Esophageal tightness

July 26, 2009 9:45 AM

Mysterious medical malady: reflux, or something more?

I had a nasty stomach virus a few months ago, and since then I've noticed a weird sensation occurring most days of the week. It's a feeling of tightness in what I'm assuming is my esophagus. The feeling can affect anywhere from the throat to the sternum. It usually comes on within a few hours of eating, and can last from minutes to hours. It's not painful, but it can be quite annoying and uncomfortable. I don't notice any breathing difficulty or chest pain when this happens, but sometimes I notice I have a slight discomfort in swallowing when this happens. I do have fairly frequent mild heartburn but it's not bad.

I've seen 2 doctors about this. One thought it might be allergies, but a combination of antihistamines and Singulair didn't do anything for it. Another though it was some form of reflux, but a barium swallow didn't show anything abnormal - no malformations, ulcers or reflux (though I wasn't experiencing the sensation at the time the study was done).

Anyone ever experience anything like this? I was thinking if it is a form of reflux (Like Laryngopharyngeal Reflux) I could try a course of OTC Prilosec, has anyone had any adverse experiences with a PPI?

If it helps, I have had a thorough heart workup and a chest CT for unrelated medical issues that came up completely clean, and I've never had any signs of asthma or anything else that could explain chest tightness. I do suffer from mild seasonal and year round nasal allergies that are well controlled with Flonase and the occasional Claritin.

Just looking for more info, and some possible areas to explore, since the doctor's I've seen don't seem to know what the cause is, and don't seem to think it's worth the effort to track down a cause.

posted by 1024x768 to Health & Fitness (15 answers total)

find a massage therapist who specializes in visceral manipulation. The source of your discomfort may be adhesions in your connective tissue surrounding your esophagus, and you could just use a manual release of your esophagus from your stomach.

... i'm realizing now that this may seem odd to someone who doesn't have a lot of experience with massage therapy, but if you can find someone in your area, i think it'll help!
posted by nitor at 9:48 AM on July 26, 2009

find a massage therapist who specializes in visceral manipulation. The source of your discomfort may be adhesions in your connective tissue surrounding your esophagus, and you could just use a manual release of your esophagus from your stomach.

Sorry - I have to chime in here. This is absurd. There is no such thing as "release of your esophagus from your stomach" unless you're being worked on by an expert surgeon. And the idea of "adhesions in your connective tissue" is nonsense.

If your primary care physician is stymied, as him/her whether or not a referral to a gastroenterologist may be helpful. Barium swallows may not capture all reflux -- they're static snapshots as opposed to dynamic images. Proton pump inhibitors are safe with few-to-no side effects. A short course of over-the-counter omeprazole (store brand or generic -- they're the same, just different prices) is a low risk therapeutic trial that you can do by yourself.
posted by scblackman at 12:50 PM on July 26, 2009 [1 favorite]

Man, I also wanted to jump on the first response. "Releasing adhesions in connective tissue" is bullsquat. If a massage therapist says such a thing to you, run away.


Try the prilosec/omeprazole solution. Good chance it will work, or at least help you diagnose the problem. Try elevating the headboard end of your bed a couple of inches. Don't eat close to bedtime. Avoid caffeine and alcohol. If any of these help incrementally, you've just diagnosed it. It certainly sounds like garden variety esophageal reflux, and scblackman is right that barium swallow tests don't always catch that.
posted by fourcheesemac at 1:09 PM on July 26, 2009

You might have eosinophilic esophagitis. IANAD but I have this condition and have similar issues.
posted by arimathea at 1:23 PM on July 26, 2009

Try generic Zantac. Uber cheap.

Or, potentially some kind of gallbladder attack.
posted by gjc at 3:14 PM on July 26, 2009

You can get side effects from PPIs but they're not dangerous and totally reversible. I had most of the possible side effects: nausea, bloating, gas, constipation and mild insomnia. Did the gold standard test (stop taking the pills, wait for symptoms to disappear, start again and see what happens) and it was clearly related to the PPIs. But the side effects all stopped as soon as I stopped taking the pills, a process which is supported by the literature (I'm a digestive physiologist and have read extensively about this stuff). Oh and also the PPIs did a great job of stopping my reflux while I was taking them. Fortunately there are other non-PPI drugs which work well for me without side effect. Lastly, if you are healthy then taking PPIs short term won't hurt you at all, just lowers your stomach acid for a while (long term use can have nutrient absorption issues but you can go over that with your doctor if it turns out to be necessary).

So yeah, I don't know if you have reflux or not. It sounds like some of the symptoms I get with mine although it's a pretty varied problem. But taking some OTC PPIs for a couple of weeks as you have suggested is a reasonable way to investigate. If you feel at all nauseous or constipated or otherwise unhappy stop taking them, if the symptoms are the same after two weeks then it's probably not helping, and if it feels better than go back to your doctor and discuss further.

Try elevating the headboard end of your bed a couple of inches. Don't eat close to bedtime. Avoid caffeine and alcohol.

Note that none of these things do a single thing to help my reflux. It really is varied and the things that do help me are unlikely to mean anything to you.

There are other tests beyond the barium meal if it comes to that but just taking PPIs for a short while makes sense as your next step. It would be nice if all meds were as safe and easy as these.
posted by shelleycat at 4:57 PM on July 26, 2009

The exact same thing happened to me (and at least two people I know - down to the time we had the original illness). In the last few months, I've have enough medical tests to last the rest of my life, and the net-net is "just one of those things."

Things are getting better - but it was difficult getting through a bout of bronchitis without chilis. Hot hot chilis to clear out the muck.

