Is My Nighttime Chest Pain Due to GERD or Peptic Ulcer?

Q: Is My Nighttime Chest Pain Due to GERD or Peptic Ulcer?

Hello： While examining the heart, you can also consult a gastroenterologist to assess whether an endoscopy is necessary, as gastroesophageal reflux can present similar symptoms. <br>It is advisable to avoid tea, coffee, smoking, alcohol, and late-night snacks. <br>Changhua Hospit

Could you please tell me if my acute symptoms are related to gastroesophageal reflux disease (GERD) or a gastric ulcer?

The symptoms occurred at night, presenting as unexplained pain located at the lower edge of the chest, just above the abdominal muscles, accompanied by soreness in the shoulders, neck, and arms.
There is also pain in the central depression of the chest when inhaling, and lying down exacerbates the pain, with left-sided lying being more severe than right-sided lying.
A visit to the internal medicine department revealed some abnormalities in the electrocardiogram, raising suspicion of pericarditis; however, during the most recent follow-up, the doctor felt it did not seem likely (an ultrasound is planned for further evaluation).

I would like to inquire about the potential underlying issues related to these symptoms, as I wish to address them promptly.
It has been a week since the onset, and while the pain has become less pronounced, it still persists.
I have taken the gastrointestinal medications prescribed during my visit, but there has not been significant improvement.
Is it possible for a peptic ulcer or gastroesophageal reflux disease to manifest suddenly without any prior symptoms (no nausea, no weight loss, no urge to vomit) and then cause severe pain? Two months ago, I experienced similar symptoms, which resolved after three days of treatment with gastric medication, but the same symptoms have recurred recently, with no gastrointestinal-related issues in between.
Should I proceed directly to an endoscopy if the cardiac ultrasound shows no abnormalities?

Phil, 20~29 year old female. Ask Date: 2017/10/04

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: While examining the heart, you can also consult a gastroenterologist to assess whether an endoscopy is necessary, as gastroesophageal reflux can present similar symptoms.
It is advisable to avoid tea, coffee, smoking, alcohol, and late-night snacks.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2017/10/04

More Info

Nighttime chest pain can be a concerning symptom, and it’s understandable that you’re seeking clarity on its potential causes. Based on your description, the pain is located at the lower chest area, accompanied by discomfort in the shoulders, neck, and arms, and worsens when lying down. These symptoms can indeed be indicative of several conditions, including gastroesophageal reflux disease (GERD) and peptic ulcers, but they may also suggest other issues that require careful evaluation.

Gastroesophageal Reflux Disease (GERD) is a common condition where stomach acid flows back into the esophagus, leading to symptoms such as heartburn, chest pain, and regurgitation. The pain associated with GERD often worsens when lying down, as gravity no longer helps keep stomach contents in the stomach. It can also radiate to the shoulders and neck, mimicking cardiac pain. The absence of nausea, weight loss, or vomiting does not rule out GERD, as many patients experience significant discomfort without these additional symptoms.

Peptic ulcers, on the other hand, are sores that develop on the lining of the stomach or the first part of the small intestine. They can cause burning pain in the stomach area, which may also be felt in the chest. While ulcers can lead to severe pain, they typically present with other symptoms such as bloating, indigestion, or changes in appetite. Like GERD, ulcer pain can also be exacerbated by lying down.

Given that you have had an electrocardiogram (ECG) that showed some abnormalities, it is crucial to rule out any cardiac issues. While your doctor has indicated that it may not be heart-related, the symptoms you describe warrant a thorough evaluation, including a possible echocardiogram to assess heart function and structure.
If your heart tests return normal, the next logical step would be to investigate gastrointestinal causes further. An upper endoscopy (esophagogastroduodenoscopy, or EGD) can be very useful in diagnosing GERD or peptic ulcers. This procedure allows a doctor to visualize the esophagus, stomach, and duodenum and to take biopsies if necessary.
In terms of treatment, if GERD is diagnosed, lifestyle modifications such as avoiding trigger foods, eating smaller meals, and not lying down immediately after eating can be beneficial. Medications like proton pump inhibitors (PPIs) or H2 blockers are commonly prescribed to reduce stomach acid and promote healing of the esophagus. If a peptic ulcer is found, treatment may include similar acid-reducing medications, along with antibiotics if H. pylori infection is present.

It’s also worth noting that stress and anxiety can exacerbate gastrointestinal symptoms, leading to a cycle of discomfort that can be challenging to break. Therefore, addressing any underlying stressors and considering relaxation techniques may also be beneficial.

In summary, while GERD and peptic ulcers are potential causes of your nighttime chest pain, it is essential to conduct further evaluations to rule out cardiac issues and to confirm a diagnosis. If your symptoms persist or worsen, please consult with your healthcare provider for a comprehensive assessment and tailored treatment plan.

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