Heart burn or what?

[ARTB]

I am a 45 year old male, 6'1", 215 lbs.  I have on and off had bowell difficulties for the last 20 years or so.  It seemed to start back when I apparently had a bad viral infection in my intestinal trac.  Anyway, about 3 weeks ago I noticed I was having upper and lower chest and stomach discomfort along with diarrhea.  Last week I finally went to the doc when the pains in my chest got me worried about a heart attack.  I saw a PCP and she took a EKG  which she said was normal and believed it was GERD or heartburn.  She perscribed protonix and told me to take OTC Zantac until it kicked in.  It has been 6 days now, and although I feel somewhat better the burning pain and cramps came back.  May latest blood test revealed a somwhat high cholesterol(234), LDL (140), and GGT (137).  I have been a moderate drinker for some time and although I did fast the night before the blood test I did not abstain from alchohol.  I have had nothing to drink for the last 7 days and have watched my diet very carefully.  I also had a ultrasound preformed on my lower abdomen last spring because of constant nausea.  It came out normal with the exception of sludge in the gallbaldder.
My question is should I wait for another 3-4 weeks to see my doctor or should I go back sooner?  
Does it take longer than this period of time for the protonix to work?
Does this sound like heartburn(I have never really had it before)?
Could this problem be related back to the sludge in my gallbladder?
The pain I am currently experiencing is right across my chest, a severe burning feeling with a bit of cramping of my lower stomach area. I sould also mention that I am taking atenolol(sp) for premature atrial beats.

[ckg]

if you're not seeing relief with Protonix by this point, you might want to consider switching therapies.

I've often seen patients who do not respond to initial therapy who might, when switched, respond better to another one.  

You might also consider taking Protonix every 12 hours.  There's some data to support 2x/day dosing with Protonix in the hospital setting.

[Kevin Pho, MD]

To answer your questions:
1) If there continues to be symptoms, I would see your physician.

2) Normally if you do not see improvement with Protonix within 3-4 weeks, then you may want to be re-evaluated.

3) Difficult to say without examination.  Heartburn is possible.  You can consider an upper GI series, upper endoscopy or 24-hr pH study for a more definitive evaluation.

4) Sludge is possible.  If there continues to be nausea, you can consider a HIDA scan with CCK stimulation looking for a lower gallbladder ejection fraction, which can lead to your symptoms.

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.
http://www.straightfromthedoc.com

[ARTB]

I forgot to mention that my untrasound showed that my gallbladder was still working in spite of the sludge.  Also, I have had a persistant sour taste in my mouth since this all started.  Thank you.