Pain under ribs, regurgitation after eating for >1 year

[VAMHA]

For more than the last year, I have been experience several problems with eating which have gotten progressively worse. I get full very easily (a small bowl of soup, some bread and a small serving of fruit and am full). This is odd considering that I used be able to eat substantially more than that. I have lost some weight in the last few months, though not a substantial about (approx 10 lbs). Over the last year, I have been regurgitating food. It is as if it had never reached my stomach, I either spit it out (gross...looks like vomit) or just swallow it again. This gives me some pretty bad breath. I used to have heartburn, but that has gone away with medication (Omeprazole OTC, then Prevacid, and now Protonix 40mg). The pain I feel is usually localized under both ribs, with some pain under my sternum. I do get pain in my midback,under the shoulder blade, but that could easily be from my sometimes sedentary work environment or preexisting back problems. My PCP and GI doc both recommended and prescribed Reglan 5 mg 3x per day, which doesn't stop the pain, but seems to make it shorter. Sometimes I get a pinching pain in my back above my kidneys, but that may or may not be related.

I recently had a Gallbladder Ultrasound (negative for stones), a Barium Swallow (showed some Diffuse Esophageal Sphincter movement), and an EGD which suggested Gastritis and a minor Hiatal Hernia. Oh...and for some reason Ice Cream makes me want to have someone cut my stomach out. My gastroenterologist wants me to RTC in 6 weeks now to see if the Protonix helps (which it doesn't seem to be, but I know it takes a while) before looking at other tests. I have only been seeking care for this for the last 3 months or so.

I would appreciate any opinions, thoughts or considerations. I would especially like recommendations of things to ask my doctor, and possible diagnostic tests.

[John Kenyon, CNA]

From the symptoms you describe, this does sound like either GERD due to incompetent lower esophageal sphincter (LES) or hiatal hernia or both. The pain also sounds a lot like what is often reported with hiatal hernia. Since you've had a number of standard tests and a trial of several medications, you should have an endoscopy. In the course of this there is one test that could at least confirm the presence of acid reflux and would also be able to measure the volume of reflux. The test involves a new technology called the Bravo pH monitoring system. It's relatively simple, although the sensor is placed by means of an endoscope. This could provide some very useful diagnostic information as well as helping to guide treatment if the problem is determined. The sensor capsule does not have to be removed (it detaches and passes unnoticed in a couple weeks time). This, during the course of a scheduled endoscopy, might well help get to the bottom of the problem once and for all. It's certainly something to ask about.

I hope this is helpful to you. Best of luck with this, and hopefully you'll be feeling much better soon.