— Mary, Michigan Arm pain is not a common symptom of GERD (gastroesophageal reflux disease), although it can occur in rare cases. In general, GERD involves the reflux of stomach contents into the esophagus. While many patients have no symptoms, heartburn is the most common complaint. However, other patients have more atypical symptoms such as chest pain, which can mimic heart attack; and sore throat, hoarseness, or a bad taste should stomach contents reach the mouth. GERD causes inflammation within the esophagus and does not directly irritate the diaphragm or the phrenic nerve that innervates (stimulates) it. Paraesophageal hernias, where part of the stomach is squeezed up into the chest beside the esophagus, may potentially lead to pain.) In terms of arm pain, here’s the likely scenario: Sometimes the contents of your stomach make their way into the trachea (or windpipe, which runs next to the esophagus), and then reach the lungs, causing exacerbations of asthma and occasionally pneumonitis or infectious pneumonia. Should that occur, the diaphragm (the big muscle under your lungs that helps you breathe) may become inflamed. Since the diaphragm is innervated by the phrenic nerve, which starts near the cervical spine, regions that are also served by spinal nerves can be affected, e.g., the arms and shoulders. Keep in mind that left arm pain is often associated with heart disease, so if you haven’t yet been evaluated for your pain, you should see a physician soon. Q2. My 8-year-old daughter has been complaining of nausea for about a month now. It began while she was eating some candy at the movies when she suddenly didn’t feel so well. Our family doctor said not to worry, but her symptoms have steadily progressed. She complains of heartburn about twice a week and says she’s nauseated after eating in the morning. She also has developed a rash on her chest and back. Any advice? It is difficult for me to diagnose your daughter without examining her and getting more detailed information about her symptoms. However, there are several common causes of prolonged nausea in children. You mentioned one common cause — heartburn, also known as “gastroesophageal reflex disease,” or GERD. Patients with GERD experience an uncomfortable sensation when acidic contents from the stomach reflux backwards up into the esophagus. Symptoms of reflux include pain in the middle of the abdomen or chest, nausea, and sometimes even a bad taste in the mouth after eating. This is a very common problem that is often treated with diet modifications such as eating fewer fatty foods, eating smaller meals, and not lying down after eating. Medications which lessen the acidity of the contents in the stomach are often used to treat symptoms. There are a variety of medications available ranging from Tums and Maalox, to Pepcid and Nexium. Another possible cause of prolonged nausea is inflammation of the stomach, called gastritis. The source of inflammation varies. Sometimes after a viral infection people will develop gastritis that can last anywhere from a week to a couple of months. Some people who experience gastritis are infected with Helicopylori, a bacteria that can cause gastritis, and other problems including ulcers. There are other causes of prolonged nausea that are not related to the stomach or the gastrointestinal system at all, such as stress. Children quite often report nausea and stomach pain when they are stressed. For instance, children who become stressed about school will experience nausea in the morning, but will feel better in the evenings and on vacation. As I noted initially, I would certainly need more information to diagnose your daughter. However, in light of her symptoms worsening and her developing a rash, I can recommend that your daughter return to her doctor and have her nausea investigated further. Your daughter may even need to see a doctor who specializes in gastrointestinal issues. Good luck!
