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- Sat Sep 13, 2008 8:47 am
I am an otherwise healthy 45 yr old female but for the last six months I have suffered from primarily one sided throat/esophageal pain radiating up to right ear. Also have a sensation of mucous at the painful site. Intial ENT evaulation - no ear infection, probable LPR. No improvement despite 10 week treatment with Aciphex (2x daily), restricted diet (initally for reflux, now only eating soft foods). Recently treated with 10 days Diflucan for possible yeast infection. No improvement. Waiting for GI consult but several week wait for appointment. Have lost 10+ pounds and pain seems to be worsening. Any ideas on what may be causing this pain? Can you tell me whether GI specialist will have tools available to exam esophagus during my office visit? Thank you.
| Dr. Safaa Mahmoud
- Tue Oct 28, 2008 2:09 pm
Your symptoms are more likely to be due to GERD and esophagitis.
The Lowe Esophageal Sphincter LES prevents the gastric acids to come up into the esophagus (reflux). When the upper part of the stomach prolapses through the diaphragm (where the esophagus pass into the abdomen) into the chest (hiatus hernia), acid reflux occurs.
In this condition people will experience one or more symptoms like chest pain, especially at night while lying down, throat and swallowing problems as well as heart burn. Esophagitis is a known complication of GERD and can lead to esophageal spasm, that can alone give similar clinical picture.
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. In addition smoking is one of the precipitating factors that should be avoided.
- In appropriate contraction of the throat or esophageal muscles causes pain that can be severe and sometimes is felt as a lump or tightness in the chest with difficult swallowing and bad breathing. The condition can be a sequence of sore throat or esophgeal (viral, bacteria or fungal) infection that subsides gradually after recovering from infections or as a motility disorder in the esophagus.
- Psychological or emotional stress and anxiety may cause or aggravate these cases symptoms.
- Diagnosis is made by complete history taking, physical examination, investigations like Upper Endoscopy, Manometric studies, and other lab tests that can be recommended by your doctor accordingly.
- Surgery is considered in case of GERD due to hiatus hernia only if lifestyle changes and medications did not improve the condition or if complications are present.
I would advise you to follow up with your doctor, it is concerning that you are losing weight and he propably will recommend upper endoscopy to exclude serious causes.
Please keep us updated.