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Does the stimulation of the vagus nerve lead to anxiety?

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Posted on Wed, 10 Jul 2019
Question: I need upper GI insight. I have been having issues that my doctor thinks might be a hiatal hernia. Last year I went to him because I was getting alarmed at how large the area right under my ribcage was getting, along with having bouts of light colored, floaty bowel movements. I told him I felt like there was a blown up balloon in there. I had lab tests done that showed my lipase to be slightly high. I had an ultrasound that showed all looked well. I tried to change my diet a bit and experimented with green shakes and various supplements. I also got my vitamin D level up, as it was pretty low. The swelling slowly went down, but now I am having other horrible issues. I am still having pain, that fluctuates between dull to mildly sharp, deep and about two fingers down from my breastbone. My bowel movements are more normal, but I have been having occasional and sudden bouts of diarrhea (that look a little on the yellow side) which I can tell are going to happen because it starts with discomfort in the area I have been mentioning. I have been having horrible sleep apnea to the point where there were times I was afraid to sleep because I felt like I might suffocate during the night (I was given Ranitidine 300 mg to take before bed, and this seems to help). Most disturbing as of the past several months is that I have been having lightheadedness and dizziness that seem to be related to pressure in the area I have been mentioning because it gets worse when I do any level of bending forward or where clothing that puts even a slight amount of pressure there. I was told this sounds like vagus nerve compression. I am scheduled for an upper GI (with repair being done through laparoscope if a small enough hiatal hernia is found). So, here are my questions:

Do all of these symptoms (including the vagus nerve situation) sound like they are related?
Would you say hiatal hernia is probably responsible?
Do you think it's possible I may have some sort of bile duct obstruction?

Thank you. I will be anxiously awaiting your response!
doctor
Answered by Dr. Ramesh Kumar (17 hours later)
Brief Answer:

Follow up.

Detailed Answer:

Hello,

Basically, in most of the cases, anxiety is associated with stimulation of vagus nerve.

Your symptoms could be related to anxiety when the levels of anxiety increase.

Amount of neurotransmitters secreted by the brain also increases which stimulate vagus and autonomous nervous system which could be possibly responsible for your problem.

Color of stools is imparted by a pigment called stercobilinogen. Bile secreted by the liver is broken down into stercobilinogen during the process of digestion.

However, if motility of intestine is fast then bile is not properly broken and stools remain yellow instead of brown.

Hiatal hernia is responsible for heartburn near breast bone pain but it has nothing to do with stools and other problems.

Yes it could be an obstruction in bile tract also, either bile is not properly broken or there is a blockage in the bile duct. Possibility of blockage is less as USG is normal.

Start taking lactium for anxiety.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Ramesh Kumar, Gastroenterologist
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Ramesh Kumar (30 hours later)
Thanks for the response.

I was told that they sleep apnea was probably due to the hiatal hernia allowing digestive juices back up into my throat at night. I was given Ranitidine and it seems to be helping.

Couple of follow up questions:

If it's not a hiatal hernia, why I might I have been swelling up right in that area under my breastbone--feeling like there was a balloon blown up in there.

Also, I am not suggesting anxiety couldn't cause a vagus nerve reaction. But, that does not seem to fit my situation. I only get this lightheadness and dizziness when there is pressure put on the specific area right under my breastbone. It happens when I bend over even slightly or slump when I am sitting. It also happens when I wear clothing with elastic or a bra that pushes in on that specific area. Are there any other possible reasons you can think of as to why this might be happening?
doctor
Answered by Dr. Ramesh Kumar (22 hours later)
Brief Answer:

A hernia with irritable bowel.

Detailed Answer:

Hello,

The main problem with patients of gastro intestinal tract problem is that almost all problems related to intestinal tract presents with the same set of symptoms.

You could be a possible case of reflux disorder associated with irritable bowel disease.Now irritable bowel is an umbrella term given to patients suffering from the set of symptoms.

Frankly speaking, I need to see at least a report of endoscopy as this is a baseline investigation for someone who is having reflux symptoms and suspecting hernia and is responding to antacid.

An endoscopy would make things clear.
Sudden bouts of stool consistency changes can be attributed to IBS while pressure near breastbone and swelling can be due to the hiatal hernia. In fact, the most common cause of acid reflux is a hiatal hernia.

So, I would suggest you get an endoscopy done. It would take an hour for the test where they would insert a small tube containing a camera which would capture images from inside.

Hope I have answered your query.

Take care

Regards,
Dr Ramesh Kumar, Gastroenterologist

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Ramesh Kumar

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Practicing since :1986

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Does the stimulation of the vagus nerve lead to anxiety?

Brief Answer: Follow up. Detailed Answer: Hello, Basically, in most of the cases, anxiety is associated with stimulation of vagus nerve. Your symptoms could be related to anxiety when the levels of anxiety increase. Amount of neurotransmitters secreted by the brain also increases which stimulate vagus and autonomous nervous system which could be possibly responsible for your problem. Color of stools is imparted by a pigment called stercobilinogen. Bile secreted by the liver is broken down into stercobilinogen during the process of digestion. However, if motility of intestine is fast then bile is not properly broken and stools remain yellow instead of brown. Hiatal hernia is responsible for heartburn near breast bone pain but it has nothing to do with stools and other problems. Yes it could be an obstruction in bile tract also, either bile is not properly broken or there is a blockage in the bile duct. Possibility of blockage is less as USG is normal. Start taking lactium for anxiety. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Dr Ramesh Kumar, Gastroenterologist