Esophageal Pain and Digestive Issues: When to Seek Help

Esophageal issues, loss of appetite, gastrointestinal discomfort?

Hello Dr.
Chen,
I have been experiencing esophageal pain during swallowing and a feeling of fullness and discomfort in my stomach for the past two months, which has led to a loss of appetite.
A recent endoscopy showed mild esophageal ulcers and polyps in the stomach, but the biopsy results were benign, so no removal was performed.
About eight years ago, I had an endoscopy that revealed Helicobacter pylori, which I treated and eradicated; this time, there was no presence of H.
pylori in my stomach.
An abdominal ultrasound of the liver and gallbladder also showed no issues.
Although medication has provided slight relief, the same symptoms reoccur shortly after (both from Western and traditional Chinese medicine).
I find that sweet, spicy, alcoholic, or spoiled foods easily irritate my condition and cause a relapse.
Additionally, I occasionally experience severe chest pain that radiates to my back, which only improves with acupuncture.

I would like to ask if this could possibly indicate a pancreatic issue, or if I should undergo another endoscopy or consult a different specialty.
Thank you!

Niming, 50~59 year old female. Ask Date: 2018/08/09

Dr. Chen Qifeng reply Gastroenterology and Hepatology

It is recommended to complete the treatment for esophageal ulcers; if there is no improvement, further evaluation and management should be pursued.

Reply Date: 2018/08/09

More Info

Esophageal pain and digestive issues can be quite distressing, especially when they interfere with daily activities and appetite. Based on your symptoms and previous medical history, it’s important to take a comprehensive approach to understanding your condition and determining the appropriate next steps.

Understanding Your Symptoms
You mentioned experiencing esophageal pain during swallowing, a feeling of fullness or discomfort in the stomach after eating, and a loss of appetite. These symptoms, combined with the findings from your endoscopy that revealed a mild esophageal ulcer and a benign gastric polyp, suggest that you may be dealing with gastroesophageal reflux disease (GERD) or esophagitis, which can lead to pain and discomfort in the esophagus.

The fact that certain foods (sweet, spicy, and alcohol) exacerbate your symptoms indicates that you may have a sensitivity to these irritants, which is common in individuals with esophageal conditions. Additionally, the chest pain that radiates to your back could be related to esophageal spasms or could potentially indicate a more serious condition, such as pancreatitis, especially given your history of digestive issues.

When to Seek Help
1. Persistent Symptoms: If your symptoms persist despite medication, or if they worsen, it is crucial to seek further evaluation. This could involve a repeat endoscopy to assess the healing of the esophageal ulcer and to rule out any other underlying conditions.

2. New Symptoms: The occurrence of severe chest pain that radiates to your back warrants immediate medical attention. While it could be related to esophageal issues, it’s important to rule out cardiac causes or pancreatitis, especially if the pain is severe and persistent.

3. Dietary Triggers: Since you have identified specific foods that trigger your symptoms, it may be beneficial to keep a food diary. This can help you and your healthcare provider identify patterns and make dietary adjustments that could alleviate your discomfort.

4. Consulting Specialists: If your symptoms continue to be problematic, consider consulting a gastroenterologist for a more specialized evaluation. If there is a concern about pancreatic issues, a referral to a hepatobiliary specialist may also be warranted.

Management Strategies
1. Medication: You mentioned that medications have provided some relief but not lasting effects. Proton pump inhibitors (PPIs) are often prescribed for GERD and esophagitis, but if you find they are not effective, discussing alternative medications or dosages with your doctor is essential.
2. Dietary Modifications: Avoiding known irritants (spicy foods, alcohol, and sweets) can help manage your symptoms. Eating smaller, more frequent meals instead of large ones can also reduce the burden on your digestive system.

3. Lifestyle Changes: Elevating the head of your bed, avoiding lying down after meals, and maintaining a healthy weight can also help reduce reflux symptoms.

4. Stress Management: Since you mentioned using acupuncture for relief, consider integrating stress management techniques such as mindfulness, yoga, or cognitive behavioral therapy, which can help alleviate the physical symptoms associated with stress.

Conclusion
In summary, your symptoms of esophageal pain and digestive discomfort warrant careful monitoring and possibly further investigation. Given the complexity of your symptoms and their impact on your quality of life, it is advisable to maintain open communication with your healthcare providers, adhere to prescribed treatments, and consider dietary and lifestyle modifications. If symptoms persist or worsen, do not hesitate to seek further evaluation to ensure that any serious conditions are ruled out and that you receive the appropriate care.

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