I am a 31-year-old male with a normal BMI. Why do I have bloating and chest pain on jogging?

Question

Hello doctor,

I am a 31-year-old male with a normal BMI. I have IBS, and my father has it too. I went to a gastroenterologist as I was having bloating and chest pain on jogging. It is not heart-related, as said by cardiologists after doing Echo, ECG, and one week of heart monitor done. It is due to exercise-induced acid reflux.

So my gastroenterologist advised me to take:

1) Celiac panel test.

2) Comprehensive metabolic panel.

3) CBC with the differential count.

4) Lipase test.

All tests were in normal range except in

Celiac panel: Total IgA was 540 mg/dl (Range: 90-386) mg/dL

Endomysial AB IgA Value= negative.

Transglutamin IgA Value = < 2 (Standard range: 0-3 U/mL)

So the above test means I do not have celiac disease.

Also, I am anxious about the elevated total IgA. What could cause it? I want to add that I also had a sore throat when I got the celiac test done. Could a mild sore throat cause elevated IgA?

Since my total protein, albumin and globulin are all in the normal range, this cannot be MGUS (monoclonal gammopathy of undetermined significance) or any other blood plasma disorder, right?

I am distraught that this could be the start of Iga neuropathy.

My gastroenterologist told me to wait for two weeks and then get the following tests done, and if the IgA does not resolve, he will refer me to hematology.

-Immunofixation (IFE) and protein, electrophoresis, serum.

-Immunoglobulin A, QN, serum.

Thinking about IgA neuropathy or MGUS or multiple myeloma causes a great deal of anxiety, resulting in more GERD and PVCs.

I want your opinion as to what do you think is causing high IgA?

Answer 1

Hello,

Welcome to icliniq.com.

Following is my answer to your questions.

Noted the only positive finding in your attached report is raised IgA level. Now you do not have any symptoms of plasma cell dyscrasia like tingling, bone pain, etc., as per your history. However, if it remains elevated after a few days than simple non-invasive immunofixation electrophoresis can be planned.

Sore throat is causing infection in the posterior pharynx. Other causes include autoimmune disease. So just now, elevated IgA seems most likely from a sore throat infection. If it persistently remains high, then will do immunofixation electrophoresis and urine Bense-Jones protein estimation to rule out plasma cell dyscrasia like myeloma and ANA (Antinuclear antibody) investigation to rule out autoimmune diseases. Do not take the stress. Stress will aggravate your acid reflux. I do not think you have plasma cell dyscrasia. But still have to check IgA after few days. Your anti endomysial and IgA values are within the range. So celiac disease is less likely to occur. Take antacid for your acid reflux and drink more water. Elevate your head while sleeping by putting a pillow below the head. In IgA nephropathy, nephritic syndrome present in which urine shows protein, and patients have swelling complaints. So it is less likely.

I hope this will help you.

Let me know still if your concern is not solved and have a further question in mind.

Best regards.

Answer 2

Hi,

Welcome back to icliniq.com.

I appreciate your health concern. Following is my answers for your follow-up questions. Yes gastrointestinal inflammation also can raise your IgA level. Sore throat also could be possible reason. IgA is secretory antibody specific to lining respiratory and GIT epithelium. So your raised IgA could be possible due to these two reason. According to attached report (attachment removed to protect patient identity) and clinical history plasma cell dyscrasia and IgA nephrology less likely. However as we have discussed if still IgA elevated after few days than investigate with immunofixation electrophoresis and full urine examination including bens Jones protein estimation to be sure that nothing is abnormal. Acid reflux usually subside within one week of antacid use. Pantoprazole is good drug to resolve esophageal inflammation. So, two week is enough to subside the esophageal inflammation and you can repeat IgA after two to three weeks. Stress aggravate reflux, so do not take stress and put pillow below head to elevate it and by this way avoid acid reflux. Do not take excess spicy foods. Cooked oatmeal helps in soothing stomach. So include it in your diet. The mentioned medicines usually does not increase IgA as per my opinion. I hope I have answered your questions. Let me know if I can assist you further. Best regards.

I am a 31-year-old male with a normal BMI. Why do I have bloating and chest pain on jogging?

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