[39M] Experiencing epigastric pain and pressure, worsened when lying down

Patient Description

A 39-year-old male reports a persistent epigastric pain that has been present for a year and worsening over the past four months. The pain is described as a dull ache during the day and a sharp, burning sensation at night, particularly when lying down, rating the pain severity as 7 out of 10. The patient also experiences pressure below the sternum, likened to a balloon in the upper stomach, which has been present for six months and is relieved by standing. The pressure is rated as 5 out of 10 in severity. Additionally, the patient has been experiencing stomach churning for the same duration. The symptoms are partially alleviated by antacids. The patient is currently taking Cimetidine and reports no known allergies or other medications. There is no history of pre-existing conditions or chronic illnesses.

Arora's Assessment

What might be happening

Based on your symptoms, the most likely diagnoses include:

Gastroesophageal Reflux Disease (GERD): This condition is characterized by a burning sensation in the chest (heartburn), usually after eating, which might be worse at night. It can also cause the feeling of a lump in your throat. GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).
- Treatment typically involves lifestyle changes and over-the-counter medications. In some cases, prescription medications or even surgery might be needed.
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 present, antibiotics will also be needed.
Gastritis: Gastritis is an inflammation of the stomach lining. Weaknesses in the mucus-lined barrier that protects your stomach wall allow your digestive juices to damage and inflame your stomach lining.
- Treatment of gastritis usually involves taking antacids and other drugs to reduce stomach acid, avoiding hot and spicy foods, and abstaining from alcohol and tobacco.

What you can do

Lifestyle changes: Avoid foods and drinks that trigger heartburn (everyone’s triggers are different, but common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine). Eat smaller meals and avoid eating 2-3 hours before bedtime.
Over-the-counter treatments: Antacids can neutralize stomach acid. Medications that reduce acid production can also be helpful.
Medical consultation: If your symptoms persist, worsen, or are associated with other concerning symptoms (such as difficulty swallowing, unexplained weight loss, vomiting blood or black material, or severe pain), seek immediate medical attention.

What you should look out for

If you notice blood in your stool or vomit, seek immediate medical attention. This could be a sign of a more serious condition, such as a bleeding ulcer.
If you experience severe abdominal pain, especially if the pain keeps you from lying still or wakes you up at night, seek immediate medical attention.
If your symptoms persist despite lifestyle changes and over-the-counter treatments, or if they are worsening, seek medical attention.

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 appropriate examination, testing, and care recommendations.

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1 yr ago

Top picked over-the-counter products for Acid Reflux (GERD): American College of Gastroenterology Guidelines