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What causes pain and discomfort in chest when diagnosed with GERD?

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Posted on Mon, 9 May 2016
Question: For about a year now my wife has had pain/discomfort on the left side chest/heart area. She went to her primary care physician who said it sounded like GERD and referred her to a specialist. The specialist immediately ruled out GERD telling her that she did not fit the typical GERD patient. She is petite (5' 4" 118 pounds) a long distant runner and has always been in excellent shape other than high cholesterol, which is hereditary in her family. She had a chest x-ray and it came back clear.

She says the pain will be around for months then go away for a while then come back again. She said the pain is more like an ache. The pain fluctuates in intensity and running does not seem to aggravate it.There are days when she is in a lot of discomfort and we would really like to get to the bottom of it. Do her symptoms sound familiar to anything you might have experienced with other patients and what should be our course of action since we've already went to a primary physician, had a chest x-ray and haven't gotten any answers?
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Answered by Dr. Robert Galamaga (40 minutes later)
Brief Answer:
Considerations

Detailed Answer:
Hello & Thank you for submitting your question to HCM.

The most common way gastroesophageal reflux disease is excluded when a patient is having symptoms suspicious for GERD, such as in your wife's situation, is to prescribe an empiric course of proton pump inhibitors or H2 blockers to observe if the symptoms resolve after empiric therapy and/or to perform endoscopic examination of the esophagus and stomach with concurrent biopsies. There are various esophageal conditions which may present with symptoms similar to GERD.


These include esophageal strictures, achalasia, diverticuli, or eosinophilic esophagitis. These conditions are diagnosed with endoscopy with small biopsy (tissue taken is usually 1-3mm in size and is a very commonly performed procedure) and/or swallowing studies. Xray is not a singular definitive diagnostic imaging modality in these other conditions.

It would be very reasonable to visit with your current (or another) gastroenterologist to discuss these possible therapeutic options and to investigate the role for endoscopic examination, especially since these symptoms have not resolved nor was a definitive diagnosis provided.

Also, given the age and Cholesterol problems, it won't be a bad idea to obtain a 12 lead EKG to rule out any underlying cardiac conditions.

I hope this has been helpful and I wish you all the best.


Sincerely,
Dr Galamaga
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Robert Galamaga

Oncologist

Practicing since :2002

Answered : 2637 Questions

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What causes pain and discomfort in chest when diagnosed with GERD?

Brief Answer: Considerations Detailed Answer: Hello & Thank you for submitting your question to HCM. The most common way gastroesophageal reflux disease is excluded when a patient is having symptoms suspicious for GERD, such as in your wife's situation, is to prescribe an empiric course of proton pump inhibitors or H2 blockers to observe if the symptoms resolve after empiric therapy and/or to perform endoscopic examination of the esophagus and stomach with concurrent biopsies. There are various esophageal conditions which may present with symptoms similar to GERD. These include esophageal strictures, achalasia, diverticuli, or eosinophilic esophagitis. These conditions are diagnosed with endoscopy with small biopsy (tissue taken is usually 1-3mm in size and is a very commonly performed procedure) and/or swallowing studies. Xray is not a singular definitive diagnostic imaging modality in these other conditions. It would be very reasonable to visit with your current (or another) gastroenterologist to discuss these possible therapeutic options and to investigate the role for endoscopic examination, especially since these symptoms have not resolved nor was a definitive diagnosis provided. Also, given the age and Cholesterol problems, it won't be a bad idea to obtain a 12 lead EKG to rule out any underlying cardiac conditions. I hope this has been helpful and I wish you all the best. Sincerely, Dr Galamaga