Palpitations, Reflux And Celiac Disease

[dfresh88]

Hello everyone - I've read many of your posts but this is my first--

To give a short background I'm a medical student so I have a unique perspective on this issue but it's not necessarily helpful.

In short over the past few months I have suffered from palpitations and frequent, silent burping. These tend to be most prominent in the evening or after meals, but I am able to feel sensations of tightness, spasms, and "zaps" all day long (yes 24 hours a day). This has made me very very anxious and required me to take anxiety medication just to get through the day. I have also developed Depression.

This has been coupled with some minor atypical reflux symptoms: epigastric pain and intermittent right hypochondriac pain (around gall bladder), and in the morning I can sometimes taste the medication I took the night before.

Additional symptoms are dental erosion in all 4 quadrants and white spots on teeth, abnormal flatulence and constipation

Meds: omeprazole 20mg b.i.d. (for 2 months) and clonazepam for anxiety

omeprazole has been completely ineffective and it's trial period has all but expired. clonazepam works as it should.

Tests:

Heart EKG and 48 Hr Holter were negative for arrythmia (it showed pvcs but within normal limits)

Labs (including nutrient deficiencies) are all normal, except...

Endomysial IgA screen 108 (normal<20) and the titer was 1:80 (I think the normal is 1:10 maybe 1:5) anyway positive.

Awaiting appointment for biopsy

I started the gluten free diet a week ago (note: not so worried about the influence on the biopsy results, I'm more interested to see results related to the acid reflux). why? from every research article I've read, if the Endomysial IgA is positive, you have Celiac Sprue (the lowest PPV I've seen is 80%, but most agree 90-95).

So finally my question:

Has anyone experienced similar symptoms and if so how long did it take for the atypical reflux symptoms to subside? After a week I've noticed little change (didn't expect to). I am hoping that once the palpitations cease that my heart perception will subside and I can go back to living a normal life (with the diet, of course).

Thank you to everyone for your help!

[nmw]

My reactions to gluten are similar to yours. As soon as I went gluten free the symptoms subsided.

[dfresh88]

My reactions to gluten are similar to yours. As soon as I went gluten free the symptoms subsided.

Thanks for the reply, was the recovery immediate or did it take a few weeks? I really haven't noticed much change and I am sure I've eliminated everything.

[ToddZ]

Hello everyone - I've read many of your posts but this is my first--

To give a short background I'm a medical student so I have a unique perspective on this issue but it's not necessarily helpful.

In short over the past few months I have suffered from palpitations and frequent, silent burping. These tend to be most prominent in the evening or after meals, but I am able to feel sensations of tightness, spasms, and "zaps" all day long (yes 24 hours a day). This has made me very very anxious and required me to take anxiety medication just to get through the day. I have also developed Depression.

This has been coupled with some minor atypical reflux symptoms: epigastric pain and intermittent right hypochondriac pain (around gall bladder), and in the morning I can sometimes taste the medication I took the night before.

Additional symptoms are dental erosion in all 4 quadrants and white spots on teeth, abnormal flatulence and constipation

Meds: omeprazole 20mg b.i.d. (for 2 months) and clonazepam for anxiety

omeprazole has been completely ineffective and it's trial period has all but expired. clonazepam works as it should.

Tests:

Heart EKG and 48 Hr Holter were negative for arrythmia (it showed pvcs but within normal limits)

Labs (including nutrient deficiencies) are all normal, except...

Endomysial IgA screen 108 (normal<20) and the titer was 1:80 (I think the normal is 1:10 maybe 1:5) anyway positive.

Awaiting appointment for biopsy

I started the gluten free diet a week ago (note: not so worried about the influence on the biopsy results, I'm more interested to see results related to the acid reflux). why? from every research article I've read, if the Endomysial IgA is positive, you have Celiac Sprue (the lowest PPV I've seen is 80%, but most agree 90-95).

So finally my question:

Has anyone experienced similar symptoms and if so how long did it take for the atypical reflux symptoms to subside? After a week I've noticed little change (didn't expect to). I am hoping that once the palpitations cease that my heart perception will subside and I can go back to living a normal life (with the diet, of course).

Thank you to everyone for your help!

I don't know if I should be responding because I haven't been officially diagnosed as a celiac but I can tell you the symptoms you are describing mirror what I experienced when my problems started. Although I didn't have the burping.

The chronic reflux and nightly heart palpitations went on for about 3 months until I finally couldn't eat solid food any longer. The heart palps hurt too and were happening even in the ER. I had blood in my stools and weird rashes on my chest popping up that would suddenly go away then reappear. I had the tightness thing too around my head and neck. Pressure in my head like I was in an airliner for 15 hours. I also experienced numb feet as well. I could go on and on with my symptoms but yes I had the crazy body zaps as well. ER thought I had some carbon dioxide ratio problem and were clueless. Ultimate diagnosis was Acute Anxiety disorder which was of course NOT it. Once I stopped eating and went liquid I started to get well rather quickly. All the tests were normal. EKG, Pancreas, thyroid, blood work, xray, bowel studies, h pylori, endoscopy etc, etc.

[S-J-L]

What do you mean by body zaps? I think i may know what you mean.

