Upper Left Back Pain During Swallowing and Belching - Gastroenterology and Hepatology

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Upper left back pain during swallowing and belching can be a complex issue, often involving multiple systems in the body. Given your symptoms and the investigations you've already undergone, it’s important to consider several potential causes and avenues for further evaluation.


Possible Causes of Your Symptoms
1. Musculoskeletal Issues: The pain you experience in your upper left back, especially if it is near the spine, could be related to muscle strain or irritation of the spinal structures. This can happen due to poor posture, repetitive movements, or even stress. The act of swallowing and belching may exacerbate this pain if there is tension in the surrounding muscles.

2. Gastroesophageal Reflux Disease (GERD): Although you mentioned that you do not have gastroesophageal reflux, the presence of excess stomach acid can still lead to discomfort in the esophagus, which may radiate to the back. The pressure from belching could also cause referred pain to the back if the diaphragm or surrounding muscles are involved.

3. Esophageal Disorders: Conditions such as esophageal spasms or inflammation can cause pain during swallowing. These spasms can sometimes be triggered by certain foods, stress, or even acid reflux. The pain may feel like it is deep within the chest or back, particularly if the esophagus is irritated.

4. Visceral Pain Referral: The sensation of pain can be referred from one area of the body to another. For instance, issues in the stomach or esophagus can sometimes manifest as back pain. The fact that you feel pain during belching suggests that there may be a connection between your gastrointestinal tract and the pain in your back.

5. Nerve Involvement: If there is any irritation or compression of the nerves that exit the spine in the thoracic region, this could lead to pain that is felt in the back during activities like swallowing or belching.


Recommendations for Further Evaluation
Given that you have already consulted with orthopedics and gastroenterology, it may be beneficial to explore the following options:
1. Consult a Neurologist: Since your symptoms involve pain that may be related to nerve pathways, a neurologist can assess for any nerve-related issues that might be contributing to your pain.

2. Physical Therapy: A physical therapist can help evaluate your posture and movement patterns. They can provide exercises to strengthen the muscles around your spine and improve flexibility, which may alleviate some of the pain.

3. Further Gastrointestinal Evaluation: If your symptoms persist, consider a follow-up with a gastroenterologist. They may recommend additional tests such as an esophageal motility study to assess how well your esophagus is functioning.

4. Dietary Modifications: Since you mentioned having high stomach acid, dietary changes may help. Avoiding spicy foods, caffeine, and alcohol can reduce irritation in the gastrointestinal tract.

5. Stress Management: Stress can exacerbate both musculoskeletal pain and gastrointestinal issues. Techniques such as mindfulness, yoga, or other relaxation methods may be beneficial.


Conclusion
In summary, the pain you are experiencing in your upper left back during swallowing and belching could stem from a combination of musculoskeletal issues, gastrointestinal conditions, or nerve involvement. It is crucial to continue working with healthcare professionals to explore these avenues and find a comprehensive treatment plan. Keeping a symptom diary that tracks your pain in relation to eating, stress levels, and activities may also provide valuable insights for your healthcare providers.