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39 year old diagnosed with reflux in fall presenting severe globus. Suffering with epigastric pressure, IBS C. Is it gastric cancer ?

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Gastroenterologist, Surgical
Practicing since : 1984
Answered : 913 Questions
39 year old female. Normal weight, healthy diet.  Diagnosed with reflux in the Fall presenting with Severe globus. Symptoms diagnosed by ENT by laryngoscope. Around the same time early Fall  began noticing onset of current below symptoms. 40mg prontonix started December with some improvement of globus symptoms. 

Current symptoms which also started in the fall. These symptoms of concern Intermittent Upper middle epigastric discomfort / pressure. Not necessarily a pain. Mostly related to during and after meals  Can go two or three days without symptoms, and not every meal causes it. Worst after lunch or evening.  Usually subsides gradually. No nocturnal symptoms, wake in the morning without symptoms.  Symptoms don't start again until food starts being ingested.  bloodwork normal. No nausea, vomiting, weight loss or loss of appetite. In fact, get starving feelings, at the same time sometimes as the discomfort. Like fullness in upper stomach, hunger in lower.  No notable change in bowels. Lifelong IBS C sufferer

I tried to google my symptoms, and gastric cancer seems to present with these same epigastric symptoms. Needless to say, I'm concerned. 
Posted Mon, 21 May 2012 in Digestion and Bowels
Answered by Dr. Ajit Naniksingh Kukreja 14 hours later

Thanks for posting your query

I can understand your stress level, but my first word would be a word of reassurance

All data available on net is not authentic, so it is always better to talk to your health care provider before stamping anything

Your symptoms are classic of acid peptic disease

You do not have a history of bleeding with vomit or blood in stool, Weight loss,
Feeling full or bloated after a small meal

Though symptoms are not the sole criteria but they do point to a diagnosis

I would suggest you continue Protonix for a minimum of six weeks and follow these :
Avoid spicy, fermented and fried meals,
Avoid aerated drinks
Avoid smoking or tobacco in any form
Avoid alcohol
Take lot of fluids daily
Exercise atleast five days a week
Take small frequent meals
If obese reduce weight
Manage your stress levels [This will help you in your IBS-C also]

The only way to stamp a diagnosis is to go for an upper GI Endoscopy

Hope this helps
Am available for followup queries
Get Well Soon
Above answer was peer-reviewed by
Follow-up: 39 year old diagnosed with reflux in fall presenting severe globus. Suffering with epigastric pressure, IBS C. Is it gastric cancer ? 4 hours later
Thank you, Doctor. 
I do have some follow up questions: 

1. The discomfort I mentioned does seem associated with meals. It doesn't feel like indigestion.  It is like a fullness or pressure, and I would say it can begin after only eating smaller amounts. I mention this because I don't know if that was clear in my initial post. Is this "early satiety" also consistent with acid peptic disease?it's not every meal, but it's frequent.  Also, the symptoms can sometimes last hours? 

2. Heartburn is infrequent (3-4x month at most). Could acid peptic disease cause the epigastric pressure/ fullness I describe without having heartburn?

3. The location of my symptoms is localized. Meaning, it's exactly in the center approximately 1-2 inches below my  sternum. Sometimes I can even press on it and it's tender. It's not painful in the sense that it makes me recoil, I can just palate tenderness on the spot that my symptoms seem to generate from.  Like pushing on a slightly sore muscle. Is this consistent with acid disease? 

Ive been on the Protonix now for a few months. Im wondering if i would benefit from increasing the dose to twice a day. I am making an appointment with a GI here in the states, but obviously my concerns are getting the best of me. 
Answered by Dr. Ajit Naniksingh Kukreja 3 hours later

Thanks for your followup queries

1] Postprandial fullness with or without heartburn is a common finding when associated with collitis
Had I been your doctor I would have added a Probiotic twice a day for 2 weeks or so
In some patients of acid peptic disease we do find the early satiety feeling but as you have mentioned it is not with all meals

2] Yes acid peptic disease can cause epigastric fullness without heartburn

3] It is the precise location of physical examination for a patient with acid peptic disease

Usually in out practice we start with Protonix twice a day for two to six weeks and then maintain it with once a day dose

Now that you are going to see a GI specialist I would suggest you request him for a H Pylori test and a Gastroscopy so that you get a stamped diagnosis

Hope this helps
Am available for followup queries
Get Well Soon

Above answer was peer-reviewed by
Follow-up: 39 year old diagnosed with reflux in fall presenting severe globus. Suffering with epigastric pressure, IBS C. Is it gastric cancer ? 21 minutes later
Thank you for your timely responses. I just have one last inquiry, and then I will let you go. You've been very helpful. 

In peptic acid disease, what is the physical cause of the post prandial fullness and/or early satiety? And unlike true "indigestion", why would it hang around for hours?

I know I keep harping on the gastric cancer, I just lost two friends recently, so it's plaguing me. I know there's no way to diagnose without EGD, but are there any differences you've seen between tumor presented  epigastric symptoms and acid peptic disease symptoms? I'm assuming not, hence the scope. 

Finally, you mentioned the post prandial fullness being related to colitis? I've never heard this before, I'd always thought colitis was in the colon and felt lower. Are you referring to something different? And is this part of the acid peptic disease?

Thank you, again. You've been very helpful and I greatly appreciate it. 
Answered by Dr. Ajit Naniksingh Kukreja 13 minutes later

Thanks for the kind words

As I have mentioned in my earlier reply we do not stamp these symptoms till we perform a Gastroscopy, till then these come under the label of Dyspepsia, it is the mucosal inflammation and the pyloric spasm which results in to postprandial fullness and/or early satiety, It hangs on for hours as the food is in direct contact of the inflammed mucosa till the stomach empties

Yes Gastroscopy is the ultimate but because you do not have symptoms of blood in vomit , I would clinically go for a commoner impression

Postprandial fullness - when Gastritis is associated with collitis not as a symptom of collitis, the symptom is more prone in patients with Acid Peptic disease who have associated collitis

Hope this helps
Am available for any followup queries
If there are no further doubts, do accept this reply and rate it

Get Well Soon
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