I have consistent chest pain and need a permanent solution. Please help.

Question

Hello,

I am current experiencing pain in my chest and have been for almost 3 years now. I have been to two different cardiologist and have had EKG, stress test, and ultra sounds on my heart performed at both locations. Nothing from either cardiologist was discovered to be out of the ordinary . I then turned to a gastroenterologist and have gone through a few more test. I have been tested for acid reflux (used a measuring device to test the PH levels in my esophagus) nothing was found and my PH levels came back normal, however the doctor did notice that my esophagus was squeezing/closing very tightly.

I had an upper endoscopy performed where they used a ballon to expand the esophagus and used injections to help relax the esophagus. Neither have resolved this issue and I am still having consistent chest pains. I have been told that the pain is due to nerve/stress and I have also been put on a medication called Amitriptyline 10mg to help with the pain but it seems do absolutely nothing and I have the same chest pain every single day. I would really like to know what causes this pain and if there is anyway to permanently fix this issue. I really want to avoid taking more medications and focus on a long term fix and what options I have available to me. Thanks for your time it Is really appreciated!

Answer 1

Hello dear

I welcome you to icliniq.

Well I can understand that you must be very anxious about your problem, and I really would like to provide you with the best suggestion I can. But before jumping in to treatment of it, it is crucial that I have all your reports in my hands to interpret in light of your symptoms. I would need some more information about this chest pain, as I can be able to differentiate the potential cause underlying it. Only after interpreting your lab results and symptomatology, I would be able to tell whether you need some more test to confirm my findings, or I can start you on some treatment right away.

Listening to your history, here is my take on this. Since you already had a PH metry and which showed up as normal. This test is basically performed to detect reflux disease. There is still some room for additional add on techniques to further elaborate the results of PH metry namely the impedance testing. Adding impedance can confirmely rule out acid or non acid reflux. So this is important investigations to be considered if not performed yet. The findings of endoscopy you mention can occur in motility disorder like achalasia, or a stricture ( narrowing ) secondary to reflux. The later can be diagnosed as mentioned above.

However for achalasia or other motility disorder we need to do a esophageal manometry testing. The Amitriptyline you have been given, probably have been considering functional heart burn in you. This is hypersensitive esophagus. But I am surprised to see if they found a narrowing ( kind of structural problem), and given you Amitriptyline considering functional ( non structural) problem. So kind of not right, I am afraid.

Lastly there comes a role of Endoscopic esophageal biopsies to rule out esoinophoilic esophagitis. This is basically an allergy of esophagus to food. Let me know also, does this pain comes after meals? after meals? do you feel acid coming in to mouth after meals? or after bending or lying over bed? does cold or hot water bring this chest pain?

Does this pain ever bother you in the middle of night while you asleep? Do you have allergies? or asthma? cough? I am sure you have been given some acid suppressant medications, did they bring any relief in to your symptoms? So you provide me all that lab reports that has been done previously, Let me interpret for you. Best regards

I have consistent chest pain and need a permanent solution. Please help.

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