Chest Pain: Esophageal Issues and Endoscopy Insights

Chest pain, esophageal issues, endoscopy?

Hello, Doctor.
I accidentally swallowed a fish bone on the evening of April 26.
I visited the ENT department on the afternoon of April 27, where the doctor noted only throat inflammation and could not see the fish bone.
He advised that if I felt unwell, I should go to a larger hospital for an endoscopy and prescribed anti-inflammatory medication.
From April 28 to April 30, I occasionally experienced chest pain and discomfort (the pain sometimes shifts location).
On May 1, I went to National Taiwan University Hospital, and after explaining my condition, the doctor mentioned that an X-ray would not reveal the fish bone and observed throat inflammation.
He speculated that the fish bone might have scratched my esophagus, causing inflammation and pain, and advised me to monitor my symptoms for 1 to 2 weeks.
If the pain persisted, I should return for a follow-up.
After the diagnosis, he prescribed pain relief medication.
From May 2 to May 10, I continued to experience occasional chest pain and discomfort, and I felt a sensation of something stuck in my throat when swallowing saliva.
On May 11, I visited the esophageal surgery department at National Taiwan University Hospital.
After discussing my symptoms, the doctor scheduled an endoscopy for the end of May and prescribed a gastric protective emulsion.
I would like to ask the doctor a few questions: 1.
Are these symptoms indicative of an esophageal ulcer? 2.
If I go to the emergency department in the evening, can I directly undergo an endoscopy for examination and treatment? Thank you for your response, Doctor.

Mr. Lin, 30~39 year old female. Ask Date: 2017/05/12

Dr. Chen Taicheng reply Family Medicine

● It has been approximately 2 weeks.
If there were a severe esophageal or gastrointestinal perforation, the symptoms would be quite serious; currently, there are no such signs, so you can be somewhat reassured.
Generally, if a fishbone is present in the digestive tract, it should have been expelled by now.
● Please first visit an ENT specialist at a clinic or hospital for an endoscopic examination to check for any fishbone at the base of the tongue or near the throat.
If none is found, the sensation of something stuck in the throat may simply be a result of a previous abrasion or inflammation.
If you continue to experience chest pain or discomfort, you may go to the emergency department of a larger hospital, where they can usually arrange for an upper gastrointestinal endoscopy more quickly.
● Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital's Family Medicine Department is concerned about you~

Reply Date: 2017/05/12

More Info

Based on your detailed medical history and the symptoms you've described, it appears that you may be experiencing issues related to your esophagus, potentially exacerbated by the incident of swallowing a fishbone. Let's address your questions one by one.

1. Is this a symptom of esophageal ulcer?
The symptoms you are experiencing, such as chest pain and discomfort, particularly when swallowing, could indeed be indicative of an esophageal ulcer or esophagitis. The inflammation in your throat noted by the ENT specialist may suggest that the fishbone caused some irritation or injury to the esophagus, leading to inflammation. Esophageal ulcers can occur as a result of chronic gastroesophageal reflux disease (GERD), which you have a history of, or from direct trauma, such as swallowing a foreign object. The intermittent nature of your chest pain and the sensation of something being stuck when swallowing could be consistent with esophageal irritation or ulceration.

2. Can I go to the emergency room for an immediate endoscopy?
In general, if you are experiencing severe symptoms such as significant chest pain, difficulty swallowing, or if you suspect a foreign body obstruction, it is advisable to seek immediate medical attention. Emergency departments are equipped to handle acute cases and may perform an endoscopy if deemed necessary. However, the decision to perform an endoscopy will depend on the clinical assessment by the attending physician. They will evaluate your symptoms, perform a physical examination, and may order imaging studies if needed before proceeding with an endoscopy.

Additional Considerations
Given your history of GERD and the recent incident with the fishbone, it is crucial to monitor your symptoms closely. If the chest pain persists or worsens, or if you develop new symptoms such as difficulty breathing, severe swallowing difficulties, or vomiting, you should seek immediate medical attention.

Management and Follow-Up:
- Medications: Continue taking any prescribed medications, such as proton pump inhibitors (PPIs), which can help reduce stomach acid and promote healing of any potential ulcers.

- Dietary Modifications: Avoid spicy, acidic, or hard foods that may irritate the esophagus further. Soft, bland foods may be easier to swallow and less irritating.

- Follow-Up Endoscopy: The scheduled endoscopy will be essential in evaluating the state of your esophagus and determining if there are any ulcers or other abnormalities that require treatment. It will also help rule out any serious conditions.

Conclusion:
In summary, your symptoms could be related to esophageal irritation or ulceration, possibly due to the recent incident with the fishbone. If symptoms persist or worsen, do not hesitate to seek emergency care. Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment as necessary.

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