Are chest pain, difficulty swallowing, and air in the esophagus sensation symptoms of the cardiac problem?

Question

Hi doctor,

I was at the emergency room earlier today. I have chest pain, difficulty swallowing, and odd sensations like there is air in my esophagus, but I cannot burp it out. The emergency room checked me for cardiac problems, said I did not have any and told me to consult with a gastroenterologist. Unfortunately, I have to wait three weeks for an appointment. I am a 59-year-old male, 5 feet 9 inches and 162 pounds. My medications are Linzess, Gabapentin, Belbuca, Symproic, Lamotrigine, Tamsulosin, and Eszopiclone. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I have reviewed your case history and all the medications that you have listed. You made the right decision; in case of chest discomfort or pain, it is essential to rule out the cardiac cause in every case. Now, if cardiac causes have been ruled out, my assessment in your case is

1) You are on multiple medications known to have gastrointestinal side effects too. Still, you are not on any stomach protective medicines like acid suppression or antacids.

2) Your weight is higher than your height, so your BMI (body mass index) must be in the overweight or obese category range.

Few relevant questions are

Is there any change in your medicine recently?

Is there any history of eating out or having unusual or unusually large meals?

Any history of painkiller intake other than the medicine you mentioned?

Is there any prior history of stomach-related issues?

Recent history of binge drinking or taking a large quantity of alcohol?

Any significant family history of GI (gastrointestinal) problems?

Have you ever noticed blood or black color in your vomiting or stools?

My suggestions will be

1) Take acid suppression medicine like a capsule of Pantoprazole 40 mg daily a half an hour before breakfast, the first dose today.

2) Syrup Gaviscon (Sodium alginate, Sodium bicarbonate, and Calcium carbonate) 10 mL after every meal and as needed, even at night.

3) Tablet Itopride hydrochloride 50 mg half an hour before breakfast and dinner for better stomach motility.

4) Take a small amount of meals; do not empty your stomach at once.

5) Avoid eating out and spicy and fatty meals. Instead, monitor your stomach symptoms, and if it does not resolve within one to two days with the above medicine, you need to go for specific investigations.

I hope you find it helpful.

Kind regards.

Answer 2

Hi,

Welcome back to icliniq.com.

You can use Pantoprazole (antacid) and Gaviscon (Sodium Bicarbonate, Calcium Carbonate, and Sodium Alginate) antacid syrup, and I hope this should improve your symptoms. If Itopride (prokinetic benzamide derivative) is not available, you can consider simple but old medicine like the tablet Domperidone (antiemetic) half an hour before breakfast and dinner. This is an anti-vomiting medicine used frequently for nausea, bloating, or reduced appetite. And, yes, you are right; as per the western BMI (body mass index) criteria, you are within the normal range.

I appreciate your response to the questions that I have asked. Monitor your symptoms on the above conditions. If there is no improvement, I suggest you to consult a gastroenterologist, and he may consider an endoscopy and relevant workup accordingly.

I hope this was helpful.

Take care.