You could see a gastro - they have all kinds of exciting tests and they give wonderful stomach massages. (At least in my experience - like being kneaded by a giant kitten.)
posted by Lesser Shrew at 7:47 PM on July 26, 2009

I've had this symptom, quite badly at times. For me, it is most like an esophageal spasm, and has been scarily painful at times.

And it is definitely connected to my heartburn/reflux symptoms. Changes in my dietary habits completely eliminated it. Hurray for veggies, fruits and whole grains.

Now that my diet is relapsing, the heartburn and spasms show up sometimes.
posted by SLC Mom at 12:25 AM on July 27, 2009

Actually the gold standard for reflux diagnosis is 24 hour pH monitoring- which you apparently haven't had yet. Get a gastro referral. Reflux can lead to bigger problems if it's not dealt with. You should probably also have an ECG, unless you've had one really recently. Good luck.
posted by sero_venientibus_ossa at 1:07 AM on July 27, 2009

Response by poster: Thanks for the great information, everyone. I'm gonna try a course of generic Prilosec and dietary changes (more veggies etc.) and see if that affects it. If not - I'll see what a gastro has to say.

"You should probably also have an ECG, unless you've had one really recently."

I did indeed have a ECG, and a boatload of other tests recently, it's almost certainly not cardiac related in my case, but it's a good idea for anyone with chest tightness nonetheless.

"The exact same thing happened to me (and at least two people I know - down to the time we had the original illness)."

Lesser Shrew - I hear you, this cold or flu or whatever it was had a really wide range of effects in the people I know who got it. Some of them got 3 days of the sniffles and others, like me, were out of work for a week or 2 and are still having sequelae. I ended up getting a weird post-viral syndrome from it that resembles a mild peripheral neuropathy with fatigue, that I'm still feeling a bit of even 3+ months after the fact. I personally know one other person in the same boat. Whatever it was, it was a doozy.
posted by 1024x768 at 5:25 AM on July 27, 2009

GERD is a complex syndrome. Best managed with the help of a gastroenterologist and regular followup and testing. For many people, the basic non-pharmaceutical techniques do provide a lot of help (raising the bed 5-6 inches, avoiding meals close to bedtime, cutting caffeine, alcohol, smoking, acidic or spicy foods etc. from the diet, losing weight, etc.) For others, occasional antacids can manage the symptoms (that's me; I go through phases of reflux that are very clearly related to *stress,* which should be mentioned as a common contributor to the syndrome; antacids plus de-stressing almost always do the trick). Others need to be on PPIs. Others (in rare cases) need surgical intervention -- and there are some exciting new procedures to deal with extreme cases of reflux disease that threaten long term sequelae.

It's unusual, but at its worst, chronic GERD can lead to Barrett's Esophagus (perforated) and even esophageal cancer. So as with all medical questions on AskMe, the right answer is: find the right doctor and work with her. Sounds like the OP has had a discouraging experience finding the right doctor. But please for the love of gawd don't let that send you off to quack therapies and useless "alternative" approaches like massage therapy. This is a well understood area of medicine, there are many treatment options -- some of which involve nothing more than adopting healthier eating habits, quite natural and safe and a true "alternative" approach -- and the consequences of not dealing with it *can* be serious, even if this is unusual. Mostly, it's just the misery of living with the symptoms that should inspire you to seek the solutions to this.

Also, I wouldn't leap to the conclusion that the OP's stomach virus of a few months ago "caused" the reflux symptoms -- could be a coincidence. Reflux is very common, and happens to many people as they get older.
posted by fourcheesemac at 5:39 AM on July 27, 2009

I'm going to add one more thought: for me, eating (raw or cooked) "veggies" doesn't help at all. In fact, it makes my reflux worse. I find eating whole grain cereal and bread helps much more. The key things to avoid, however, are fatty and high-acid foods. And eating smaller meals more frequently, and far away from bedtime, is also helpful (eating right before I sleep is disastrous for me).
posted by fourcheesemac at 5:44 AM on July 27, 2009

Oh, and you mention "fatigue" as a symptom of the post-viral syndrome. I find a nearly perfect correlation between stress-induced fatigue and reflux. If I am having reflux symptoms, it is a sure sign that I need to stop what I am doing and rest.
posted by fourcheesemac at 5:58 AM on July 27, 2009

Note that when I mentioned the gold standard I meant for assigning side effects to a medication not for testing for reflux. The 24 hour test sero_venientibus_ossa mentions is the main one I was referring to as 'extra tests available' but I figure your doctor can advise you better about that if it's necessary.

Also keep in mind that GERD is something that can develop if you have reflux but isn't a given. Having reflux doesn't mean you automatically have GERD. Most laypeople get this wrong (although I don't know why, the disctinction is pretty clear). If you do have reflux then you want it treated so you don't end up with GERD but mild reflux on it's own isn't a big deal and generally treatable, so don't worry just yet about scaremongering and complications.
posted by shelleycat at 4:47 PM on July 27, 2009

fourcheesemac - no one would sign off on the illness causing this, however they did say that in my case it seemed the most likely cause. One of the gastros called is PTS syndrome of the gut. Still not sure how I feel about that.

The "in my case" was all based on what I told them about my previous eating habits, I think. Or it could be because they had seen a lot of people with the same flu, some of whom had to be hospitilized, and the same after effect. Like 1024x768 says, we really had our asses handed to us by whatever we had.

It was weeks, maybe months, before my inner ecology was back in balance - and that's with meds to speed the process.
posted by Lesser Shrew at 9:11 PM on July 27, 2009