Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
Question: severe pain with GERD?
|bluewillow - Mon Jan 01, 2007 6:49 pm||
I am a 51-year-old female, (possibly perimenopausal, hysterectomy, kept ovaries 2004), and I just had my first visit with a gastro dr,who highly suspects I have GERD (I have all the classic symptoms). About three months ago, I made a trip to the ER with chest pressure and palpitations, thinking I was having a heart attack, but did not, had EKG, Echo/ stress test, and Holter monitor, and my cardiologist said they were all clear and my heart is fine. (My cholesterol is 162, take Zestoretic for HBP, no heart attacks in immediately family.) However, I still have chest pressure and occasionally severe pain, which is still very scary and makes me wonder in the back of my mind if it is heart related, like I don't believe my cardiologist! It seems I have heartburn almost constantly, not necessarily just after I eat. I began taking Protonix 40 mg in the morning plus Zantac at night a week ago, but relief is slow in coming. Is it common to have severe chest pain caused by GERD, even with medication? I am scheduled for an endoscopy and colonoscopy on Jan. 29. Hopefully I can wait that long, because I am at wit's end and this is very stressful-- I haven't felt good in three months! Thank you very much.
|Dr. Safaa Mahmoud - Tue Jan 02, 2007 1:17 am||
The anatomical relation between the diaphragm and the Lowe Esophageal Sphincter LES prevents the gastric acids to come up into the esophagus (reflux).
Esophagitis is a known complication of GERD and can lead to esophageal spasm, that can alone give similar clinical picture.
Initial treatment with proton pump inhibitors ( protnix) is indicated in erosive esophagitis (suspected or proved by endoscopy).
Therapy should be taken regularly and evaluation should be done to see if symptoms improved or not.
When there is no adequate response to treatment Endoscopic evaluation should be done to exclude gastric ulcer, gastritis, erosive esophagitis, Barrett's esophagus and hiatus hernia.
Prokinetic drug that strengthens the sphincter and improves the gastric emptying in cases of associated hiatus hernia and erosive esophagitis. When there is an acid reflux it is not enough to treat the symptoms with one drug instead the addition of Anti acids, Acid H2 blockers or proton pump inhibitors mat help to control the symptoms.
Certain foods are known to aggravate the condition, and you better avoid them. These include chocolate, beverages containing caffeine, fatty and fried foods, garlic and onions, spicy and tomato containing foods.
Treatment is modified according to the underlying cause and your response.
Surgery is considered only if lifestyle changes and medications did not improve the condition or if complications are present.
I advise you to follow up with your Doctor for proper management .
Keep us updated.
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