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What are the underlying causes for having pain under ribs and difficulty in swallowing?

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Internal Medicine Specialist
Practicing since : 1980
Answered : 1357 Questions
woke on morning felt like Icouldnt swallow, pain under left rib, somtimes goes around to spleen, first time ever for any of these sytoms burping gurgaling all time of fullness of air in my esphogus if in the morning have to belch,lots of foam and saliva in what seems to be pockets in my throat ,that I spit up.Every swallow seems like my spit is turning into a bubble and I feel everything go down, and I would swear they wernt.When I lay down food and drink rolls up.I lost 65 pounds from this oh and I have not been able to breath easily since this happen.11 mounths now.Ok wait you will think you know what it is untill I tell you, gastric empying, neg, ph bravo neg, les normal, all biopsies normal 2 monomety test one show a reading of 220 in on spot before les said it is nutcraker wanted to do heller op.went to big famous clinic on newer monomety machine they laughed and said you dont have that .oh yes and 2 barrium swallow and upper gi, negitive.Lost my job all that money now losing my mind because I cant believe in 2013 and 45 healthly woman can just wake up sick and no cure.Why is God letting this go on so long. 2 egds also streached eshogus , no help.Dont drink, smoke eat red meat no coffee or coke said I have allagy to eggs went off 6 months no help. email YYYY@YYYY
Posted Tue, 24 Dec 2013 in GERD
Answered by Dr. Rakesh Karanwal 1 hour later
Brief Answer: Recommended course of action is penned below Detailed Answer: Hi Ma'am, Thanks for your query. I fully understand the agony that you are passing through. I have gone through your problems very carefully and also taken full note of the test-reports given by you. However, there are still some more information required. Hence, in order to PINPOINT the exact cause of your problems; give you a SOUND professional advice; and, TRUE VALUE FOR YOUR MONEY, may I request you to kindly provide additional information as follows :- # Have you been having episodes of watery diarrhea in the past? # Apart from egg allergy, have you ever noticed that you get abdominal upsets and discomfort, pain, diarrhea after having wheat, barley or rye products; sugar, milk, cheese or yoghurt? # Though it is evident that you are passing through tremendous mental stress due to your health problems, have you ever passed through chronic anxiety/mental stress PRIOR to the onset of present problems? Nevertheless, pending receipt of the requested additional information, the possible causes of your problems- based on the information provided- are :- * H.pylori infection of the esophagus, stomach and intestine with consequent GERD: ALL your symptoms fit into this possibility, apart from Post-Cholecystectomy Dumping Syndrome (a complication of gall-bladder removal) as given below. * Post-Cholecystectomy Dumping Syndrome : occurs due to unregulated spilling of bile into the stomach, duodenum and early part of intestine. This condition manifests as all symptoms that you have been undergoing since long. * Achalasia cardia : a condition in which the propulsive movements of the esophagus wall is abnormal. This can be due to functional abnormality of nerves responsible for coordinating esophageal movement; or, as a complication of Chaga’s disease, contacted in the past. However, I presume that this condition was EXCLUDED through barium swallow study. * Mental stress/persistent anxiety-related hyperacidity. If I were your treating physician, my course and sequence of action would have been as follows:- (a) A regular, short-term course of a combination of anti-depressant + anti-anxiety drug to curb your mental stress/persistent anxiety and thereby, eliminate one of the aggravating factors of your abdominal problems. (b) Simultaneously, I would have empirically started a 14 days’ course of anti-H.pylori therapy + a Pro-kinetic drug, such as, metoclopamide or domperidone; followed- with effect from Day 15- by 3-6 months’ regular course of an anti-acid drug, such as, lansoprazole or rabeprazole along with prokinetic drug as above. (c) Simultaneous supplementation of Probiotics, such as, Lactobacilli and pancreatic enzymes for at least 4 weeks or more, as required. (d) Further advice : small frequent meals 5-6 times/day; eat slowly and chew properly; high fiber, high protein, low fat diet; sleep in 30 degrees propped up position. Consult your doctor and apprise him of my opinion. I am certain that he will agree with my opinion/course of action and prescribe the recommended treatment in appropriate doses. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. In any case, I SHALL BE LOOKING FORWARD TO HEARING FROM YOU ALONG WITH THE REQUESTED ADDITIONAL INFORMATION. Fond regards and have a nice day, Dr. Rakesh Karanwal
Above answer was peer-reviewed by
Follow-up: What are the underlying causes for having pain under ribs and difficulty in swallowing? 26 minutes later
