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Gastroenterology (Expert Forum)
Aerophagia, backpain and chronic nausea
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Aerophagia, backpain and chronic nausea
by technotracer, Jul 08, 2004 12:00AM
Dear Dr. Pho,
I am a 35 year old male living in the UK. I am normally of good health but very slim (always have been) and have not had any operations etc.
I spend a lot of time sitting infront of the computer and I know my posture is not good. I should also get a lot more exercise.
I will try to describe my symptoms as best I can.
SYMPTOMS:
2 years ago
I started to get air coming up the oesophagus and bouts of nausea that did not last long. The aerophagia seemed to start suddenly overnight and was quite strange for me as I never had it before. It is more voluntary than involuntary - I can bring up air any time I like. The nausea lasted possibly 3-4 hours and then left and seemed to come in cycles of about 3 months.
TESTS:
1 1/2 years ago
I went to see my local doctor and he described the air coming up as aerophagia and possibly I was just swallowing air. I am quite a nervous and stressed person and he put most of it down to my psychology I think. I saw him a few times and I said I would feel better if I had an endoscopy which he agreed to and it was normal.
ENDOSCOPY= Normal
I also had a blood examination and I had very elevated bilirubin levels. Doctor could not see anything else in the blood to be a concern so he diagnosed Gilbert's for that.
BLOOD = High Bilirubin levels
==========
Fast forward to today:
SYMPTOMS:
1. Aerophagia is still there.
2. Nausea - I now seem to have chronic nausea.. Possibly a few months ago it has gotten much worse and now I seem to have it most days. It seems to be better after I have had something to eat and worse on an empty stomach. It is interferring with my apetite which is normally fine.
3. Upper back pain - Six months ago I had pain in my upper back - middle of the spine area; opposite and slightly above the sternum. The pain then disappeared until recently. Now the pain is worse - it also radiates to the front of the chest too and also to the upper right and sometimes upper left quadrant of the shoulder at the back. Usually the pain is in the back area. I can also feel this same discomfort (which is not bad) at my back when I drink fluids and also when I bring up air in the oesophagus. Sleeping is sometimes affected by it. However the pain is never bad. It seems if I lie on my left side this will help. It does not seem to be affected if I take breaths in or out etc. Normally I sleep like a baby - no problems whatsoever except the last few nights.
4. Skin colour - I have noticed that my skin colour is more tanned than usual - I would not describe it as yellow but a bronzing of the skin in my face - which is quite nice actually :-) I am normally fairly pale. I have not been exposed to the sun lately.
5. Bowels seem ok - constipated some days; sometimes I have bouts of wind and also short anal pain which does not happen at all often. Also I sometimes get a little leakage after urination. I have not noticed any blood.
6. Feel hot sometimes (mornings?) but I generally have a high metabolic rate and higher temperature (always had this)..
7. Recently I have noticed a few dizzy spells, a little faint feeling. Seems to be better when i have a bowel movement.
TESTS:
I went back to the doctor and told him all of the above. I went for the following tests:
1. BLOOD (had haematology, biochemistry, endocrinology screening): All normal except for the following which were flagged:
Bilirubin (high): 78 umol/L (normal = 0 - 20)
Iron (high): 38.0 umol/L (normal = 10.6 - 28.3)
Iron saturation (high): 60% (normal = 20 - 55)
Lymphocytes (low): 1.33 X10^9/L (normal = 1.5 - 4.0)
The high iron could be due to Chinese herbal medicine I was taking 5 days before and doc says to wait until out of my system and then retest blood iron levels to see if they have come down.
