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Gastroenterology (Expert Forum)
Advice please!
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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Advice please!
by G-funk, Feb 13, 2006 12:00AM
I am 26 years of age, female, and aside from the following would say I am quite healthy and fit.
From the ages of 13-16 I self induced vomiting at least 4 times a day. The only negative symptoms I experienced at the time were ulcers at the back of my throat. From 16-19 the bulimia took a backseat and it was rare I would resort to such drastic measures. At around 19, several things happened, which I have put down to a change in lifestyle like going to uni etc. I developed asthma, not severe, but bad enough to once need a visit to A&E. I also developed allergies to cats, dogs, dust etc and was always blocked up. Sinus problems like this run in the family somewhat, and had always been 'bunged up' as a kid. For about a year and a half, I also developed a reaction to alcohol that was inconsistent. Sometimes I could drink too much and be ok, but generally, any amount made me repeatedly sick for the entire duration of the next day.
I also noticed around this time that I could not eat large meals. I assumed this was psychological, as an eating disorder never really leaves you, and the feeling that food was sitting in my throat and the need to be sick (not for weight reasons, but to alleviate the discomfort) was sometimes great. It did relieve the discomfort.
Today I have no reaction to alcohol, and ironically love white wine and can generally eat normal sized meals. I still have asthma, and the sinus problems have worsened, I have had a sore throat for about 2 years (!) and feel like my sinuses just do not work properly, apparently the throat looks fine, just have plenty of post-nasal drip! My teeth are also so sensitive I have to brush them in warm water.
I occasionally get the feeling of food coming back up, but must say I do not experience indigestion or feelings of acid that often. The symptoms I have are, for the past three days I have had pain in my upper-middle back when swallowing, trouble eating (to the point where it is very un-enjoyable) and a need to get something up and out of the way from my esophagus, and sometimes it does, but with no relief. Coughing is painful, my asthma has got worse, although I have just got over a cold. Aside from this, I have not had indigestion this bad since about 9 months ago when it was excruciating in exactly the same place, which I put down to eating too many seeds and nuts (which I was in to at the time!).
I am also currently on Effexor XR 150mg a day for panic and anxiety, and my psychoanalyst thinks most of the above is psychosomatic. Given my ailments and my anxiety/ed record, I am worried that another trip to the doctors and they will think I am a hypochondriac. And I have to admit I do feel as though I am searching for a 'reason' for all these ailments. But it is looking increasingly like my antics as a teenager have caused this, Barrett's Esophagus really fits the bill and I was wondering how much of the above can be related to it, and if so, what the next step is?
From the ages of 13-16 I self induced vomiting at least 4 times a day. The only negative symptoms I experienced at the time were ulcers at the back of my throat. From 16-19 the bulimia took a backseat and it was rare I would resort to such drastic measures. At around 19, several things happened, which I have put down to a change in lifestyle like going to uni etc. I developed asthma, not severe, but bad enough to once need a visit to A&E. I also developed allergies to cats, dogs, dust etc and was always blocked up. Sinus problems like this run in the family somewhat, and had always been 'bunged up' as a kid. For about a year and a half, I also developed a reaction to alcohol that was inconsistent. Sometimes I could drink too much and be ok, but generally, any amount made me repeatedly sick for the entire duration of the next day.
I also noticed around this time that I could not eat large meals. I assumed this was psychological, as an eating disorder never really leaves you, and the feeling that food was sitting in my throat and the need to be sick (not for weight reasons, but to alleviate the discomfort) was sometimes great. It did relieve the discomfort.
Today I have no reaction to alcohol, and ironically love white wine and can generally eat normal sized meals. I still have asthma, and the sinus problems have worsened, I have had a sore throat for about 2 years (!) and feel like my sinuses just do not work properly, apparently the throat looks fine, just have plenty of post-nasal drip! My teeth are also so sensitive I have to brush them in warm water.
I occasionally get the feeling of food coming back up, but must say I do not experience indigestion or feelings of acid that often. The symptoms I have are, for the past three days I have had pain in my upper-middle back when swallowing, trouble eating (to the point where it is very un-enjoyable) and a need to get something up and out of the way from my esophagus, and sometimes it does, but with no relief. Coughing is painful, my asthma has got worse, although I have just got over a cold. Aside from this, I have not had indigestion this bad since about 9 months ago when it was excruciating in exactly the same place, which I put down to eating too many seeds and nuts (which I was in to at the time!).
I am also currently on Effexor XR 150mg a day for panic and anxiety, and my psychoanalyst thinks most of the above is psychosomatic. Given my ailments and my anxiety/ed record, I am worried that another trip to the doctors and they will think I am a hypochondriac. And I have to admit I do feel as though I am searching for a 'reason' for all these ailments. But it is looking increasingly like my antics as a teenager have caused this, Barrett's Esophagus really fits the bill and I was wondering how much of the above can be related to it, and if so, what the next step is?
Doctor's Answer
by Kevin Pho, MD, Feb 13, 2006 12:00AM
, Feb 13, 2006 12:00AM
You can consider a variety of upper GI disorders that can lead to your symptoms. This can include an esophageal stricture or ring, gastroparesis, GERD, an ulcer, or inflammation of the upper digestive tract.
Tests to evaluate for these possibilities would include an upper GI series and/or an upper endoscopy (the latter being a more complete evaluation), as well as a 24-hr pH study with esophageal motility studies, and a gastric emptying scan (looking for gastroparesis).
If the upper GI workup is non-revealing, you can consider some imaging including an abdominal ultrasound.
The post-nasal drip can lead to nausea. An ENT evaluation as well as a sinus CT scan can further evaluate this symptom.
These options can be discussed with your personal physician.
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.
kevinmd_b
Tests to evaluate for these possibilities would include an upper GI series and/or an upper endoscopy (the latter being a more complete evaluation), as well as a 24-hr pH study with esophageal motility studies, and a gastric emptying scan (looking for gastroparesis).
If the upper GI workup is non-revealing, you can consider some imaging including an abdominal ultrasound.
The post-nasal drip can lead to nausea. An ENT evaluation as well as a sinus CT scan can further evaluate this symptom.
These options can be discussed with your personal physician.
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.
kevinmd_b
Member Comments
by parttime, Feb 15, 2006 12:00AM
Have you been to a gasteroenterologist? Look up on the internet about something called Eosinophilic esophagitis. Your symptoms are very similar to mine and I was just recently diagnosed. It has been a long struggle and since it is relativly a new diagnosis, the doctors are still learning on how to treat it. When you see the GI doc he would have to do the biopsy when he does an endoscopy that acually lookes for it. It's worth the trip. But be prepared to take steriods, either inhaled or swallowed and it takes about 2 months for the effects of the medicine to work. I have been on the meds for a couple of months and still if I eat just a little too much, the feeling gets into the back of my throat and it my food just comes up and yes I does feel better. {I never suffered from an eating disorder.) As for the pain, it does hurt very bad especially in the back and the area between the ribs. It's real and it's not in your head!!! Good luck
by G-funk, Feb 28, 2006 12:00AM
thank you!
