Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
153 Doctors are Online

Retrosternal pain and depression - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2009
Answered : 613 Questions
User :   For the last 23 months I have had the following symptoms near constantly day and night: - Severe to moderate pressure-type pain in the middle of my chest from my throat to my upper stomach
- Pain and sensitivity to pressure (like when I press on it, lean forward, or when I eat) in my upper stomach
- Nausea
In September 2008 I tested positive via Hida Scan (34.9%) for low gallbladder function. Later that month, my gallbladder was removed, but my symptoms have remained.
In February 2009 I underwent an Endoscopic Ultrasound, which revealed that I was born with a Pancreatic Divisem. Doctors ruled out that this was the cause of the symptoms due to the fact that my amylase and lipase levels are normal.To date doctors have been able to rule out the following as possible causes: GERD/Bile Reflux,Esophageal Spasms ,Gallbladder Stones/ Dysfunction,Pancreatic Dysfunction
Cardiac Related Problems (Angina, Coronary Spasms, Pereicarditis, etc). ,Hiatal Hernia,Achalasia ,Celiac Disease,Sphincter of Oddi Dysfunction,Thyroid Condition,Cancer,Gastroparesis
Since my symptoms started in May of 2008 I have been to the ER almost 10 times and have had multiple blood draws for (among others) amylase/lipase, sprue panel, thyroid levels as well as CBC rate and hepatitis and a H. Pylori stool sample. I have also had the following tests all which turned up negative: 07-08-08 Gallbladder Ultrasound
07-23-08 Endoscopy
07-28-08 EKG Stress Test/Pulmonary SVC
09-12-08 Barium Swallow
09-17-08 Hida Scan
09-26-08 Gallbladder Surgery
01-09-09 Chest MRI
01-19-09 EGD with MRCP
02-02-09 EGD with Ultrasound
02-06-09 Barium Meal (Gastric Emptying Study)
02-12-09 Small Bowel Follow-Through
02-17-09 EGD with Bravo Placement
06-15-09 Colonoscopy
03-16-10 EGD with Sprue Biopsy
On May 19th 2008 my wife and I took a day trip to Tijuana, Mexico while on
User :   vacation in .... Before crossing back over to the US, I stopped ate at taco stand close to the boarder eating two chicken tacos and two pork tacos along with two bottled Cokes. There were no immediate negative effects, but 24 hours later I was having signs of food poisoning in the form of severe cramps, dehydration, nausea and diherria. After a visit to the doctor's office I was given some anti-biotics and felt better generally except for a persistent gnawing at the top of my stomach. Another trip back to the doctor and I was diagnosed with gastritis, tested for H. Pylori and parasites and given a prescription for general Protonix and anti-parasitic medicine. After a few weeks I began to feel better generally and went for a run. This proved to be a mistake because after the run the gnawing sensation returned. I went to the doctor again and this time was checked for gallstones through an ultrasound which came up negative. I was told to continue taking the Protonix and limit my diet to things containing low fat and low acid. That same day I began having severe chest pain, but being only 28 and in good condition assumed that it was nothing serious and after calling the doctor was told that it was most likely acid reflux or esophageal spasms. After a few more weeks of pain and no results from the Protonix I decided to switch to another general practitioner and was able to get in to see a GI specialist. After a barrage of tests ordered by both physicians in late September I had gallbladder surgery. When my symptoms didn't clear up after a few months I was subjected to more testing and tried various drugs to combat smooth and then skeletal muscle tension including nitro glycerin. My GI doctor has ruled out the need for an ERCP, claiming that because my amylase and lipase levels are steady and the risks for the test are too high. The doctor also claimed that I
User :   most likely had 'Heightened Viscera Noceception' (which from what I can tell, means absolutely nothing) and that I should get onto an SSRI to correct the problem. This idea was fast-tracked following an emotional breakdown after the death of my brother. I was put on Paxil and Ativan for anxiety and told by my newly prescribed psychiatrist that my pain could be a constant series of anxiety attacks. I was on these medications for eight months and even at maximum dosage both saw no significant improvement. In January 2010 I received the results of a blood draw from a third-party 200 Food Panel testing for IgG. The test indicated that I had an alarmingly high intolerance for wheat, gluten and yeast. To confirm the results I saw a local allergist who performed 50 panel skin prick test. This test came up negative along with subsequent blood-work and a biopsy taken from another EGD. I am currently looking into the viability of IgG food allergy testing and have been on a gluten-free diet for 2-weeks (with no results), with plans to remain on the diet for a least 8 weeks.
What is wrong with me?
Doctor :   Hi
Doctor :   Let me read your query.
User :   OK.
User :   Everything got kind of jumbled together...let me re-post it and see if it comes up easier to read...
