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What causes severe heartburn after a gastric bypass surgery?

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Gastroenterologist
Practicing since : 1986
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Hi, I'm a 52 year old healthy female with no history of heart problems. I have constant medium pain last 48 hours in upper right torso near rib cage and radiates to mid-back area. Does not get any better with water, or tums or food? Have not eaten much this week at all but I do eat healthy. I never have heartburn.
I have no gall bladder or appendix. I did have gastric bypass surgery 12 years ago and I'm at a great weight and have normal check ups. I guess blood work is first in order? I almost went to urgent care/ER last night but this a.m. I felt a little better. I was fine all day today, but pain is back now again. Thank you. My email address i s YYYY@YYYY
Sat, 14 Apr 2018 in Digestion and Bowels
 
 
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Intermittent pain needs proper evaluation as per protocols.

Detailed Answer:

Hello,
Thanks choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.
Pain along the ribs area and radiating to mid back in a otherwise healthy person(as you said you are not at cardiac risk so i would assume that in past(with in ladt 6 months) your basic cardiac investigations like 2d echo and stress test were normal) could be a result of pathology involving intercostal muscles.Theses muscles are there running along the lower border of ribs with intercostal nerves and vein.

However again i would say that intially as pain is constant and is typically involving area around rib i would suggest you to go for few baseline test like-
Cardiac troponin I -Highly sensitive blood marker for cardiac ischemia.
2d echo-Any cardiac pathology would be reflected as a motion abnormality in walls of heart.
Ultrasound abdomen-To rule out any abdominal pathology.
All three would take less then 45 minutes.
Now if these 3 tests are normal we could assume that it could be a sprain along intercostal muscles in the ribs which can be a result of injury or even posture.This lead to irritation of the joints where they attach in the mid-back, or the muscles running between each rib causing pain in the mid-back and thoracic area.
A anti inflammatory like Tylenol( over the counter) can be taken twice a day for 3days along with proper physiotherapy.It could take two to three weeks for therapy to relieve symptoms from moderate intercostal muscle strain fully, but healing times vary according to the severity of your injury. Severe strains may take up to six weeks to heal.
Again my dear patient i would like to say that as per books and protocol initially we should rule out possibility of cardiac involvement(as neglecting this can even cause sudden fatality) after that we should try to eliminate abdominal involvement.
Once cleared we could proceed with therapy for strain.

Hope i was helpful.
Please feel free to follow up.
Thank you and get well soon.
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