Uncomfortable Gas and Pain Under Rib Cage

Dear Ask The Doctor:  For the past week, I've had pretty insane upper belly gas. The pressure resides right under my rib cage and makes it difficult to take a deep breath at times until I burp a little or keep trying. I'm taking Zantac and that certainly makes things feel a bit better but the constant pressure feeling , comes and goes in depths of badness, and trouble getting a deep breath are worrisome. Every time that I eat anything, it comes with a few bouts of burping for awhile and causes an increase in the pressure gas feeling under my rib cage. At times, the pressure feels like nothing makes it better, laying down, sitting up, slouching, etc. It is quite uncomfortable. Occassionally, there is a slight issue with swallowing, rather, a discomfort when swallowing. I'm thinking of stopping the Zantac and taking Prilosec but I don't know if that will make it better. Does this still sound like acid reflux?

Dear Patient:  It seems like acid reflux is the cause from your description of the symptoms. However increased secretion of the acid may not be the only cause, it may be possible that the ring of muscle fibers prevents food from moving backward into the esophagus, may be weak or doesn't close well, allowing the food, liquids, and stomach acid to leak back into the esophagus, producing the symptoms that may not be relieved as much by the medications. You should try to avoid foods and beverages that may trigger your symptoms like alcohol, caffeine, spicy and fatty foods etc. Avoid smoking, bending or exercising just after eating. Eat smaller meals and do not lie down immediately after meals. Sleep with your head raised about 6 inches, may be done by tilting your entire bed, or by using a wedge under your body, not just with normal pillows. Losing weight if you are overweight would make a difference. If the symptoms don’t get better, you may want to see your GP for further clinical evaluation and investigations.

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