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Intermittent upper middle epigastric discomfort. Diagnosed with reflux in fall presenting Severe globus. Reasons?

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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. Localized, meaning i can touch  it and it feels tender. Not recoiling, more like a sore muscle. Mostly related to during and after meals. Sometimes feels like early satiety, other times just feels like a discomfort. Can go two or three days without symptoms, and not every meal causes it. Worst after lunch or evening.  Sometimes goes away quickly and hunger immediately returns, sometimes lasts hours. 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. Heartburn roughly once a week, even on Protonix.

I tried to google my symptoms, and gastric cancer seems to present with these same epigastric symptoms. Needless to say, I'm concerned. The tenderness is also a concern, it's right under my sternum I the center and feels sure to touch. Symptom severity waxes and wanes and tends to change daily.

Currently on 40 mg Protonix once a day. 
Posted Thu, 12 Jul 2012 in Digestion and Bowels
Answered by Dr. Dinesh Kumar Singal 13 hours later

Thanks for posting your query.

You are already suffering from IBS-C and you have globus sensation along with it. Your upper abdominal symptoms suggest that you are having dyspepsia. But you dont have any alarm symptoms (alarm symptoms are weight loss, anorexia, blood in vomitus, anaemia, lump in upper abdomen). Absence of alarm symptoms suggests that you dont need to worry about serious illnesses like gastric cancers. Probably what you are having is non-ulcer dyspepsia.

Since your symptoms are persisiting even while taking Protonix, I think you should undergo an ultrasound examination of abdomen, an upper gastro-intestinal endoscopy and possibly a test for Helicobacter pylori infection. These should rule out any serious illnesses as well as should lead on to the diagnosis of your problems.

Any other queries you can ask freely.

Wishing you all the best.

Dr Dinesh Singal
Above answer was peer-reviewed by
Follow-up: Intermittent upper middle epigastric discomfort. Diagnosed with reflux in fall presenting Severe globus. Reasons? 4 hours later
Thank you for your response.

Does PPI therapy like Protonix always successfullu treat Dyspepsia? I guess I'm wondering if that's a red flag that I still have symptoms while on it. I think the severity of the symptoms has lessened a little, but they still are there.

I also still get heartburn (maybe once a week). Is it possible that the once a day dose isn't enough to stop all acid production?

Is the upper epigastric tenderness consistent with dyspepsia? Again, it feels like a sore muscle right under my sternum in the center?

When gastric CA usually presents itself, does it usually present so intermittently?

Thank you.
Answered by Dr. Dinesh Kumar Singal 14 hours later

PPI like Protonix may not always be successful in treating dyspepsia. Non-ulcer dyspepsia is also a type of functional bowel disease just like IBS-C. One may have to add prokinetics or tricyclic antidepressants to a PPI if PPI alone is not working. Also one has to investigate for other causes of symptoms too.

Once a day PPI may not be able to stop all the acid production. In fact many individuals may get a nocturnal break through of symptoms. In such a scenario one may try twice daily dose.

Upper epigastric tenderness is consistent with dyspepsia.

Gastric Ca can have symptoms intermittently.

Hope these answers help you feel better.

Best wishes.

Dr Dinesh Singal
Above answer was peer-reviewed by
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