Is this acid reflux? Is this heartburn?
December 19, 2013 1:05 AM   Subscribe

YANAD - but I went and saw a doctor and I'm still a little confused about things! The medication isn't helping and the symptoms aren't "standard", so is this reflux or something else?

I’m 28 and a generally healthy female (but a grad student, so I am somewhat sedentary and often stressed). For a while, I was feeling pretty nauseous after eating big meals and also felt a weird constricting feeling at the back of my throat. One doctor put me on PPIs for only a week, and I ate fairly mild foods (staying away from all of the acid reflux triggers you see listed online) and felt fine for a few months. The throat constriction feeling came back (but not the nausea), so I went to see a different doctor and she told me to take Ranitidine 150 mg twice a day. I’ve been doing this for about a week and a half, and the throat thing is still sticking around. Another symptom is that when I eat something and have to stand for a long period after (I work in retail part-time), my stomach muscles are insanely tight for about an hour or two and it is really uncomfortable.

I also haven’t experienced anything heartburn-y (in that I have no idea what heartburn actually feels like, but haven’t experienced any burning in my chest per se). I have had a couple of occasions where my (mid to left of mid) chest has felt strange - like a vague pain that comes in and out, occasionally with some shooting pains (sorry - I’m not feeling it now so it’s hard to describe!) This happened once while I was working out so I went to the doctor AGAIN, and she ruled out anything heart related, and chalked it up to a possibly strained muscle + some acid reflux. My muscle didn’t feel sore at all, so I wasn’t sure if it was just the reflux alone?

So my questions are: from your own personal experiences with reflux — does this sound like reflux to you, even though my only symptom is my throat and stomach muscles feeling tight (usually after eating large meals/particular foods but sometimes just out of nowhere)? Should I still be experiencing this even though I’m taking Ranitidine 150mg twice a day?

AND: do those chest pains sound like heartburn? Google tells me heartburn should be a warm, burning feeling but I’m wondering whether some of you have experienced something different!

I’ll probably going back to the doctor yet again, but it’d be helpful to hear what your experiences have been. I’m getting a little frustrated trying to avoid all of the foods that supposedly trigger reflux with few results. Thanks mefites!
posted by thebots to Health & Fitness (19 answers total) 4 users marked this as a favorite
Best answer: I'm sure someone will give you a more medical answers here, I just wanted to add these two from a family member's experience (IANYD):
1. Can you raise your sleeping position with an extra pillow?
2. It could be down to, or exacerbated by, stress. Especially as you mention that in your question. i.e. stress about your studies and now stressing about your health.
posted by 0 answers at 1:51 AM on December 19, 2013

Best answer: It certainly sounds consistent with reflux to me, specifically so-called 'silent reflux'. A feeling of constriction in the throat (due to irritation caused by acid) is part of it. The irritation can produce symptoms not unlike asthma (tight airways, wheezing, a feeling of pressure in the throat). It can take a while for things to get back to normal because it's basically a mild chemical burn.

The occasional pinprick-like pain in the chest is another symptom I've noticed, and can be quite alarming if you're not aware of what's causing it. Taking an antacid will usually completely fix it for me.

'Heartburn' is a symptom of ordinary reflux, which can be very different in terms of the sensation.

You should probably ask your doctor about assessing you to see if you have GERD (reflux disease).

And yes, stress causes all kinds of physical symptoms, including a tight feeling in the throat and various kinds of chest pain. So that also may be part of it.
posted by pipeski at 2:04 AM on December 19, 2013

Best answer: This is a thing that I've experienced, and in my case, I have a bunch of family history for context: at least one grandparent and both of my parents had a stenosis of the esophagus. I seem to have it, as well, and at some point in the halcyon future when I have health coverage, hope to get it taken care of. It feels almost like there's something stuck, or like things are suddenly inexplicably tight, and it eases over the course of anywhere from a few minutes (usually if it happens while eating) to many hours. Sometimes it's accompanied by nausea, pain, and excessive salivation, which is gross.

