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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 63757
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I had am MI 2 yrrs ago with stent place in the LAD. Since

Customer Question

I had am MI 2 yrrs ago with stent place in the LAD. Since then I have had chronic chest and upper abdominal pain almost every day. Endoscopy showed some gastritis and a low LES pressure. Being treated with a pip. No changes in symptoms. Cardiac work up show no issues and was assured that the pain is not cardiac in origin. Hide scan showed gallbladder ejection fraction of 83%.. Was told that was high but not an issue. Been suffering for almost 2 yrs now and no one can tell me why. Very frustrated... Nothing seems to work... Mornings are worse filled by an ok day then symptoms return late after noon. Pain, light headed and mild nausea.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. David replied 1 year ago.

This is Dr. David

you could have food allergies to certain foods or oils which could be causing inflammation of your stomach and nausea. gluten or caseine milk protein could cause allergy

sphincter of oddi dysfunction could be causing the pain as well.

you should keep a food diary and see what foods cause worse symptoms.

have you been tested for H Pylori in your stomach?

Expert:  Dr. Thomas, MD replied 1 year ago.

Hello

I disagree that this sounds like food allergy or gluten problems.

I am a double board certified clinician and I can tell you we need much more information here.

What cardiac tests have been done since the stent.

When was the endoscopy, and was full manometry done?

Let me know

Expert:  Dr. Thomas, MD replied 1 year ago.

Microvascular heart disease can cause pain that even evades an angiogram.

This needs to be considered.

Esophageal spasm needs to be excluded, and is treatable with calcium channel blockers and nitrates, as, ironically , are some forms of angina.

Typically, they would have biopsied for h pylori on endoscopy, and if it were active, they would have seen ulcers or gastritis, which you do not report.

I suggest further cardiac and esophageal pressure testing, muscuioskeletal assessment, and consideration of stones in the ducts, which would only show up on ERCP or MRCP.

OK, so that is an initial answer….

Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 1 year ago.
Cardiac: Cardiac cath showed no issues (3/2014)
Nuclear stress test showed no issues ( 4/2015)
Echocardiogram showed no issues. (5/2015)
Endoscopy ( 2/2015) showed mild gastritis
Esophageal manometer 3/2015 showed low LES
Hilda scan 6/2014 with ejection fraction of 83%
Discomfort is daily. I do not panic as I was told it was not cardiac but it's hell nonetheless
I do not burp or have any regurgitation
Expert:  Dr. Thomas, MD replied 1 year ago.

So I suggest the following.

a. Discuss microvascular disease, that possibility, with your cardiologist.

b. Discuss esophgeal spasm with the doctor that did the scope. Ask this doctor if an MRCP is indicated.

c. Have a musculoskletal assessment if the other two are negative: MD of PM&R is best...physical medicine and rehabilitation.

This is not a typical presentation for gluten problems or food allergies, as was suggested to you.

These would be easy to investigate with blood tests if you are so inclined.

please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 1 year ago.
Cardiologist said micro vascular disease is seen mostly in smokers... I have never smoked
I will ask about an MRCP.
Is a biliary ejection fraction of 83% a concern... I'm told no but have read it may be an area currently overlooked in medicine
Customer: replied 1 year ago.
Esophageal spams were ruled out by GI doc
Expert:  Dr. Thomas, MD replied 1 year ago.

No that ejection fraction is good, and it is not the problem

please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.

Customer: replied 1 year ago.
Back to square one.... Nothing is wrong. Just asking here online shows how frustrating this has been. No one can tell me what the issue is. Thanks anyways... I didn't actually expect an answer... Just desperate I suppose. Have nice day
Expert:  Dr. Thomas, MD replied 1 year ago.

It is nor our purpose to diagnose here

IT is to answer questions.

I have given you some avenues that not even the doctors who have examined you have suggested.

Please review my suggestions.

If you still have questions [we answer questions only], let me know.

Subtle musculoskeletal problems are often overlooked in this situation

Hidden stones are often overlooked.

Food allergies and the like would have a pattern: I don't think that is it.

Please click a positive rating: that is the only way Just Answer will pay us for our time.

thanks.

Expert:  Dr. Thomas, MD replied 1 year ago.

It is nor our purpose to diagnose here

IT is to answer questions.

I have given you some avenues that not even the doctors who have examined you have suggested.

Please review my suggestions.

If you still have questions [we answer questions only], let me know.

Subtle musculoskeletal problems are often overlooked in this situation

Hidden stones are often overlooked.

Food allergies and the like would have a pattern: I don't think that is it.

Please click a positive rating: that is the only way Just Answer will pay us for our time.

thanks.