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Dr. Andrew Rynne

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Are pressure below sternum and stomach distention symptoms of GERD?

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Dr. Parin N. Parmar

Allergist and Immunologist

Practicing since :2006

Answered : 870 Questions

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Posted on Mon, 25 Aug 2014 in Lung and Chest disorders
Question: I have asthma and recently had the worst bout I've ever had. Usually I bounce back within a week after prednisone but although the asthma seems fine I am extremely fatigued. On top of that I feel a pressure below my sternum if I have a cup of tea and a donut. My stomach feels and looks distended after any type of meal. I've had some bouts of heartburn as well. Could this be gerd ? I also have about 3-4 cups of tea a day and have chocolate all the time. The fatigue is really bad.
doctor
Answered by Dr. Parin N. Parmar 1 hour later
Brief Answer:
Antacids for GERD & review asthma management

Detailed Answer:
Hello.

Thank you for asking at HCM.

I went through your history.

I would like to ask a few more questions like -
a. Apart from prednisolone, which drugs/inhalers do you use for asthma?
b. Are you using any daily medications for asthma?
c. How frequent are your episodes of asthma?
d.Do you have any other allergies/nose allergies/sinusitis?
e. Have you ever been tested for allergies?
f. Do you have any other medical conditions?
g.Do you take any other regular medications?
h. What were your last investigations suggestive of?
i. Are you exposed to dusts, smokes (including second hand smoking) or pollution on regular basis?
j. Since what age you are having asthma? How it was diagnosed?
k. Have you ever had spirometry? What were the last reports?
l. Are you overweight?

I will be able to help you more after knowing above details.

From your history, I would like to make following suggestions to you:

1. From your complaints of Heartburn and chest symptoms aggravated by tea, I would first think of GERD (Gastroesophageal Reflux Disease). Were I treating you, I would suggest you as follows:

a. I would prescribe antacids like ranitidine, omeprazole or pantoprazole (any one of them) 30 minutes before every meal for at least 6-8 weeks. This long duration of regular antacids is necessary for healing of esophageal mucosa.

b. I would suggest avoidance of tea, coffees, chocolates, hot & spicy foods/beverages for the same duration.

c. Oral corticosteroids (such as prednisolone) also can aggravate gastritis. So it is advisable to take antacids while you are taking oral corticosteroids.

2. If you need oral corticosteroids repeatedly, I would suggest you to use regular "controller" types of medications such as inhaled corticosteroids and montelukast. These will improve your asthma control and also will reduce need for oral corticosteroids.

For reviewing your asthma control management, I would suggest you to consult your regular doctor.

3. Personally I would suggest you to avoid exposure to dusts, smokes and air pollution as much as possible. Please do not smoke if you smoke. These all aggravate asthma symptoms.

4. Many times GERD and asthma are linked. Treatment of GERD will improve your asthma symptoms.

5. Regarding your complaints of fatiguability, personally I would suggest you to have a multivitamin with minerals and also take iron supplements if your hemoglobin is less than 13 g%.

If you had a viral fever recently, it would take a few weeks to recover.

6. I would like to know whether you are overweight. Being overweight/obese increases affects negatively all your complaints - GERD, asthma and fatigueability. In such case, weight reduction under expert guidance will help.

7. A simple diet rich in vitamins and minerals and anti-oxidants (e.g., adequate amounts of green leafy vegetables, fruits, sprouts, plenty of fluids, etc) will make you feel good and hasten recovery.



Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask. I will do my best to give you a helpful opinion.

Wish you the best of health.

Thank you & Regards.

Dr Parin N. Parmar
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Parin N. Parmar 8 hours later
Hi, i also take albuterol 4 times a day as needed and Symbicort twice a day. I get a xolair shot every two weeks. My asthma is a very gradual tighness which is usually alleviated by the albuterol. I havent had to go for a prednisone course in a few years. It was a short course lasting 12 days. 40 mg-3 days, 30 mgs 3-days, etc. i was also given a prednisone shot. The week before that i was also given just a prednisone shot. It made me very hungry and also gave me heartburn. I also have nasal allergies and take flonase during the horrible pollen season we had in the northeast but since it started unusually late i think i misjudged when i should have started. I had asthma since birth and was tested many times for allergies. My regular dr. Is also a cardio-pulmonary specialist. I havent seen him about the pressure i feel when eating yet. I have never been diagnosed with spirometry and in fairly good shape. I was working out regularly before the bout and have been thin most of my life. Only within the last several months have i begun to get a pressure and extended belly after eating. I had half a chicken salad yesterday around 4 pm and still feel pressure right below my sternum. I feel better when maintaining a rigid straight posture. Someone else at my job is experiencing the same symptoms almost to the letter except that he is constantly hungry. We have a very sedentary job doing technology support. If not moving i am fine, but find myself winded going up one flight of stairs. I used to go up all 3 at work with no problem. I dont know if i am still in the "fatigue phase" after a severe bout or not, but the upper abdominal pressure is fairly new. Ive heard that gerd can also exacerbate asthma or vice-versa. I recently had bloodwork and xrays done and the x-ray tech showed me that my stomach "line" as i call it was perfect so she didnt think i had a hiatal hernia. Im debating cancelling a vacation to XXXXXXX on the 11th if im going to feel like i cant walk a city block. Going to try walking the beach today to see how i feel.
doctor
Answered by Dr. Parin N. Parmar 1 hour later
Brief Answer:
Add montelukast-antacids, discuss with your doctor

Detailed Answer:
Hello.

Thank you for your follow up.

I went through your details.

In addition to my suggestions in first answer, my opinion will be as follows:

1. If you still need daily albuterol 4 times a day, that suggests your asthma is not well controlled. Not only that, albuterol itself can aggravate GERD.

So, my important suggestion to you would be to tell your doctor about your upper abdomen symptoms. So that he can advise you about other options.

2. Were I treating you, I would add montelukast daily in your regular asthma controller treatment. Montelukast is a good drug for patients with both allergic rhinitis and asthma. Also, it can be used as steroid-sparing drug.

As you have allergic rhinitis also, a per my opinion, montelukast is a good option for you. You can discuss about this option with your doctor.

3. As suggested in my first answer, I would advice you regular antacids for your upper abdomen symptoms.

4. It's really good that you haven't had prednisolone course in last few years (apart from the recent one). So over the years, asthma has been stable. That is a good sign.

5. There are so many causes for fatigue/weakness. Viral infection (if it has caused asthma exacerbation), micronutrient (vitamins & minerals) deficiencies, even oral corticosteroids themselves can cause fatigue.

6. Should you have allergic rhinitis symptoms, you can continue using Flonase for them. Control of allergic rhinitis is also very important for control of asthma.

So, over the weeks, if your fatigue has been improving or steady, I don't think you should worry. You should talk about it with your doctor, but you will recover with time. Simple diet, rest and vitamin-mineral supplements will hasten the recovery.

Hope above suggestions will be helpful to you and solves your queries.

If you have any further query, you are most welcome to give follow up. It will be my humble pleasure to respond to them with best of my knowledge and efforts.

Wish you a quick recovery and the best of the health.

Thank you & Regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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