I have no idea how common this thing is, but if you continue to not find relief from generic heartburn medication, etc, it may be something you wish to explore. For my parents, at least, it was diagnosed by endoscopy, and the brief procedure to correct it happened at the same visit.
posted by MeghanC at 2:15 AM on December 19, 2013

Best answer: I have GERD and I rarely have classic heartburn. For years, starting in my twenties (and I am now middle aged) my only symptom was a constricted, uncomfortable dry/tight feeling in my upper chest. I also get some shooting pains now, too. My own MD said that (and he might have been speculating) the vagus nerve sends ambiguous sensory signals when it's irritated by acid, so you can get pains and odd sensations in places that aren't exactly the focal point of the heartburn. Again, I don't know if my MD was citing definitive information or whether he was just theorizing.
posted by third rail at 3:14 AM on December 19, 2013 [2 favorites]

Best answer: Omeprazole daily for a full month, in the AM before you eat anything, and take it easy on coffee. If you feel relief from that you've self-diagnosed, but should still see an actual gastroenterologist.

A week will tell you nothing. It needs to be at least a month.

Rantidine is an antacid. It can at best provide temporary symptom relief.

"Shooting" chest pains are not typical of heartburn, usually. (But a typicality seems typical!) Dull pressure, dysphagia, bad taste in your mouth, chest pressure, or the classic "burning" pain are more typical.

We have to presume your doc ruled out more serious causes of chest pain? Could it be costochondritis?

Inactivity and stress can definitely exacerbate GERD.
posted by spitbull at 3:16 AM on December 19, 2013 [3 favorites]

Best answer: Sounds like GERD to me, with associated esophageal damage. I speak from personal experience here. Mine was so bad I was actually choking on my food. The only way they can know for sure is an Upper Endoscopy.
posted by COD at 5:19 AM on December 19, 2013 [2 favorites]

Best answer: My reflux is the feeling of a lump permanently stuck in my throat. When it got particularly bad a couple years ago I had problems swallowing, especially pills. The doctor wasn't much help (suggested rantidine), so I ended up doing a 2-week course of Prilosec and cutting out a bunch of food from my diet. Alcohol and dairy seemed to be the culprits, though I also cut out wheat, chocolate, and citrus. When the lump comes back now I know I've overdone it on the wine. Getting old sucks sometimes.

P.S. I experienced "real" heartburn for the first time while pregnant, combined with waking up in the middle of the night ready to puke from the acid reflux shooting up my throat. That was definitely a "you know it when you see it" experience.
posted by Maarika at 5:35 AM on December 19, 2013

Best answer: Your symptoms sound similar to mine as well.

At the onset the main symptom was nausea. But there was also a bunch of other symptoms that came and went. This included: trouble swallowing, constant salivation, irritable bowels, hot breath, mild choking.

I tried PPIs but they never agreed with me. The way I learned to manage it was to:
-not drink or eat anything too hot (this would sometimes cause burning pain)
-eat lighter meals (you can have more meals just not one that makes your stomach really full)
-cut down on alcohol and fatty foods
-not eat or drink too close to bedtime
-sleep at a slightly upright angle so that any acid coming up during the night goes back down rather than pools at the back of your throat
-after a meal that disagreed with me, I'd take Gaviscon (the UK version)

You'll notice I said "manage" and not "cure" The main cause of my acid reflux was stress. Perhaps it is the same as you. Not until I learned to relax and not stress (about this stressful event in my life) and to take control of things did the reflux finally start to subside.

I do none of the above things now. My episode of reflux lasted about a year and a half. It is over and now I eat what I want although I do try and live healthily anyways.
posted by vacapinta at 5:47 AM on December 19, 2013 [2 favorites]

Best answer: I am on my phone so need to be brief. I had the same symptoms and it was diagnosed as GERD after ruling out anything cardiac. The throat feeling lasted many months, but got better after PPI medication.
posted by Lescha at 6:00 AM on December 19, 2013

Best answer: Please get an ultrasound (quick, non-intrusive) to check for gallstones.
posted by meepmeow at 6:53 AM on December 19, 2013 [1 favorite]

Best answer: Another thing to ask about: hiatal hernia.
posted by soelo at 7:08 AM on December 19, 2013

COD - I think once you start choking on your food it is actually achalasia? That is what I have.
posted by getawaysticks at 7:12 AM on December 19, 2013

Best answer: H2 blockers such as ranitidine don't work for everyone, around half of people don't respond. The number is slightly higher for proton pump inhibitors such as omeprazole, but they take two weeks to kick in.

