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Sudden indigestion and nausea, upper endoscopy, hiatal hernia, anxious feeling in my stomach. Gastric cancer?

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Sudden indigestion and nausea. Gastric cancer? :

--26 year old male.
--14 months ago, I had a sore throat that persisted for weeks and noticed that food was occasionally slow to go down my esophagus (would get stuck if I didn't drink water to force it down). Eventually had an upper endoscopy as well as a barium swallow fluoroscopy. Doctor noted a hiatal hernia. Was given diagnosis of GERD/LPR and Rx for Nexium.
--I took the Nexium for a short time, but stopped a short while later when the symptoms abated.
--Since then I have occasionally had issues with mild indigestion at night, but nothing unusually concerning. Usually, I would need to sit up to burp, but that was the extent of it.

--Last week, the persistent mild sore throat (of the same type as before) returned.
--3 days ago, I woke up hours after going to sleep with intense nausea and feelings of indigestion. It was more severe than I have ever felt before. I felt as if I would vomit, but never did. Eventually, I took antacids and fell back to sleep. Earlier that night, I had drank alcohol and eaten a large meal.
--Since then, I have had mild GI discomfort and occasional light belching (even in the morning, when I haven't eaten for a long time).
--I have a tight, anxious feeling in my stomach. (I am an anxious person, so I don't know if this is physical or psychological).
--I have resumed the Nexium,

The internet has given me cause to think that I have stomach cancer, because of the sudden onset of the new nausea and painful indigestion that I never had before. What could it be? The thought of that is making me even more anxious.
Posted Sun, 15 Apr 2012 in Chron's Disease
Answered by Dr. Poorna Chandra K.S 9 hours later
Thanks for the query.
Given that the endoscopy and barium studies were normal, I would like to reassure you that the possibility of you having stomach cancer is extremely low.
Your symptoms currently correlate with that of recurrent reflux episodes due to hiatus hernia. The clinical information provided correlates with the endoscopic finding of a hiatus hernia and the associated reflux disease.
Hiatus hernia compromises the integrity of the lower esophageal sphincter and hence may predispose to the reflux. Hence, people with hiatus hernia tend to have recurrent reflux episodes. Reflux esophagitis may cause throat irritation, painful defecation as well as feeling of food being stuck in the throat.
Performing diaphragmatic exercises will tone up the diaphragm and counter the effects of the hiatus and may help to prevent reflux. Meanwhile, add a prokinetic tablet like domperidone to Nexium after consultation with your GP.
Above answer was peer-reviewed by
Follow-up: Sudden indigestion and nausea, upper endoscopy, hiatal hernia, anxious feeling in my stomach. Gastric cancer? 4 days later
Thank you again for answering my prior question.

For reference, the facts were the following:
* 26 year old male.
* 14 months ago: upper endoscopy and barium swallow revealed esophageal irritation and hiatal hernia. At this time, biopsy was negative for H Pylori.
* was prescribed Nexium, but did not consistently take it.
* reflux symptoms are usually mild. sore throat, and occasional need to sit up in bed to burp.

* 1 week ago, I woke up with bad nausea and feeling of bloating. Felt the need to vomit, but didn't.
* I started taking the Nexium at 80mg per day (1 40mg capsule in morning, 1 at night).
* Since then, I have had a frequent urge to belch/feeling of air trapped in my stomach/upper chest. However, I am usually unable to belch except for small amounts. Often the belching comes with fluid if I have eaten within a few hours. This frequent urge to belch symptom just began this week and has never occurred before.
* Went to see my gastroenterologist, who will perform another upper endoscopy in a few weeks to see if the irritation on the esophagus has healed from the Nexium.

Specific questions:

1) Concerning stomach cancer: you said that the negative studies from last year made stomach cancer unlikely. Is this true despite the fact that they are now a bit old? It is my understanding that this is something that usually takes years to develop, and thus it seems that something would have been visible even a year ago. Can I then still infer some comfort and reassurance from the fact that the tests were negative?

2) As the "urge to belch" only started after I started taking the Nexium, could it be a side effect? I have read that PPIs can cause gas, and it seems as though my dose is toward the higher end of the spectrum.

Thanks again. I am hoping to calm my anxiety until the endoscopy.
Answered by Dr. Poorna Chandra K.S 7 hours later
Hi and thanks for the clarification
1) A symptomatic gastric cancer doesnot develop so fast
2) Belching is because of either an incompetent lower esophageal sphincter or a reduced gaastric compliance. Both of these may be seen in a bad reflux
3) PPIs ( proton pump inhibitors ) can lead to small bowel bacterial overgrowth if used over long term and hence flatulence. Belching is not a side effect of PPIs
Above answer was peer-reviewed by
Follow-up: Sudden indigestion and nausea, upper endoscopy, hiatal hernia, anxious feeling in my stomach. Gastric cancer? 36 hours later
Thank you Dr. XXXXXXX

A quick point of clarification: the two studies I mentioned were conducted around 14 months ago. Is that recent enough for me to still infer some reassurance?

Thank you again.
Answered by Dr. Poorna Chandra K.S 11 hours later
Hi and thanks for the reply.

As you are anyway going to have an endoscopy, I think it is wise to wait for it and not do any other investigations. On the endoscopy I would expect to see a hiatus hernia with some reflux esophagitis.

Hope this information will be of help. Please write back if you have additional queries.

Accept the answer if you have no queries.

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