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recurring indigestion

For a few years now I have been suffering from indigestion, but over the past couple of years it has got worse. I can go for a week without much in the way of symptoms, then for a week or more I will have symptoms which include wind in centre of upper abdomen going into back, wanting to burp. Sometimes there is tenderness under my breastbone and tightness in chest. The symptoms are worse if I drink alcohol the night before, which I understand is the alcohol irritating my stomach. I had an ovarian cyst a year ago and thought the symptoms might be to do with this but the consultant said not. I subsequently had the cyst removed and it was benign. I have been taking prednisolone, formerly cortisone acetate since I was around age 17, I am 53 now, and I understand this can irritate the stomach. Due to the symptoms being almost permanent, I had an endoscopy recently but this was normal, there were no ulcers, hernias etc. I have also been tested for H Pylori virus which was negative. I do suffer from quite severe stress and am wondering if the indigestion is just down to this, although I can get the symptoms when I am not feeling particularly stressed out. I am going back to doctor but wanted a second opinion. Could you advise what the possible causes of my symptoms are, bearing in mind tests have all been normal. I have a little peace of mind now as I was worried about stomach cancer (I am a worrier) but I am still having the symptoms and it is affecting my quality of life. I also take bisoprolol for high blood pressure and thyroxine in addition to prednisolone.

Doctor's Response

Date:Jan / 2012

Thank you for your question.

I am sorry to hear about the problems you are having.I am sorry to hear about the problems you are having.

The symptoms you describe can result from several causes. However, the key reassuring feature is that you have been seen by doctors and your investigations have included an upper gastro-intestinal Endoscopic examination (with H Pylori test negative). This however, does not entirely exclude the possibility of intermittent gastro-oesophageal reflux due to poor lower oesophageal sphincter tone - this does not necessarily result in an ulcer or Oesophagitis but can be associated with symptoms you describe. The fact that your symptoms are worse if you dring alcohol the night before do go with this possibility. The other fact that may point to an 'excess' of gastric acid or reflux is Prednisolone medication - it is kown to sometimes contribute to  upper gastro-intestinal tract symptoms. Some doctors my prescribe a 'trial' of medication (such as Proton Pump Inhibitor group of medication that reduce gastric acid secretion and others may prescribe 'prokinetic' medication that hasten gastric emptying - this is done after full clinical examination).

In some people, Anxiety alone predisposes to reflux symptoms and 'aerophagia' - swallowing of air without a persons' knowledge (ie., person unaware that this is happening) and subsequent increased 'burping' and bloating sensation

Another cause of the symptoms you describe my be gall stones. Very occassionally secretion of bile is interrupted by a gallstone, affecting digestion in the upper small bowel- again this requires clinical examination, Liver Function (blood) tests and possibly ultrasound scan with attention to the gall bladder area (looking particularly at the common bile duct). Another remote possibility that can produce upper gastro-intestinal symptoms is chronic pancreatitis and yet another is Coeliac Disease.

I am pleased to learn that you are going back to your doctors for a second opinion / review and feel this is the best action at this point due to persistant symptoms. I do hope that the information I have provided is useful to you and wish you good health.

Thank you for using ThanksDr. I do hope this information is of use to you.
Yours faithfully,
The ThanksDr Team

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