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What Causes Chest Pain?

Posted on Tue, 21 Oct 2014

Question: Hi. a couple of months ago went to have an EDG done as I was having chest pain on right side by breastbone and throughout my back. I had EKG done and all was fine. I was diagnosed with acute esophagitis. Biopsy came back ok. I did self induce vomit to lose a few pounds and i could kick myself for that. That was stupid. I was on omeprazole and ranitidine. I have degenerative disc disease, so they had to take me off omeprazole. I am now on ranitidine and sucralfate. i have no i nfection. It is acid related because of vomiting. I have had this chest pain for a few months and I am getting disgusted. That is all I think about. When will it go away??? I made lifestyle changes. What can you eat and what cant you eat? Are the meds ranitidine 300mg and sucralfate ok? i would appreciate your input as I am getting so disgusted. Thanks

Answered by Dr. Rakesh Madhyastha (27 minutes later)

Brief Answer:
Esophagitis

Detailed Answer:
Hello

Thanks for the query

Here are my suggestions to you

1. Continue taking Ranitidine, you can take 150 mg twice daily instead of 300 mg once a day. I recommend Syp sucralfate as SOS basis as in use it when absolutely necessary
2. It usually takes about 6 to 8 weeks to feel better
3. You should have smaller meals 4 to 5 times a day instead of 3 heavy meals. It will help prevent your symptoms
4. Avoid milk, milk products, caffeine, alcohol and smoking
5. Syp Mucaine gel can be used for the heart burn. It gives instant relief

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (20 minutes later)

Thanks for responding. i dont understand what syp means before the sucralfate and what does SOS basis mean? what is that chest pain that I am getting? and why is is constant? thanks

Answered by Dr. Rakesh Madhyastha (8 minutes later)

Brief Answer:
Sorry for short forms

Detailed Answer:
Hello
Thanks for getting back

I am sorry I used short forms, I am so used to writing it on my prescription I forget these short forms are not known by the general public .
Syp meant syrup and SOS basis means that you can use the surup as and when required and not on a daily basis. For example when the pain and burning are very severe.
The chest pain is because of the esophagitis itself. Since the cardiac examination did not reveal any issues, it is unlikely to be from the heart

I hope I was of help, if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (22 minutes later)

I guess I am really disgusted as I have been having this pain for over 4 months. Can stress cause this to be worse? Also, somebody said I could have milk. I guess I am totally confused as what to eat. Thanks

PS. Why the liquid instead of tablet sucralfate?

Answered by Dr. Rakesh Madhyastha (9 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

I understand the pain you are going through.

There is no doubt about milk. Milk is acidic in nature and it is best avoided when you are having esophagitis.
I prefer liquid sucralfate as it gives a soothing effect and reduces pain than tablet sucralfate. Please ask your doctor for syrup mucaine gel, it is a local anethestic and reduces pain instantly

I hope I was of help

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (16 minutes later)

thanks. Does the ranitidine and sucralfate help cure the esophagitis. do they help in repairing inflamed tissue? Is the gel to be taken in place of sucrafate or as an add on. Thanks again

Answered by Dr. Rakesh Madhyastha (4 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Ranitidine and sucralfate will help the healing process. I recommend that you take ranitdine morning and night before food for faster recovery. A check endoscopy after 3 months will help to know how effective the treatment was.

The gel is an add on to sucralfate.

I recommend that you avoid milk and milk products. Skimmed or full fat will not make a difference

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (8 hours later)

Hi and thanks. When i had EDG done , the biopsy came out good except for inflammation (THANK GOODNESS) If the meds arent helping, is there a chance that there could be a change in biopsy for the worse or are meds preventing that change. Also, I quit smoking but have an electronic cigarette every so often. Is that preventing healing? thanks

All I have is 300mg ranitidine. Do I nerd a new ones prescription for 150 or cut them in half

Answered by Dr. Rakesh Madhyastha (2 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

The biopsy could not have changed. I am happy that you have quit smoking, it would have helped the healing process. Electronic cigarette contains nicotine and it might hamper healing, i advice you to stop that as well.

You can cut Ranitidine into half, from next time I prefer that you take a stronger anti gastric medicine like Tab Pantoprazole instead of Ranitdine. Approach your doctor with my suggestion. I have seen better results with Pantoprazole and esomeprazole than Ranitidine on my patients with similar issues.

I hope I was of help

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (11 minutes later)

thanks you. i am borderline osteoporosis and have degenerative disc disease in my lower back. my doctor wont put me on ppi because of that. is she right? those meds you mentioned are ppi's right? thanks

My upper back feels tender too along with chest pain

Answered by Dr. Rakesh Madhyastha (38 minutes later)

Brief Answer:
Follow up

Detailed Answer:

I know that you are borderline osteoporosis. But Pantoprazole can still be given along with Vit D supplementation.
If I were to be your doctor I would have put you on PPI along with Vit D for atleast 15 days. It would take care of your pain and also reduce inflammation faster than Ranitidine.

The tenderness along the chest and back is because of the esophagitis. You should take syrup mucaine gel at this point for the pain

I hope I was of help

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (1 hour later)

I am going to another GI Dr next week to get another opinion from the one I am going to now. I am getting my EDG pics on Monday to take.
Every once in a while I get a heaviness around my neck. I do not have trouble swalling food but sometimes throughout the day I have trouble swallowing saliva. Not often. Also, can worrying about this delay healing? Thanks so much

Answered by Dr. Rakesh Madhyastha (6 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for the query

It is unlikely that esophagitis is causing trouble in swallowing or heaviness around the neck. It most likely to be due to anxiety over the issue.

Yes worrying can increase the gastric acid secretion and cause further delay in healing.

I would like to add here that what you have got is a simple and treatable lesion. You will get better with time and once it all goes away you will completely forget that you ever had this issue

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (44 minutes later)

hi. Yes I am hoping there is just one lesion. could there be more? I am not too familiar with this. If it wasnt for the chest pain and and tenderness all around front and back, it would not bother me as much. I also have gastritis. I sure wish you were my doctor. Thanks so much

Biopsy report said sections show squamous mucosa with a neutrophilic inflammatory infiltrate within the epithelium. Reactive changes are noted. Stomach show antral type gastric mucosa with a minimal lymphoplasmac ytic inflammatory infiltrate within lamina propria. I don't have a clue what that means

Answered by Dr. Rakesh Madhyastha (2 hours later)

Brief Answer:
Follow up

Detailed Answer:
Hello

Thanks for getting back with the biopsy report

Here are my interpretations

1. The inflammation ia mainly infectious is nature and it caused by a bacteria called H Pylori. It will require treatment. Please make sure you are put on anti H. Pylori kit, these are a set of tablets to be taken for 14 days.
2. The inflammation is nothing to worry about, it is easily treatable.
3. Make sure that you avoid spicy food, have smaller meals (4-5 meals) rather than 3 heavy meals per day
4. Do not sleep for atleast 2 hours post dinner

Please make sure you ask for anti H Pylori treatment with your doctor, it is essential that you get treated for it. Tab Ranitidine is not enough for it.

I hope I was of help

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar