Heartburn Sharp Pain

Q.Occasionally, I will eat something that later causes an incredible amount of pain in my chest, behind the sternum. It feels like it could be centralized in the area between the esophogus and stomach, so my first thought was heartburn or reflux. However, it is not a burning sensation that I would associate with acid reflux. When I swallow water (or even nothing), I can feel it go down my esophogus until it hits that area, then BAM I get an intense, sharp pain, that then fades in to a dull pain. I do not have this all the time...just once in awhile. It feels like an intense gas bubble or something that I cannot burp out. When I get like this, I have tried everything I can think of....Pepto Bismal, Rolaids, anti-gas tablets, Mylanta, cold water, eating, etc. and nothing effects it. It seems the only thing I can do is wait it out. It generally goes away after a few hours, with a lot of gurgling noises afterward (and burping). I do not have any physical problem swallowing or eating...just the pain. Does anyone have any idea what this could be? Is it reflux? Is it gas? Is it food poisoning of some sort?

A.With such chest pain, it's important to be sure that it is not due to some sort of heart problem. Only about 40% of people with GERD have typical "heartburn". The other 60% have a wide variety of symptoms, but the next most common symptom is chest pain. Having said that, gallbladder disease is indeed a possibility with such symptoms and ultrasound of the gallbladder is a frequent component of the workup for GERD. Additionally, another very common cause of such chest pain is an esophageal dysmotility disorder, such as nutcracker esophagus. These problems would be diagnosed by esophageal manometry. A common workup for symptoms such as you describe if empiric treatment failed to control the symptoms would include upper GI endoscopy, ambulatory pH testing, and esophageal manometry.

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