Symptoms of Gastroesophageal Reflux and Related Conditions

I would like to ask Dr. Chen what symptoms might be indicated by a sudden tightening in the center of the chest when changing positions or after eating?

Two years ago, I frequently enjoyed late-night snacks, particularly spicy and fried foods.
One night, after finishing a snack, I suddenly experienced acid reflux from my throat.
I later realized that I might have gastroesophageal reflux disease (GERD).
I started paying more attention to my health and began working out at the gym, focusing on heavy weight training.
I trained intensely each time and learned how to train on my own, as I had read online that one should take a deep breath and hold it while lifting weights.
However, I suffered a sudden muscle strain and it took a while to recover.
My job also requires lifting heavy objects, and during lunch one day, I strained myself again while lifting.
A few days later, after having spicy hot pot for lunch, I immediately drank a bottle of Red Bull (carbonated energy drink).
About a minute later, I felt a sudden constriction in my chest, which persisted even while trying to sleep that night.
I later visited a gastroenterologist who performed an endoscopy and noted some signs of acid erosion near the cardia, with slight bleeding.
They also removed a small polyp and prescribed a three-course medication regimen, but the results were limited, and I continued to experience intermittent chest constriction.
I then tried traditional Chinese medicine, but the effects were also limited, and I visited three different clinics.
During this time, my weight suddenly dropped from 80 kg to 65 kg.
On two occasions, I experienced sudden shortness of breath, feeling as if oxygen was trapped in my throat.
Fortunately, I managed to recover using diaphragmatic breathing.
I went to the emergency room twice, and both times I was told it was due to "hyperventilation" and "autonomic nervous system dysregulation." I relied on herbal medicine for treatment, which yielded mixed results.
Over time, I discovered that I often felt uncomfortable after eating, especially when bending over or putting pressure on my abdomen.
I researched online and found that "hiatal hernia" could also cause similar symptoms.
After two years of ongoing issues and concerns about breathing difficulties, my quality of life has significantly declined due to the unpredictable episodes.
I also noticed that my muscles sometimes twitch involuntarily, and I have tried treatments for autonomic nervous system issues with no effect.
Therefore, I would like to ask Dr.
Chen about the symptoms I have described and what might be causing these problems.

Qi, 30~39 year old female. Ask Date: 2024/06/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

It may be caused by anxiety.
In addition to controlling it with gastric medication, it is still recommended to undergo pharmacological treatment and relaxation training from a psychosomatic specialist.

Reply Date: 2024/06/26

More Info

Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backflow of stomach contents into the esophagus, leading to various symptoms such as heartburn, regurgitation, and discomfort in the chest area. Your experience with GERD, particularly after consuming spicy and fried foods, is not uncommon. The symptoms you describe, including chest tightness, difficulty breathing, and the sensation of food or air being trapped in your throat, can be distressing and may indicate a combination of factors contributing to your condition.

Firstly, the tightness in your chest and the feeling of not being able to breathe could be linked to several underlying issues. One possibility is that the diaphragm, the muscle that separates the chest from the abdomen, may be affected by your history of heavy lifting and straining during workouts. This can lead to a condition known as hiatal hernia, where part of the stomach pushes through the diaphragm into the chest cavity. This condition can exacerbate GERD symptoms, as the anatomical changes can affect the lower esophageal sphincter (LES), which is responsible for preventing stomach acid from flowing back into the esophagus.

Additionally, your symptoms of chest tightness and difficulty breathing could also be related to anxiety or panic attacks, especially given your history of feeling like you couldn't catch your breath. The episodes of hyperventilation you experienced in the emergency room may indicate that anxiety is playing a role in your symptoms. Stress and anxiety can lead to muscle tension, which may further contribute to the sensation of tightness in the chest and difficulty breathing.

The fact that you have experienced significant weight loss (from 80 kg to 65 kg) is concerning and could indicate that your body is under stress, either from the physical symptoms you are experiencing or from the psychological impact of living with a chronic condition. Weight loss can also affect your overall health and may lead to further complications if not addressed.

Your ongoing symptoms, including the sensation of food being trapped and the discomfort after eating, suggest that your gastrointestinal motility may be impaired. This could be due to a combination of factors, including dietary choices, stress, and possibly the medications you have been taking. It is essential to monitor your diet closely and avoid foods that trigger your symptoms, such as spicy, fatty, or carbonated foods.
In terms of treatment, it is crucial to work closely with your healthcare provider to find a management plan that works for you. This may include medications to reduce stomach acid, lifestyle modifications such as weight management, and possibly physical therapy to address any muscular issues related to your diaphragm or core stability. Additionally, exploring cognitive-behavioral therapy or other forms of psychological support may help manage anxiety and improve your overall quality of life.

In summary, your symptoms may be the result of a complex interplay between GERD, potential hiatal hernia, anxiety, and lifestyle factors. It is essential to continue seeking medical advice and to consider a multidisciplinary approach to your treatment, including both gastrointestinal and psychological support. Regular follow-ups with your healthcare provider can help ensure that you are on the right track to managing your symptoms effectively.

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