[19M] With difficulty swallowing, indigestion, and dizziness

Patient Description

A 19-year-old male reports significant difficulty swallowing food, persistent indigestion, and frequent lightheadedness, particularly when standing up. The lightheadedness is described as a sensation of being lightheaded, lasting about 2 seconds, and rated as a 5 out of 10 in severity. Closing his eyes provides some relief. He has experienced a weight loss of 40 pounds over the past month. The patient was previously on pantoprazole, which alleviated his symptoms, but upon discontinuation, the symptoms returned. He also experiences occasional heartburn and constipation but denies nausea, vomiting, or blood in the stool. The patient vapes nicotine daily. He has a history of taking pantoprazole and famotidine for GERD. No other significant medical history or recent stressors reported. No known drug allergies, but he is allergic to dogs, cat dander, and pollen.

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Arora's Assessment

What might be happening

Based on your symptoms, here are some possible explanations:

  • Gastroesophageal Reflux Disease (GERD): Your history of GERD and relief with pantoprazole suggest this could be a factor. GERD can cause indigestion, heartburn, and difficulty swallowing. Weight loss might occur if eating becomes uncomfortable.

    • Treatment: Typically involves medications like proton pump inhibitors (e.g., pantoprazole) and lifestyle changes.

  • Esophageal Stricture or Motility Disorder: Difficulty swallowing and weight loss could indicate a narrowing of the esophagus or a problem with how it moves food.

    • Treatment: May involve endoscopic procedures or medications to improve swallowing.

  • Orthostatic Hypotension: Lightheadedness when standing could be due to a drop in blood pressure.

    • Treatment: Includes staying hydrated, standing up slowly, and possibly medications.

  • Nutritional Deficiencies: Rapid weight loss and dietary changes might lead to deficiencies, contributing to dizziness and fatigue.

    • Treatment: Nutritional support and supplements as needed.

What you can do

  • Consult a Doctor: It's important to see a healthcare provider for a thorough evaluation and appropriate tests.
  • Dietary Adjustments: Try eating smaller, more frequent meals and avoid foods that trigger heartburn.
  • Stay Hydrated: Drink plenty of fluids, especially if you're experiencing dizziness.
  • Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share insights with your provider.

What you should look out for

  • Seek Immediate Care If:
    • You experience severe chest pain or difficulty breathing.
    • You notice blood in your vomit or stool.
    • Your symptoms worsen or don't improve with treatment.

Remember, this information is not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and treatment plan.

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2 mo ago

People Also Ask

What are the common symptoms of GERD and how can they be managed?

Common symptoms of GERD include heartburn, indigestion, difficulty swallowing, and regurgitation. Management typically involves lifestyle changes such as avoiding trigger foods, eating smaller meals, and medications like proton pump inhibitors or H2 blockers.

What could cause difficulty swallowing and significant weight loss?

Difficulty swallowing and significant weight loss could be caused by conditions like esophageal stricture or motility disorders. These conditions may require medical evaluation and treatment, which could include endoscopic procedures or medications to improve swallowing.

What is orthostatic hypotension and how can it be treated?

Orthostatic hypotension is a condition where blood pressure drops significantly when standing up, causing dizziness or lightheadedness. Treatment includes staying hydrated, rising slowly from sitting or lying positions, and possibly using medications to manage blood pressure.

How can vaping nicotine affect digestive health and overall well-being?

Vaping nicotine can affect digestive health by potentially worsening GERD symptoms and contributing to dehydration, which can exacerbate lightheadedness. It may also impact overall well-being by affecting cardiovascular health and increasing the risk of addiction.

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