The following were all normal:
HAEMOGLOBIN, HCT, RED CELL COUNT, MCV, MCH, MCHC, RDW, PLATELET COUNT, MPV, Neutrophils, Monocytes, Eosinophils, Basophils,
ESR
SODIUM, POTASSIUM, CHLORIDE, BICARBONATE, UREA, CREATININE, ALKALINE PHOSPHATASE, ASPARTATE TRANSFERASE, ALANINE TRANSFERASE, LDH, CK, GAMMA GT
TOTAL PROTEIN, ALBUMIN, GLOBULIN, CALCIUM, PHOSPHATE, URIC ACID, RANDOM BLOOD GLUCOSE (FL), AMYLASE, TRIGLYCERIDES (low), CHOLESTEROL (low)
T.I.B.C., C'Reactive protein
TOTAL THYROXINE
==
2. URINE dipstick = Normal except trace of blood (due to running 2 days before?)
3. CHEST X-RAY = Normal
4. TESTICULAR ULTRASOUND = Normal
5. HEART ECG = Normal except late RV depolarisation
6. ABDOMEN ULTRASOUND = Normal
The liver is of normal homogeneous reflectivity. There is no focal intrahepatic lesions and no evidence of duct dilatation. The gall bladder is normal and does not contain any calculi. Gall bladder wall thickness is normal and there is pericholecystic fluid. Both kidneys are of normal size with no evidence of PC system dilatation. No renal masses were demonstrated. The pancreas and spleen are normal. There is no evidence of intra-peritoneal fluid. The abdominal aorta has a normal calibre.
The doctor just seems to think it is all pyschological or stress/posture at computer related. What other tests should I have as I am quite worried and it is on my mind. Being nauseous all the time is not nice. I will be coming to the USA in about a month and think I will continue my testing there as I feel more comfortable with doctors in US (I did my education in USA) Please can you help? Sorry for the long report! :-) Thanks for all your help and time.
I am a 35 year old male living in the UK. I am normally of good health but very slim (always have been) and have not had any operations etc.
I spend a lot of time sitting infront of the computer and I know my posture is not good. I should also get a lot more exercise.
I will try to describe my symptoms as best I can.
SYMPTOMS:
2 years ago
I started to get air coming up the oesophagus and bouts of nausea that did not last long. The aerophagia seemed to start suddenly overnight and was quite strange for me as I never had it before. It is more voluntary than involuntary - I can bring up air any time I like. The nausea lasted possibly 3-4 hours and then left and seemed to come in cycles of about 3 months.
TESTS:
1 1/2 years ago
I went to see my local doctor and he described the air coming up as aerophagia and possibly I was just swallowing air. I am quite a nervous and stressed person and he put most of it down to my psychology I think. I saw him a few times and I said I would feel better if I had an endoscopy which he agreed to and it was normal.
ENDOSCOPY= Normal
I also had a blood examination and I had very elevated bilirubin levels. Doctor could not see anything else in the blood to be a concern so he diagnosed Gilbert's for that.
BLOOD = High Bilirubin levels
==========
Fast forward to today:
SYMPTOMS:
1. Aerophagia is still there.
2. Nausea - I now seem to have chronic nausea.. Possibly a few months ago it has gotten much worse and now I seem to have it most days. It seems to be better after I have had something to eat and worse on an empty stomach. It is interferring with my apetite which is normally fine.
3. Upper back pain - Six months ago I had pain in my upper back - middle of the spine area; opposite and slightly above the sternum. The pain then disappeared until recently. Now the pain is worse - it also radiates to the front of the chest too and also to the upper right and sometimes upper left quadrant of the shoulder at the back. Usually the pain is in the back area. I can also feel this same discomfort (which is not bad) at my back when I drink fluids and also when I bring up air in the oesophagus. Sleeping is sometimes affected by it. However the pain is never bad. It seems if I lie on my left side this will help. It does not seem to be affected if I take breaths in or out etc. Normally I sleep like a baby - no problems whatsoever except the last few nights.
4. Skin colour - I have noticed that my skin colour is more tanned than usual - I would not describe it as yellow but a bronzing of the skin in my face - which is quite nice actually :-) I am normally fairly pale. I have not been exposed to the sun lately.
5. Bowels seem ok - constipated some days; sometimes I have bouts of wind and also short anal pain which does not happen at all often. Also I sometimes get a little leakage after urination. I have not noticed any blood.
