Abdominal Pain In Abs Along With Distension, Choking Sensation. GP Says Gastric Reflux, ENT Says Branchospasm. Confused ?

Posted on Thu, 12 Jul 2012

Question: Hello Dr, I have a tough time lately in last 2 months on Gastro side. I had my first endoscopy done on 16th April..was diagnosed with mild antral gastritis and doc said I had a mild reflux as well..so he recommended nexium, librax to me. During this period, I also experienced choking sensation. I changed my doctor in May..he prescribed me Lafter medicine and EsozD 20. But my choking sensation continued. Along with it, I had bloating and cramps in stomach. He prescribed the LFT test and my serum bilirubin came to 1.35 which was diagnosed as jaundice and he indicated that these symptoms cud also pertain to jaundice.the level has now come down to .91. However, i still had abdominal pain in abs along with distension.The Doc changed my course and put me on Levezao and Tiniba 300..however, it trigerred nausea. He recommended me to go for endoscopy. Today, the diagnosis came as gastric ulcer with gastritis changes. He has added Clariwin 500 to the course. . I have also been on acupuncture therapy for reflux. Endoscopy today indicated that there was no Gerd. Pls help me and let me know if we are on right course.I am confused as to how things can change in 1 month and whether the cause of the ulcer is due to medicines or the first endoscopy simply missed the ulcer, ENT told me choking cud be due to bronchospasm . MY Gastro told me it cud be due to allergy or reflux.

Answered by Dr. Ketan Vagholkar (49 minutes later)

Hi XXXXXXX
Thanks for writing in.
Going through your medical history it appears that there are two issues which need to be addressed.
1. Abdominal problem
2. Choking problem.

Abdominal problem.
The endoscopy reports have misguided your course of treatment. Assuming that the second endoscopy report is true then you just need to take treatment for peptic ulcer disease. If it is a gastric ulcer then a biopsy is advisable just to be on the safer side. Once this diagnosis rules out the malignant cause then you just need to undergo a course of anti ulcer treatment for 6 weeks followed by a follow up endoscopy.
Regarding the jaundice problem, if your liver function tests are normal or moving towards normalcy then you just require rest and a course of liver tonics with dietary modifications.
In the mean time stop all antibiotic and relaxing agents.

Choking problem.
The choking problem may be related to either ENT or respiratory causes. A spirometry and a pulmonology consult would help.
I hope my explanation provides you with a guideline for further treatment
With regards

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Ketan Vagholkar (1 hour later)

Dr XXXXXXX

Thanks for writing in. It is indeed diagnosed as Gastric ulcer, however, my doctor hasn't suggested biopsy as yet and instead prescribed Clariwin 500 for 5 days to start with.Should I insist on Biopsy now..what wud be the difference b/w a peptic ulcer and Gastric ulcer?

Answered by Dr. Ketan Vagholkar (45 minutes later)

Hi,
Yes it would be advisable to have a biopsy done for an established gastric ulcer.
Peptic ulcer envisages ulceration in any part of the gastrointestinal tract. In the context of the upper tract it could mean esophagitis and reflux and in the stomach it could mean either gastric ulcer or duodenal ulcer. Duodenal ulcers never ever turn malignant but gastric ulcers do have a significant malignant potential.
In view of the multitude of symptoms in your case it would be a safe practice to get a endoscopic biopsy done. If the biopsy report comes negative for any malignancy then you just require a good course of medications and life style modification with respect to your diet. I feel that should solve your problem.
I hope my explanation serves as a guideline for your dilemma.
With reagrds

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar