I have a question. Why is it that I can go all day and feel really
good ( I have GERD), no chest pains, no pain anywhere to be found,
then I come home in the evening and want to sit down and take a break
and all of a sudden, all the pain comes back just like it started. I
don't understand it. I don't have shortness of breath, I dont have
sharp chest pain, just pain around my sternum or behind my lower
breast bone. Also my arms hurt sometimes, a dull ache. I take 40mg
Nexium in the morning (just started it 3 days ago). Do you think I
need to get a hold of my doctor and tell him all of this or just try
to let the Nexium do its work and put up with this for a while.
Sometimes the pain scares me into thinking there is something else
wrong. I am a little overweight for my height, but excercising and
trying to lose. I used to smoke, but quit, and I dont eat the things
that I think are going to bother me. I am giving up. Please
help....Desperate in WV

The diagnosis of chest pain can be difficult, since there are many
possibilities -- and it's not possible to provide any diagnositic
information from  such a post. However, there are a few things that
can be said. It must be as clear as possible that your pain is indeed
due to GERD; which means ruling out other causes, such as heart,
gallbladder, lung problems, to mention a  few, and to confirm the
diagnosis in some way; either by looking down the esophagus with a
scope, or at least determining appropriate response to treatment.  Are
you having noticeable reflux? When you get the pain, is it related to
what you eat or drink, or is it related to postion (some people get
home and have a drink, and tip back in a recliner. Such things could
have an effect). Is the pain relieved by taking antacids? These are
things you need to discuss with your doctor. It never hurts to keep
the doctor up to date on your symptoms and how you are responding to
treatment. No one providing online answers can come close to giving
meaningful advice or diagnosis or therapeutic recommenations.

Hello - thanks for asking your question.

I am currently out of town, and can answer your question in detail at
a later date.  In the meantime, you can try Medhelp International
(www.medhelp.org) and go to the Gastroenterology forum.  I am the
physician moderator of that forum and have answered recent questions
about GERD.

Thanks,
Kevin, M.D.

I am very mindful of the fact that you have a medical condition and
that you've been given some excellent advice, but just so that you can
add to your knowledge base, have a look at this website:
www.watercure.com. It's probably too simple, I know, but it certainly
can't hurt and just might help provide some balance in your poor old
digestive system. And, if ever you feel that you should let your
doctor about pain or a reaction to a new medication, don't hesitate.
That's what they're there for!

Hello - thanks for asking your question.  You should definitely follow
these symptoms up with your personal physician.

The clinical manifestations of GERD can be extremely variable.  GERD
needs to be distinguished from gastritis, infectious esophagitis, pill
esophagitis, peptic ulcer disease, non-ulcer dyspepsia, biliary tract
disease, coronary artery disease, and esophageal motor disorders.

Unexplained chest pain should be evaluated with an electrocardiogram
and exercise stress test prior to a gastrointestinal evaluation.

If your symptoms are refractory to Nexium, you may want to undergo
further tests such as an upper endoscopy or 24-hr pH study to see
whether there is another process that is present.

Thanks,
Kevin, M.D.

Links:
Medline Plus - GERD
http://www.nlm.nih.gov/medlineplus/gastroesophagealrefluxhiatalhernia.html

Family Doctor.org - Dyspepsia
http://familydoctor.org/handouts/474.html