Symptoms of Stomach Ulcers and GERD: What to Do Next

Symptoms related to gastric ulcers and gastroesophageal reflux disease (GERD)?

Hello Doctor: I have a symptom where my chest becomes increasingly uncomfortable when I am fasting; it feels tight, and I experience excessive stomach acid.
If I don't eat quickly, I feel very uncomfortable.
Sometimes I have breakfast at 6:00 AM, and by around 8:00 AM, I feel the need to eat again.
If I don't eat, the symptoms worsen, but after eating, I feel relief.
I need to eat almost every two hours, and I consume a considerable amount of food each time.
The hospital has suggested that I undergo an endoscopy, but it seems that I cannot do it on an empty stomach given my current condition.
I would like to ask the doctor what I should do.
Thank you for your response; I greatly appreciate it.

Lin Junyi, 30~39 year old female. Ask Date: 2023/05/26

Dr. Yang Zhichao reply Gastroenterology and Hepatology

You can come to the outpatient clinic for a detailed assessment, followed by the necessary examinations and treatment.

Reply Date: 2023/05/26

More Info

It sounds like you are experiencing significant discomfort related to your stomach and possibly related to gastroesophageal reflux disease (GERD) or peptic ulcers. Your symptoms of chest tightness and increased stomach acid when fasting, along with the need to eat frequently to alleviate discomfort, are indeed concerning and warrant further investigation.

Understanding Your Symptoms
1. Frequent Eating and Relief After Meals: The fact that you feel better after eating suggests that your symptoms may be related to gastric acid secretion. When the stomach is empty, acid can irritate the gastric lining, leading to discomfort. This is common in conditions like gastritis or peptic ulcers. Eating food can buffer the acid and provide temporary relief.

2. Chest Tightness: This symptom can be associated with GERD, where stomach acid flows back into the esophagus, causing irritation and discomfort. It can also be a sign of esophageal spasms or even anxiety, which can mimic gastrointestinal symptoms.

3. Need for Endoscopy: Your healthcare provider has recommended an endoscopy (EGD) to visualize the esophagus and stomach lining. This is a critical step in diagnosing conditions like ulcers, gastritis, or Barrett's esophagus. However, it is essential to follow the preparation guidelines for the procedure, which typically require fasting. If you are unable to fast due to your symptoms, communicate this with your doctor. They may be able to adjust the timing or provide alternative options for evaluation.

Next Steps
1. Medication: In the meantime, consider discussing with your doctor the possibility of starting proton pump inhibitors (PPIs) or H2 blockers. These medications reduce stomach acid production and can help alleviate your symptoms. However, it’s crucial to follow your healthcare provider's recommendations regarding medication use, especially if you have concerns about long-term use and its effects on calcium absorption, particularly given your history of osteoporosis.

2. Dietary Adjustments: Since you find relief from eating, focus on smaller, more frequent meals that are low in fat and acid. Avoid spicy foods, caffeine, and alcohol, as these can exacerbate GERD symptoms. Keeping a food diary may help identify specific triggers.

3. Follow-Up: If your symptoms persist or worsen, it is essential to follow up with your healthcare provider. They may consider additional tests, such as a 24-hour pH monitoring study, to assess acid reflux severity.

4. Lifestyle Changes: Incorporate lifestyle modifications such as elevating the head of your bed, avoiding lying down immediately after meals, and maintaining a healthy weight, as these can help manage GERD symptoms.

5. Monitoring Symptoms: Keep track of your symptoms, noting when they occur and their severity. This information can be valuable for your healthcare provider in determining the best course of action.

Conclusion
Your symptoms are indicative of a potential underlying gastrointestinal issue that requires further evaluation. While waiting for your endoscopy, managing your symptoms through medication, dietary changes, and lifestyle modifications can provide relief. Always communicate openly with your healthcare provider about your symptoms and any concerns regarding the timing of your procedures. Your health and comfort are paramount, and appropriate management can significantly improve your quality of life.

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