Tightness in the clavicle?
Hello Doctor, I have a history of liver transplantation and cesarean delivery.
My doctor mentioned that I might have mild intestinal adhesions.
Since my liver transplant, I have undergone gastroscopy every six months to a year.
At National Taiwan University Hospital, there were instances of mild gastric mucosal erosion, but everything else was normal.
In 2016, I switched to Taipei Medical University for examinations, where the doctor diagnosed me with mild gastroesophageal reflux disease (GERD), but I have no symptoms of reflux, so I did not take any medication.
In 2017, I returned to National Taiwan University, and the doctor noted mild gastric mucosal erosion again.
I asked if I had GERD, and the doctor said no.
Six months later, I went back to Taipei Medical University, and they again stated that I still had mild GERD.
A year and a half ago, I experienced a month of abdominal bloating, constipation, flatulence, and belching.
An X-ray of my intestines showed a lot of stool and gas.
I consulted my hepatologist about why I belch air from my mouth daily, and the doctor suggested it might be due to incomplete gastric emptying and mild intestinal adhesions, which would not affect the esophageal mucosa and were unrelated to GERD.
Three years ago, I experienced tightness around my collarbone but did not have difficulty breathing; sometimes deep breaths helped.
A pulmonologist noted that I had mild asthma, and over the past three years, I occasionally felt tightness around my collarbone for a few days every couple of months.
However, I rarely used inhalers, and I would recover on my own.
Since July of last year until the end of March this year, I did not experience any tightness around my collarbone.
In mid-April, I suddenly felt tightness around my collarbone again, similar to before, but I did not have difficulty breathing.
Last Friday, I visited a different pulmonologist who said that my collarbone tightness did not indicate difficulty breathing or coughing and did not appear to be asthma.
He referred me to an ENT specialist, who found a small polyp on my vocal cords.
The doctor said it was not a concern but suggested a biopsy.
I was scheduled for surgery, and the doctor mentioned that the small polyp was very minor and did not affect my airway, so the tightness in my throat should not be related to it.
When I asked the doctor why I had a polyp, he said it could be due to smoking, drinking, or GERD.
I do not smoke or drink, and I weigh 164.46 pounds and have regular bowel movements every one to two days.
In April, I suddenly had pain in my lower right abdomen for half a day.
The clinic was concerned about appendicitis and referred me to a larger hospital.
An X-ray showed a lot of stool and gas, and after taking laxatives, I felt better.
I would like to ask the doctor the following questions:
1.
Why do I have so much stool even though I have bowel movements every day or every two days?
2.
I have always eaten until I am about 70% full and rarely eat until I am very full.
Why did I suddenly develop symptoms of belching and incomplete gastric emptying a year and a half ago?
3.
Is my vocal cord polyp really caused by GERD?
4.
I read online that when belching, the lower esophageal sphincter can open, and sometimes stomach acid can come up with the belch.
Is this true?
5.
Can anxiety also cause GERD?
6.
Recently, I sometimes still feel tightness around my collarbone and throat.
Yesterday, I felt chest tightness upon waking that lasted until after 8 PM.
I had an X-ray that was normal.
This morning, I woke up with a brief sharp sensation in my chest.
Can GERD cause chest tightness? Does it occur only after eating, or can it happen even if I haven't eaten breakfast?
7.
Is my chest tightness and sharp pain related to GERD?
8.
I have a lot of post-nasal drip.
I read online that laryngopharyngeal reflux is more severe than GERD.
Am I experiencing laryngopharyngeal reflux or GERD?
9.
Why do I sometimes belch even in the morning before eating anything, just drinking water? Can stomach acid come up if I haven't eaten?
10.
Recently, I have experienced moments where I feel the urge to belch but cannot.
This has not happened before.
My mother-in-law has been critical since I married into the family 11 years ago, and I tend to get anxious over small matters.
My sister says that all my issues are due to the pressure I put on myself.
Can stress affect gastrointestinal function?
Wenwen, 40~49 year old female. Ask Date: 2019/05/04
Dr. Cai Anshun reply Gastroenterology and Hepatology
Hello: Your issue is quite complex.
Please consult a gastroenterologist and discuss it in detail with Dr.
Tsai An-Shun at Changhua Hospital.
Reply Date: 2019/05/04
More Info
After undergoing a liver transplant, many patients experience a variety of gastrointestinal issues, including gas, bloating, and even throat tightness. These symptoms can be attributed to several factors related to the surgery, the medications taken post-transplant, and the underlying health conditions of the patient.
1. Gastrointestinal Motility Issues: One of the common complications after abdominal surgeries, including liver transplants, is the development of adhesions or scar tissue. These adhesions can lead to gastrointestinal motility issues, causing symptoms like bloating, gas, and constipation. The feeling of fullness or pressure in the abdomen can be exacerbated by the presence of gas, which may not be effectively expelled due to these motility problems.
2. Delayed Gastric Emptying: The sensation of bloating and the need to burp frequently can also be linked to delayed gastric emptying, a condition where the stomach takes longer than normal to empty its contents into the small intestine. This can lead to feelings of fullness, discomfort, and increased gas production. In your case, the doctor mentioned that your stomach might not be emptying properly, which could explain the gas and bloating symptoms.
3. Gastroesophageal Reflux Disease (GERD): The diagnosis of mild gastroesophageal reflux disease (GERD) suggests that stomach acid may be flowing back into the esophagus, which can cause symptoms such as throat tightness, heartburn, and regurgitation. Even if you do not experience typical symptoms of GERD, it is possible to have silent reflux, where the acid does not cause heartburn but can still lead to throat discomfort and other symptoms.
4. Voice Changes and Vocal Cord Nodules: The small nodule on your vocal cords could be related to irritation from acid reflux, as chronic exposure to stomach acid can lead to changes in the throat and voice box. While your doctor indicated that this nodule is not a cause for concern, it is essential to monitor it, especially if you experience changes in your voice or throat discomfort.
5. Stress and Anxiety: Psychological factors such as stress and anxiety can significantly impact gastrointestinal health. Stress can lead to increased gastric acid production and exacerbate symptoms of reflux and bloating. It can also affect bowel habits, leading to constipation or diarrhea. The tightness you feel around your collarbone and throat could be related to muscle tension from anxiety, which can mimic gastrointestinal symptoms.
6. Dietary Factors: Your eating habits, including the amount and type of food consumed, can also play a role in gastrointestinal symptoms. Eating smaller, more frequent meals may help alleviate some of the bloating and gas. Additionally, avoiding trigger foods that are high in fat or difficult to digest can be beneficial.
7. Medical Evaluation: Given the complexity of your symptoms, it is crucial to maintain regular follow-ups with your healthcare providers. They can perform necessary evaluations, such as endoscopies or imaging studies, to rule out any underlying issues that may be contributing to your symptoms.
8. Managing Symptoms: Over-the-counter medications like antacids or proton pump inhibitors may help manage symptoms of acid reflux. However, it is essential to consult with your healthcare provider before starting any new medication, especially after a transplant, as some medications can interact with immunosuppressive drugs.
In summary, the gastrointestinal issues you are experiencing post-liver transplant can be multifactorial, involving motility problems, reflux, dietary habits, and psychological stress. It is essential to work closely with your healthcare team to address these symptoms comprehensively. Regular monitoring and adjustments to your treatment plan can help improve your quality of life and manage these gastrointestinal concerns effectively.
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