How do I manage chest pressure, bloating, and black stools?

Question

Hello doctor,

I have been feeling off for the past two to three days, particularly at night when I lie down to sleep. I experience a feeling of missing or emptiness, and I get pressure on my chest. Sometimes, I feel short of breath, although not all the time. I have also been feeling bloated, and my stools have changed color, appearing brown or blackish.

Recently, I visited a gynecologist who diagnosed me with PCOS (polycystic ovarian syndrome) after finding polycystic ovaries. She prescribed medications, including Diane-35 and Inofolic, which I have been taking for about a week. However, I am still experiencing these symptoms, and I am concerned that I might also have a problem with GERD. I took Omeprazole (Risek) and Gaviscon for a week, and it felt better, but the chest pressure has started again. I would appreciate it if you could help me understand what is going on.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on your symptoms, chest pressure, especially when lying down, bloating, blackish or mushy stools, nausea, and difficulty burping, it strongly suggests that you are experiencing gastroesophageal reflux disease (GERD), possibly compounded by post-infectious gastritis or a functional gastrointestinal issue following the recent food poisoning episode. The fact that you initially improved with Omeprazole (a proton pump inhibitor, or PPI) but worsened after stopping it and only continued with Gaviscon (antacid) supports ongoing acid-related irritation in the upper gastrointestinal tract.

The black or dark stools are particularly concerning, as they may indicate upper gastrointestinal bleeding (such as from gastritis or an ulcer), especially after recent NSAID use, vomiting, or infection. You should not ignore this. A stool occult blood test and complete blood count are necessary, along with consideration for an upper gastrointestinal endoscopy to assess the condition of your stomach and esophagus.

Restart Omeprazole (or Esomeprazole) daily, ideally before breakfast, and continue for at least four weeks. Avoid lying down for at least two hours after eating, eat smaller meals, and eliminate spicy or fatty foods, caffeine, and carbonated drinks. Diane-35 (Cyproterone acetate-Ethinyl estradiol, a combination drug) can occasionally cause nausea or contribute to indigestion, so take it with food. Your PCOS and hormonal medications are likely unrelated to these acute GI symptoms, but bloating can overlap.

Please follow up in person soon to rule out bleeding or a peptic ulcer, especially if the black stools persist. If your breathing worsens or you develop sharp abdominal pain, seek urgent medical attention.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.