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Block jam feeling
My father, (79 yrs), has been experiencing a persistent “block” or “jam” feeling between his upper abdomen and lower chest, mostly after lunch and an afternoon nap. The discomfort is not associated with chest pain, sweating, or fatigue, and it gradually subsides with time or distraction.His cardiac and respiratory evaluations — ECG, 2D Echo (EF 58%, no RWMA), Chest X-ray, BNP — are all normal. Endoscopy showed gastric erythema and erosions, RUT negative.
Over the past two months, he has tried several gastric and motility medicines:Voltapraz 20, Razo-L, Omez DSR
Sucral-O, Mucaine Gel
Acogut (Lupin), Itovyom
Bloatpill
Ganaton (Itopride).
Despite these treatments and lifestyle changes (light diet, sitting upright for 2–3 hrs post-lunch), the “block/jam” feeling continues to appear almost daily after meals.Kindly advise whether this could be due to reflux-related diaphragm pressure or something else ?
(a photo with a red marked line showing the area where this discomfort happening)
Answers (12)
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Sir, this might be due to the valve and reflux only, he is already on medication that will support in resolving the issue. All necessary investigations are normal as said by you. If u still have questions, kindly consult with me on 94 two six 86 seven eight 96.
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Complex case. Since cardiac/respiratory causes ruled out and endoscopy shows gastric issues, this is likely REFRACTORY GERD with possible HIATAL HERNIA or ESOPHAGEAL DYSMOTILITY.
Why medicines not working:
- Wrong diagnosis or incomplete treatment
- Hiatal hernia causing mechanical obstruction
- Esophageal motility disorder
- Delayed gastric emptying
Further Investigation Needed:
1. Barium swallow study - check for hiatal hernia
2. Esophageal manometry - check motility
3. 24-hour pH monitoring - confirm GERD
4. Gastric emptying study
5. CT abdomen if not done
Treatment Modifications:
1. Combination therapy:
- PPI (Pantoprazole 40mg) BEFORE breakfast
- Add H2 blocker (Ranitidine 150mg) at bedtime
- Prokinetic: Domperidone 10mg before meals
2. Lifestyle (already doing but reinforce):
- Head elevation while sleeping (6 inches)
- No lying down 3 hours after meals
- Small frequent meals
- Avoid tight clothing
3. Consider:
- Baclofen 10mg (reduces reflux episodes)
- If hiatal hernia found, may need surgery
Age 79 - also rule out cardiac ischemia definitively with stress test if not done recently.
Next Steps
1. Consult Gastroenterologist Urgently: - Request Barium swallow study - Esophageal manometry test - Discuss refractory GERD management 2. Modify Current Treatment: - Take PPI 30 min BEFORE breakfast (empty stomach) - Add Ranitidine 150mg at bedtime - Take Domperidone 10mg before each meal 3. Strict Lifestyle: - Sleep with head elevated 6 inches - No food/water 3 hours before lying down - Small meals every 3 hours - Avoid: coffee, tea, spicy, fried foods 4. If No Improvement in 2 Weeks: - Consider Baclofen trial - Surgical evaluation for hiatal hernia 5. Red Flags (ER immediately): - Severe chest pain - Difficulty swallowing solids - Vomiting blood - Black stools - Unintentional weight loss
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Take a glass of milk daily.
Thanks.
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Does he have constipation as well, if that is so, needs to be corrected.
Give him frequent small meals, with no fats or spices, less of sugary food, avoid late evening meals, heavy meals in evening, much of tea, coffee.
Let him take tab pantaprazole 40mg one before Breakfast for 4 to 6 weeks.
Tab dom d.t one morning and one evening for 10 days.
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