6. Feel hot sometimes (mornings?) but I generally have a high metabolic rate and higher temperature (always had this)..
7. Recently I have noticed a few dizzy spells, a little faint feeling. Seems to be better when i have a bowel movement.
TESTS:
I went back to the doctor and told him all of the above. I went for the following tests:
1. BLOOD (had haematology, biochemistry, endocrinology screening): All normal except for the following which were flagged:
Bilirubin (high): 78 umol/L (normal = 0 - 20)
Iron (high): 38.0 umol/L (normal = 10.6 - 28.3)
Iron saturation (high): 60% (normal = 20 - 55)
Lymphocytes (low): 1.33 X10^9/L (normal = 1.5 - 4.0)
The high iron could be due to Chinese herbal medicine I was taking 5 days before and doc says to wait until out of my system and then retest blood iron levels to see if they have come down.
The following were all normal:
HAEMOGLOBIN, HCT, RED CELL COUNT, MCV, MCH, MCHC, RDW, PLATELET COUNT, MPV, Neutrophils, Monocytes, Eosinophils, Basophils,
ESR
SODIUM, POTASSIUM, CHLORIDE, BICARBONATE, UREA, CREATININE, ALKALINE PHOSPHATASE, ASPARTATE TRANSFERASE, ALANINE TRANSFERASE, LDH, CK, GAMMA GT
TOTAL PROTEIN, ALBUMIN, GLOBULIN, CALCIUM, PHOSPHATE, URIC ACID, RANDOM BLOOD GLUCOSE (FL), AMYLASE, TRIGLYCERIDES (low), CHOLESTEROL (low)
T.I.B.C., C'Reactive protein
TOTAL THYROXINE
==
2. URINE dipstick = Normal except trace of blood (due to running 2 days before?)
3. CHEST X-RAY = Normal
4. TESTICULAR ULTRASOUND = Normal
5. HEART ECG = Normal except late RV depolarisation
6. ABDOMEN ULTRASOUND = Normal
The liver is of normal homogeneous reflectivity. There is no focal intrahepatic lesions and no evidence of duct dilatation. The gall bladder is normal and does not contain any calculi. Gall bladder wall thickness is normal and there is pericholecystic fluid. Both kidneys are of normal size with no evidence of PC system dilatation. No renal masses were demonstrated. The pancreas and spleen are normal. There is no evidence of intra-peritoneal fluid. The abdominal aorta has a normal calibre.
The doctor just seems to think it is all pyschological or stress/posture at computer related. What other tests should I have as I am quite worried and it is on my mind. Being nauseous all the time is not nice. I will be coming to the USA in about a month and think I will continue my testing there as I feel more comfortable with doctors in US (I did my education in USA) Please can you help? Sorry for the long report! :-) Thanks for all your help and time.
Doctor's Answer
by Kevin Pho, MD, Jul 10, 2004 12:00AM
, Jul 10, 2004 12:00AM
I think there are more comprehensive tests you can consider. The upper endoscopy is pretty good in evaluating for inflammation, ulcers, as well as any structural abnormalities. Things like GERD, gastroparesis as well as esophageal motility disorders can cause the symptoms you are describing. A normal abdominal ultrasound would make liver or gallbladder disorders less likely.
I would consider a referral to a GI specialist to discuss further testing. This would include a 24-hr pH study with esophageal motility testing. This is the definitive test for GERD and can evaluate for any motility disorders. I would also suggest a gastric emptying scan, which would evaluate for gastroparesis (delayed gastric emptying).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
I would consider a referral to a GI specialist to discuss further testing. This would include a 24-hr pH study with esophageal motility testing. This is the definitive test for GERD and can evaluate for any motility disorders. I would also suggest a gastric emptying scan, which would evaluate for gastroparesis (delayed gastric emptying).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
I am not really sure.. I only took one days worth but made too much liquid and instead of drinking 2 cups, I made 1 litre and drank it all. My Chinese doctor also could not be sure if there was iron in it. I was taking the medicine for allergies, and to gain energy. I asked her for the ingredients of the herbs and she wasnt able to give to me the English names (I got the feeling she was not even sure herself) :P