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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18905
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I went to hospital yesterday in agony with pain behind my sternum

Customer Question

I went to hospital yesterday in agony with pain behind my sternum and between shoulder blades. I have had this for a few weeks and had an operation 3 weeks ago for endometriosis. I have been in hospital a few times with this and at drs also. I have looked very pale the last month or so and lost some weight. When I eat it feels like food is getting stuck behind my sternum and I burp quite a lot after food. I am taking omeprazole which seems to help in the last day or two. I am having an endoscopy in a week and a half but am worrying that I have something sinister. I have had blood tests at hospital which came back ok and chest x-ray which seemed ok. Would they have seen something on x-ray? Please can you give me some advise as to what may be going on. I am in extreme discomfort with all of this.
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. D. Love replied 4 years ago.
Thank you for using JustAnswer. I will be glad to assist you today.

There are several issues to consider in this situation.

The most likely cause of these symptoms is acid reflux, or gastroesophageal reflux disease (GERD). It is also possible that severe pain could be related to a complication of the GERD, esophageal spasm. The sensation of food getting stuck and the burping is also consistent with this cause of chest pain.

The endoscopy is the appropriate test to assess the amount and the effect of reflux. However, the endoscopy is not effective at detecting whether esophageal spasm is present. The best test at detecting esophageal spasm is esophageal manometry, which measures the pressure in the esophagus. In most people with GERD and in whom it is possible that they may also have esophageal spasm, the test is not done initially, as treatment of the GERD will usually lead to improvement in the esophageal spasm. In your case, if the improvement on the omeprazole that you have noticed in the past few days continues and the pain resolves, there is no need to consider the evaluation for esophageal spasm. However, if the pain persists, it may be necessary to obtain esophageal manometry to determine if this is present, and it may require specific treatment, such as a calcium antagonist.

As to whether it may be something more sinister, the answer is yes, although unlikely. In reality, with virtually any symptom that can develop, there is a type of cancer that can cause such a symptom. Certainly, there are certain symptoms and situations that are more worrisome for being cancer, but the symptoms that you describe are not one of these certain symptoms or situations.

Regarding what sinister diseases could cause such symptoms, it is possible that chronic GERD can cause such damage to the lower esophagus that the lining will develop changes that can become cancer over time. Although the vast majority of people with GERD do not develop this problem, this is one of the reasons why chronic GERD should be treated and why persistent GERD symptoms should be evaluated with an endoscope.

You asked about whether a chest x-ray would detect any of these sinister problems, and the answer depends upon what sinister problem that may be present. The chest x-ray is primarily oriented towards assessment of the lungs, and although it can miss early lung cancer, it would typically detect lung cancer that has progressed to the point that it is causing this type of pain. Therefore, a normal chest x-ray can reliably say that there is no lung cancer causing this pain. However, the chest x-ray is not accurate in detecting cancer in the esophagus or neighbouring structures. This is why endoscopy would need to be done to assess the GERD.

Therefore, it is unlikely, but possible, that there could be something more sinister present, but the endoscopy that you have scheduled will not only assess the GERD, but also determine whether such a problem is present.

If you have any further questions or need clarification, please let me know.