Reflux can have all kinds of different symptoms for different people, and it's so much more common that any doctor is going to make sure a trial run of PPIs doesn't fix it before looking for more exotic stuff like esophageal spasm, stenosis, webbing, or achalasia.
posted by hobo gitano de queretaro at 7:46 AM on December 19, 2013 [1 favorite]

getawaysticks - My choking was caused by a 90% blockage of the esophagus down near the stomach due to inflammation. The Gastro cut out the scar tissue during the Upper GI and put me on Oneprazole. That was 2008 and I've been fine since.
posted by COD at 9:21 AM on December 19, 2013

Best answer: Yes, acid reflux can still be happening even if your only symptoms are tight throat and chest. Classically, heartburn is a symptom (one of many) of gastro-oesophageal reflux. You can also get 'laryngopharyngeal reflux', where the refluxate spends less time in the oesophagus and therefore is not there long enough to damage and cause pain through the protective lining. However, it also reaches the less protected area of the throat and larynx, so can cause damage there without causing as much damage further down.

Another useful google term is 'globus' (in the UK globus pharyngeus, but that doesn't seem to be so helpful on googling), which is the word for the feeling of a lump in your throat. In many of the people I see this turns out to be reflux-related, though it can be anatomical, psychological or tension related.

In the UK, treatment is often PPIs in large doses twice a day (tapering the dose over several months) to reduce the acidity and therefore the damage, and an alginate-based drink after meals that forms a physical barrier to reflux. This is best done in conjunction with lifestyle changes.

So yep, could still be reflux and there are other things you can try if this doesn't work. Our rule of thumb used to be that if you had seen no change in a month it probably wouldn't help, so it's worth giving it a bit longer (though we were looking at voice change, which may take a while to heal).
posted by kadia_a at 10:30 AM on December 19, 2013

Response by poster: Oh man, you guys are awesome. I think I will ditch the ranitidine and try prilosec/omeprazole, since the PPIs back in September totally worked. I'll also get a referral to a gastroenterologist to check out what's happening, too. I'm just happy to know what's happening is actually what's happening. I'm sad that I'll still have to avoid chocolate (especially now that it's the holidays!) but them's the breaks, I guess.

@spitbull - yes, she was really thorough in checking out the possible causes of my chest pain and ruled out anything really serious.
posted by thebots at 11:20 AM on December 19, 2013

Best answer: I just came in here to say that I had a similar issue last year, but the acid reflux medications never worked at all for me, really. I never really got the "classic" heartburn symptoms, but I did get a sort of gnawing pain in my stomach, which sort of feels like hunger even though I knew it wasn't. I had multiple tests, an endoscopy, blood tests, etc. All came back fine.
What really helped immensely was cutting out bread, raw onions, and a few other foods. Spicy foods never really affected me, but eating some garlic toast with dinner did it every time. So you might want to look more deeply into food intolerances, and taking out excess sugar and processed carbs from your diet. After changing my diet, the everyday bad feelings after a meal went away completely.
Read article here:
posted by photoexplorer at 11:37 AM on December 19, 2013

Best answer: I have GERD, with symptoms similar to yours.

Do the omeprazole twice a day for a month and see if it helps. Lay off acidic foods (coffee, tomatoes, citrus, etc.). Don't lie down too soon after eating. Try to get some more exercise--even just a walk or run up and down the stairs a few times a day. Yoga is helpful for me. The exercise and yoga is more for stress reduction, but stress exacerbates GERD.

If you're feeling better, you probably don't need to see a gastroenterologist (although if you have insurance and would prefer the peace of mind, it's not inappropriate). If you're not feeling better, then maybe something else is going on that needs to be investigated, or at least ruled out.
posted by elizeh at 8:55 PM on December 19, 2013

Just a point of difference, I think omeprazole *once* daily for a month would be the usual place to start. Omeprazole does have some associated risks if used regularly, too.

And even if it solves every symptom you should still see a gastroenterologist and likely have endoscopy. Long term (even asymptomatic) GERD can cause damage that puts you at risk of several more serious conditions. It's worth having a look to see if a more aggressive approach or watchful waiting are suggested. The worst risks are quite serious, among them an elevated risk for a deadly cancer. Risk is still low, but not one to ignore.

I'm not a doc but I know from GERD.
posted by spitbull at 6:33 AM on December 26, 2013

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