[36F] Experiencing upper abdominal pain and dysphagia

Patient Description

A 36-year-old female presents with a one-week history of sharp pain in the upper abdomen, rated between 5 to 8 in severity, particularly exacerbated by eating. The patient describes a sensation of food being stuck during meals and denies relief from not eating. Bowel movements are reported as normal, with the last being this morning, producing solid light brown stool. The patient denies experiencing fever, chills, or any additional symptoms, but reports feeling generally tired. The pain is localized to the solar plexus, directly below the breastbone. There is no presence of black or tarry stools or blood in vomit. The patient has been taking Prilosec for heartburn, which is not providing relief for the current symptoms. Difficulty swallowing has been noted, with no unintentional weight loss. There is a family history of esophageal issues, with the patient's mother requiring periodic esophageal stretching, suggesting a potential hereditary component to the condition.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are a few possibilities:

  • Gastroesophageal Reflux Disease (GERD): This condition occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus and cause heartburn. You mentioned that you've been taking Prilosec, which is a common treatment for GERD.

    • Treatment typically involves lifestyle changes and over-the-counter medications. If these don't help, stronger medications or even surgery might be necessary.
  • Peptic Ulcer: Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.

    • Treatment usually involves medications to decrease stomach acid. If an H. pylori infection is the cause, antibiotics are also part of the treatment.
  • Gastritis: Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. It can occur suddenly (acute) or gradually (chronic).

    • Treatment involves taking antacids and other drugs to reduce stomach acid, which helps relieve gastritis pain and promote healing.
  • Esophageal Stricture: This is a narrowing of the esophagus, the passageway from the throat to the stomach. Stomach acid, if it repeatedly comes into contact with the lining of the esophagus, can cause it to become scarred and narrowed, leading to difficulty swallowing.

    • Treatment typically involves dilation, where a device is placed down your esophagus to carefully expand any narrow areas of your esophagus.

What you can do

It's important to consult with a healthcare provider for an accurate diagnosis. They may recommend an endoscopy to examine your esophagus and stomach. In the meantime, here are some steps you can take:

  1. Avoid foods and drinks that trigger heartburn. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
  2. Eat smaller meals. Avoid overeating by eating smaller meals.
  3. Don't lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  4. Elevate the head of your bed. If you regularly experience heartburn while trying to sleep, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches.

What you should look out for

Seek immediate medical attention if you:

  • Experience severe or persistent abdominal pain
  • Have difficulty swallowing
  • Vomit blood or have bloody or black stools
  • Experience persistent nausea or vomiting
  • Notice a decrease in appetite or unintended weight loss

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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9 mo ago


People Also Ask


What are the common symptoms of gastroesophageal reflux disease (GERD)?

Common symptoms of GERD include heartburn, regurgitation of food or sour liquid, difficulty swallowing, chest pain, and the sensation of a lump in your throat. Symptoms often worsen after eating or when lying down.


How is a peptic ulcer diagnosed and treated?

A peptic ulcer is typically diagnosed through an endoscopy, where a doctor examines the stomach lining and small intestine. Treatment often involves medications to reduce stomach acid, and if an H. pylori infection is present, antibiotics are prescribed.


What lifestyle changes can help manage gastritis symptoms?

Lifestyle changes to manage gastritis include avoiding spicy and acidic foods, eating smaller meals, reducing alcohol consumption, quitting smoking, and managing stress. Over-the-counter antacids may also help relieve symptoms.


What is an esophageal stricture and how is it treated?

An esophageal stricture is a narrowing of the esophagus that can cause difficulty swallowing. It is often treated with dilation, where a device is used to gently stretch the narrowed area. In some cases, medication or surgery may be necessary.

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