User :   For the last 23 months I have had the following symptoms near constantly day and night: - Severe to moderate pressure-type pain in the middle of my chest from my throat to my upper stomach - Pain and sensitivity to pressure (like when I press on it, lean forward, or when I eat) in my upper stomach - Nausea In September 2008 I tested positive via Hida Scan (34.9%) for low gallbladder function. Later that month, my gallbladder was removed, but my symptoms have remained. In February 2009 I underwent an Endoscopic Ultrasound, which revealed that I was born with a Pancreatic Divisem. Doctors ruled out that this was the cause of the symptoms due to the fact that my amylase and lipase levels are normal. To date doctors have been able to rule out the following as possible causes: GERD/Bile Reflux Esophageal Spasms Gallbladder Stones/ Dysfunction Pancreatic Dysfunction Cardiac Related Problems (Angina, Coronary Spasms, Pereicarditis, etc). Hiatal Hernia Achalasia Celiac Disease Sphincter of Oddi Dysfunction Thyroid Condition Cancer Gastroparesis
Doctor :   Ok
User :   Looks like the formating isn't working on the chat - ignore that last big post as it is redundant.
Doctor :   Ok
Doctor :   Can you explain the nature of the pain that you perceive ?
User :   Yes -
User :   The pain is like a tight pressure going from the base of my throat down to the top of my stomach...
Doctor :   Is the pain related to the food?
User :   More like the pain is related to pressure and eatting food builds up pressure...
User :   but the pain thusfar is not related to any particular kind of food.
User :   I have been on several diets to restrict acid and fats as well as diary and gluten with no results or change.
User :   I often get the worst pain when I am hungrey.
Doctor :   Ok.
Doctor :   Does the pain subside after food?
User :   While I am eatting the pain seems to go down...
User :   but maybe that's because there is something sliding down my throat so it distracts the nerves or something...
Doctor :   Ok.
Doctor :   Are these symptoms related to particular time of the day?
User :   The pain NEVER totally goes away...but if I eat a little then usually can help soothe the pain.
User :   No. It can happen day or night.
Doctor :   Ok.
Doctor :   Do you have nausea or vomiting during these episodes?
User :   I am pretty much always a little nauseous...
User :   No vommitting, but a great deal of indigestion.
Doctor :   Ok.
User :   The pain is often at a level 2-3 but spikes up to 5-7 throughout the day...
Doctor :   Do you smoke, consume alcohol?
User :   No and no.
User :   Sometimes the pain gets up to a 7+ and I go to the ER.
Doctor :   Do you have any other medical illness?
User :   But it's been this way for almost two years.
User :   Not that isn't related to the this specifically. I have basic symptoms of IBS and some lower GI discomfort but all of that was after the onset of the pain.
Doctor :   Ok.
Doctor :   Let me explain it to you.
Doctor :   From what you have described and from the brief history that you have provided, your symptoms are related to both gastrointestinal causes and psychogenic causes.
Doctor :   Gastrointestinal illness in the form of gastritis/reflux gastritis or indigestion.
Doctor :   2. As explained by your doctors there are psychogenic components.
Doctor :   I shall suggest you a few measures that may be able to help you.
User :   OK.
Doctor :   1. Continue using protonix as suggested by your doctor.
Doctor :   2. You may use antacid syrup as well.
Doctor :   Both these medication have to be taken before diet.
Doctor :   3. Be regular with your diet habits and do not skip meals.
Doctor :   4. A proper bed rest is needed.
Doctor :   If you are not able to sleep well, modification in your sleeping environment with or with out sleep aid medications are needed.
Doctor :   5. It is important, that you understand the psychogenic factors may also be playing in your illness, if not completely but at least to a significant extent.
Doctor :   Hence follow with the depression treatment strictly.
Doctor :   They would help your present symptoms on long term basis.
Doctor :   6. I would not suggest you any further test, however, if you symptoms are persisting, an endoscopy may have to repeated, if the symptoms are aggravated.
Doctor :   7. Follow small and frequent meal dietary pattern instead of 3 time meal pattern.
User :   Thanks for the advice. What about the fact that the four EGDs that I have had show no damage from acid?
User :   Or that after being on protonix for a course of 8 months and then again for 6 months showed no improvement?
Doctor :   SInce there are two factors that are causing your symptoms, and I cannot predict the most significan t among those,
Doctor :   That would be the probable explanation to your query.
User :   OK.
Doctor :   The endoscopic changes would be present in the persistence of gastritis.
Doctor :   And medications would need to be followed with the strict home measures too.
User :   So...wouldn't one conclude that because I haven't had any changes picked up by EGD that gastritis isn't the problem...or did I miss the logic?
Doctor :   Pantoprazole on long term can lead to tolerance too,
Doctor :   So you may have to changes these medications frequently too.
Doctor :   My conclusion is because for the fact that Pantoprazole did succeed in helping your symptoms initially.
User :   Good information - so you would reccomend a higher dosage?
Doctor :   So your symptoms may also have been caused by the gastritis which is ineffective with pantoprazole.
Doctor :   Probably a change of the medication would be better.
User :   Also can the gastritis pain exist without the EGD picking it up then?
User :   Well - thanks for trying.
Question is related to
© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor