Question Title: Am I having esophageal spasms?

I am a 44 year old female and am troubled by occasional attacks of intense colicky like pain in my back. If it's bad enough I will feel it simultaneously in my right jaw and base of right ear. I quickly sip some very warm milk and take tylenol. The warm milk seems to really help. Afterward, I will have some belching up air. Burping up some air really makes me feel better. It's like I get air trapped for some reason.
Here is some history about me to help you. Gall bladder ultrasound was normal. Upper GI showed some reflux (I was lying down and had just drank alot of barium when the radiologist said she saw some reflux). Stress echo done several years ago showed some benign PVC's (I had been troubled by skipping beats). Otherwise normal. Recent EKG normal. I take Corgard for hypertension and the PVC's, Zantac 150 mg twice a day, Dipentum for Ulcerative colitis which is in remission. By the way, I never had colitis until I quit smoking in 1992. I was so sick with it for a year that I went back to smoking 1/2 pack a day and no longer have any colitis symptoms. I try to chew Nicorette gum instead when I can. Wonder also if the cigarettes can cause esophageal spasm or if stress can. I really don't think my doctor is sure exactly what it is.
I had these attacks in my 20's and wasn't bothered by them for years and now they're back. What could it be?
A spasm? Air trapped for some reason? I forgot to mention that I know that previous chest x-rays said that I have minimal eventration of the left hemidiaphragm probably congenital. Could that have anything to do this my problem? Thank you for your time. I look forward to your response.

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Dear Carolyn,
Thank you for your letter. It is difficult to know the cause for your chest pains. Esophageal reflux and esophageal dysmotility are both causes for this symptom complex. If symptoms are interfering with your life or are a cause for concer, then you should have investigation to make a definitive diagnosis. I would do an esophageal motility study and 24 hr pH probe test to detrermine if you have spasm. Correlation of pain with episodes of reflux would argue for reflux as the cause for your symptoms.

Your observation of the relationship between ulcerative colitis and smoking is correct. There have been epidemiologic studies showing that smoking has a protective effect in ulcerative colitis. Some studies have suggested that the nicotine patches serve the same role (i.e. reduce symptoms of ulceratyive colitis) but other studies do not suggest a therapeutic effect. Two points of caution: 1) smokijng has many serious adverse cardiac and respiratory effects and is not therefore considered a treatment for colitis and 2) smoking makes Croh's disease worse.

This information is presented for educational purposes. Ask specific questions to your personal physician.

HFHSM.D.-rf
*keywords: chest pain, ulcerative colitis, soking
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