at my meeting with my MD and wonder if there is other tests that may be usefull.  Finally, I do suffer from mild gastritis and have found Prevacid works great but does not help this problem and I have tried Levsin a couple of times with no help.  Frankly, I have found taking 2-3 Tylenol helps the best and on days when the discomfort is really severe, I have tried a xanax which takes the edge off the discomfort and tends to loosen up things a little.  I can find no relevant history like this in any text I have seen.  Your thoughts on this are appreciated.  Keep up this great service.  I am sure it is appreciated by many.  Many thanks!!!    
Dear James,
As we discussed previously, chest pain can be secondary to a cardiac, pulmonary, gastrointestinal or  musculoskeletal cause but can sometimes be a manifestation of anxiety or panic disorder. The fact that acetaminophen (Tylenol) relieves some of your pain suggests a musculoskeletal component. The fact that alprazolam (Xanax) helps can suggest an anxiety component. On the other hand, in order to rule out a gastrointestinal cause such as esophageal spasm, gastroesophageal reflux, gastritis, nonulcer dyspepsia or another esophageal motility disorder an upper GI endoscopy should first be performed. If that is negative tests to confirm gastroesophageal reflux, correlate reflux episodes with your symptoms (24 hour ambulatory pH monitoring) and measure pressures in the esophagus (esophageal manometry) may be indicated. As I mentioned in my previous answer to you, a variety of medicines have been tried for atypical chest pain (such as nitroglycerin, calcium channel blockers and anti-depressants) with variable success.
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. Muszkat, one of our experts in Gastroenterology.
*Keywords: chest pain, causes, evaluation, treatment

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