Never have diarrhea always constipation. No other food allergies. I never noticed a problem with eggs, it's just what they told me after testing. Normal stress level before this. No h-pylori per biopsy through EDG, Negative for Cancer and Chrones. First EDG noted small amount of bile in stomach after not eating or drinking for 15-hours. Did note slightly smaller than usual duodunum hole. Before this could eat, drink and swallow without an ounce of pain, burping, reflux or anything. Woke up like this one day. Not one day of relief in 11-months no matter what I try relieves any of it. If it is the bile situation what would be the treatment. If it's not what do you think it may be?Could a bad sress day 11month ago cause these symptoms to this extent, and consistet fothis long? Bless you
Answered by Dr. Rakesh Karanwal 1 hour later
Brief Answer: Problems suggestive of gall-bladder removal effect Detailed Answer: Hi Ma'am, Having gone through the entire information, I am firmly of the opinion that you have a combination of inter-related conditions (Irritable Bowel syndrome + GERD + highly possible H.pylori infection + irritable tightening of Lower esophageal Sphincter, esophagitis due to reflux of acid and bile in esophagus), FOLLOWING gall bladder removal. Hence, my recommended course of action REMAINS THE SAME, along with addition of empirical medication on experimental basis. Additional Treatment recommended ( in addition to the treatment recommended earlier) :- * Add Nitrates (Isosorbide dinitrate or Mononitrates) or Calcium channel blockers, (such as amlodipine, diltiazem) to relax XXXXXXX and duodenal sphincter/narrowing. * Cholestyramine to neutralize the effects of bile on stomach and duodenum. It is also suggested that Pancreatic function tests, liver function tests and, if your surgeon feels appropriate, ERCP may be conducted to see for an impacted stone in the bile duct. It is possible that gradually progressive increase in size of an old silent stone in bile duct, might have produced abrupt obstruction of the Common Bile Duct. I am highly confident that you will gradually BUT steadily, exhibit tremendous response to the RECOMMENDED TREATMENT. You may therefore discuss in great detail, my opinion and recommendations with your doctor. I am sure he will agree with me and act on my advice. Take care, Dr. Rakesh Karanwal
Above answer was peer-reviewed by
Follow-up: What are the underlying causes for having pain under ribs and difficulty in swallowing? 23 minutes later
I truly appricate your opion and will give my gasto tommarow appt, your info.But just to clarifhy my gallbladder removal was like 7 years ago, why now?I had the ph probe in my esphogus for the days being moniters, said no acid reflux, my Dr.seemed socked I guess I am only one in XXXXXXX this, no gurd either.Now I know bile reflux is differnt and was told, ppi ans such dont help.The biopsies for HYLORI were also is it jut the bile causeing all this.As for the irritable bowel ,I have no pain in my bowels, no gas or anything but constipation and pain under left rib high up.The only thing irritable is me.Always feel food in chest and upper spinker, regugataion, naussea buring belching gurgalling in high throat.Please just on more review and I wont bother you again.Just wish I could have my life back.So sad and ugly and broke now.Sickness takes away everything.I feel the old Ava is dead and all thats left is this broken doll.
Answered by Dr. Rakesh Karanwal 25 minutes later
Brief Answer: You have IBS-Constipation Predominant type. Detailed Answer: Well ma'am, Firstly, there are 3 subtypes of Irritable Bowel Syndrome (IBS) : 1. diarrhea predominant, 2. constipation predominant and, 3. diarrhea alternating with constipation. You are suffering from IBS - Constipation Predominant type. Further, as already mentioned, possibility of a dormant gall stone in the common bile duct(CBD) may have-over the years- increased in size, big enough to cause sudden obstruction of CBD. This can account for the sudden onset of your symptoms 11 months back. that's why, I have recommended ERCP. Quite often, acid and bile cause reflex, tight constriction of XXXXXXX which relaxes intermittently and cause reflux of acid and/or bile. It is possible that the XXXXXXX was tightly constricted at the time probe was put in to your esophagus. H.pylori infection can occur any time. It could have occurred AFTER biopsies were taken and found negative for it. In my clinical practice, I routinely come across several patients who were tested negative for H.pylori, but showed miraculous response to anti-H.pylori therapy! All symptoms described by you just now, point towards the diagnosis of GERD. The pain/discomfort under left rib cage in the spleen area is called "Splenic Flexure Syndrome", characterized by trapping of intestinal gas in the part of colon which overlies the spleen and under the left rib cage. I once again assure you that you will certainly show remarkable improvement with the treatment advised by me. Lastly, you may also discuss possibility of D.difficele infection of the intestine, with your gastroenterologist tomorrow. PLEASE DO NOT HESITATE IN SEEKING FURTHER CLARIFICATIONS, IF ANY. I will be happy to answer your queries. Dr. Rakesh Karanwal
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