Stomach Pain: Managing GERD and Anxiety Effects - Gastroenterology and Hepatology

Stomach pain has affected my mental state!

Doctor: Hello! In May, due to excessive mental stress, I experienced stomach pain and diarrhea.
After evaluation by a physician, I was diagnosed with irritable bowel syndrome and gastroesophageal reflux disease (GERD).
In August, I underwent several tests, including an upper endoscopy, fecal occult blood test, and abdominal ultrasound.
Besides finding gastritis and esophagitis, no other significant symptoms were detected! I started taking "Nexium" at the end of August, and by mid-September, I no longer had the sensation of a foreign body in my throat or acid reflux symptoms.
As my condition improved, my mental state stabilized, and my diarrhea also significantly improved! However, in mid-October, while taking Nexium, I still experienced a feeling of gastric discomfort.
I informed my doctor, who suspected it might be a side effect of Nexium and advised that I could resume taking it after November 1 if the pain persisted.
Therefore, after November 1, I stopped taking it, but since the day before yesterday, my stomach discomfort has returned, and this morning I experienced sharp pain, which is worse than before.
This has made me feel even more uncomfortable mentally and physically, and I am deeply afraid it might lead to stomach cancer.
I have a few questions to ask: (1) In August, the upper endoscopy showed grade B gastroesophageal reflux, but a Helicobacter pylori test was not performed.
Is it necessary to check for H.
pylori? The doctor believes it is not necessary! (2) Today, my stomach hurts again.
Although I had an upper endoscopy in August confirming GERD, why do I still experience stomach pain despite taking medication? I no longer have acid reflux or throat discomfort; could this still be a manifestation of GERD? (3) If I finish this course of Nexium, can I still request another upper endoscopy? I am very worried about the possibility of stomach cancer, and this concern has caused me slight palpitations! I appreciate your response.
Thank you.

Zhuang Xiansheng, 40~49 year old female. Ask Date: 2012/11/06

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, (1) Helicobacter pylori is not directly related to gastroesophageal reflux disease (GERD), so it is reasonable not to perform a H.
pylori test.
The prevalence of H.
pylori is about 50% to 60%; however, if there is no history of peptic ulcers, duodenal ulcers, or family history of gastric cancer, eradication may not be necessary.
(2) Analyze your recent diet to see if it includes tea (black or green), coffee, carbonated beverages, spicy foods, fried foods, smoking, or alcohol, as well as stress.
Please avoid these one by one.
The causes of GERD or stomach pain are actually due to excessive gastric acid, and the symptoms of esophagitis may resemble those of gastritis.
(3) Under the premise of a detailed endoscopic examination, significant changes (such as cancerous lesions) are rarely observed in a short period.
Whether to repeat the endoscopy depends on clinical symptoms; if there are no symptoms, it is not recommended, but if symptoms are present, a re-examination is warranted.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2012/11/06

More Info

Understanding stomach pain, particularly in the context of conditions like gastroesophageal reflux disease (GERD) and anxiety, is crucial for effective management and treatment. Your situation reflects a common intersection of gastrointestinal issues and psychological factors, which can complicate diagnosis and treatment.

1. Helicobacter pylori Testing: You mentioned that your doctor did not see the necessity for a Helicobacter pylori (H. pylori) test after your endoscopy. H. pylori is a bacterium that can cause chronic gastritis and is associated with peptic ulcers. While your doctor may have deemed it unnecessary based on your symptoms and findings, it is generally a good practice to test for H. pylori, especially if you have a history of gastritis or ulcers. If you have persistent symptoms, discussing this with your healthcare provider could be beneficial.

2. Persistent Symptoms Despite Treatment: It is not uncommon for patients with GERD to experience ongoing symptoms even while on medication. The medications, such as proton pump inhibitors (PPIs) like "耐適恩" (Nexium), are designed to reduce stomach acid and alleviate symptoms. However, if you are still experiencing stomach discomfort, it could be due to several factors:
- Incomplete Response to Medication: Not all patients respond to PPIs in the same way. Some may require a higher dose or a different medication.

- Dietary Triggers: Certain foods can exacerbate GERD symptoms. Keeping a food diary may help identify any potential triggers.

- Anxiety and Stress: Psychological factors can significantly impact gastrointestinal health. Anxiety can lead to increased stomach acid production and muscle tension, which may contribute to your symptoms.

3. Concerns About Gastric Cancer: It’s understandable to be concerned about the possibility of gastric cancer, especially with ongoing symptoms. While your endoscopy did not reveal any alarming findings, it is important to communicate your concerns with your healthcare provider. If you feel that your symptoms are worsening or if new symptoms arise, requesting another endoscopy may be warranted. Your doctor can evaluate your risk factors and symptoms to determine the necessity of further testing.

4. Management Strategies: To manage your symptoms effectively, consider the following strategies:
- Medication Adherence: Continue taking your prescribed medications as directed. If you experience side effects or feel they are ineffective, discuss this with your doctor.

- Dietary Modifications: Avoid foods that trigger your symptoms, such as spicy foods, caffeine, and acidic foods. Eating smaller, more frequent meals can also help.

- Stress Management: Since anxiety can exacerbate gastrointestinal symptoms, incorporating stress-reduction techniques such as mindfulness, yoga, or therapy can be beneficial.

- Regular Follow-ups: Keep regular appointments with your healthcare provider to monitor your condition and adjust treatment as necessary.

In summary, your symptoms may be influenced by a combination of GERD and anxiety. It is essential to maintain open communication with your healthcare provider regarding your symptoms, treatment efficacy, and any concerns you may have about your health. By addressing both the physical and psychological aspects of your condition, you can work towards achieving better management of your symptoms and overall well-being.

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