Im on heart medication for a fast and irregular heart beat. If im not on it, sometimes when i try to sleep at night, if my heart is going fast i soon get a headache for some reason. Then, i cant fall asleep because its like some zapping is occuring in a circuit through my body, from my heart to my brain. I find it really uncomfortable, not painful though. Its like some nerve thing to wake me up.

[dfresh88]

Todd,

I think we are on fairly the same page as far as symptoms.

Have you asked for a blood test for gluten intolerance? As I mentioned all my other labs were normal, except for celiac disease and I have a (2nd degree) fam history. I only ask because your extremity paresthesia would be typical of vit deficiency caused by any malabsorptive disorder and neuro symptoms such as headaches (also anxiety, depression, and ataxia) have been associated with celiac disease, though the evidence is inconclusive, hence my inquisitive thread.

Since I am asking alot of questions I would really like to give back. If you are going to get a blood test please get the EMA IgA ELISA, even though your primary physician may be impressed by the results of an anti-gliadan test, your GI specialist will not. The fact is that the EMA IgA test has no competitor in terms of positive predictive value (which means that if the test is positive, you have the disease). The PPV of EMA IgA at the very lowest is 80% but most likely is closer to 90-95%. Not to mention, it also has comparable measures of specificity and sensitivity to the anti-transglutaminase test. (I realize you've had an EGD) but for anyone else, even with the possible errors of biopsy, if that blood test is positive you have about a 1 in 10 chance of a negative biopsy, probably less. A lot of people on here don't feel the need for biopsy, I understand that as the serological tests are 90% diagnostic alone. However, I would do it - you may have substantial damage that should be checked periodically with dietary change.

The test is expensive, but if I were on a liquid only diet, I would do it. Of course you will probably want to couple it with a total IgA to make sure you aren't deficient.

Question: are you on a gluten-free diet and if so what do you drink on your liquid diet?" It is pretty difficult for me to find gluten-free meal replacement shakes, although next to an IV this would be the best initial treatment for anyone starting a gluten-free diet as it would speed the healing of your intestine. I've thought about stealing a few banana bags from the hospital (j/k)

Question2: have your palps/regurg stopped since the liquid diet? how long did that take to subside?

Last comment: I'm not sure acute anxiety is the term I would use and I'm only a student but anyone with our symptoms is going to have anxiety. Unequivocal research relates anxiety to the gut and the heart so I wouldn't be so upset about the diagnosis of anxiety. they are obviously missing the root cause but I wouldn't be hesitant to treat the anxiety, meds or no meds.

If you have not seen an allergist that would be my next step. The blood tests aren't the most reliable but you could at least use them as a reference to start an elimination diet and then add the questionable foods back slowly and see how your body responds.

SJL

It's hard to say if we are experiencing the same thing, I kind of doubt it. My heart pounds but the rate/rhythm are not really irregular (I take my carotid or radial pulse while listening to my heart and they are identical). The Zaps I am referring to are like sudden mini jolts that occur in muscle fibers directly over areas of stress (so mostly over my heart/stomach/intestines. These are normally very weak but so frequent that I can't stand them. You could almost equate them to a tickling or light touch but stronger. Once in a while I will get a stronger, painful jolt but that's about once every day or two. People with gen anxiety disorder or depression will commonly describe these systemically but for me it is localized.

[ToddZ]

Well I see my gastro doc next month and will definitely request a test so... no I have not been officially tested. Also, I am no longer on a liquid diet. I was finally able to come off it after finally feeling better. Basically what happened is that I could no longer eat solid food. I physically could not eat anything without feeling deathly ill. I could however drink water and some nutrition type drinks. I ended up drinking Ensure to help stabilize my drastic weight loss and found that I was OK and non reactive while drinking it. My symptoms slowly began to disapper over the next 3-4 months.

To answer your second question -- Yes, my heart palps, high heart rate (after eating), reflux, body zaps, etc all stopped after going on the liquid Ensure diet. All I drank was Ensure (the high calorie vanilla flavor type). Eventually I felt well enough to start eating regular foods again (mainly at night).

Today, it's still very much a trial and error food selection process. So far, I am finding that if I avoid crap and gluten containing foods - I start to feel like my old non-sick self. A bowl of pasta or a few slices of pizza will cause a very severe and obvious type of reaction. It's like I gobbled down some horrible toxic substance.

BTW, the zaps you describe I have had as well. I experienced many types and one of them was a zapping of the heart and entire abdomen. It's hard to describe what these felt like but they hurt. I thought it had something to do with the vagus nerve? Who knows but they went away. I also had full body zaps that were painful.

It has taken me well over 4 months to finally get from death bed to finally being able to eat again. I assume this would have taken less time had I known what to eat and what not to eat. I'm still fumbling and eating the wrong thing and it will set me back. 5 steps forward, 3 steps back.. But each time, I do bounce back and move forward. I still however am not fully recovered but I'm slowly learning what to avoid. I'm going to start a celiac diet and see if things improve even more.

Am I a celiac? I don't know but all my symptoms seem to point in that direction. Eat the wrong thing then bam... everything is centered around what I eat. No more eating what I want and when I want. No more Taco Bell.

Also, thanks for the info. I will let my gastro doc take a look at what you said and see where to go from here. Let me know if you have any other questions.

[ToddZ]

What do you mean by body zaps? I think i may know what you mean.

Im on heart medication for a fast and irregular heart beat. If im not on it, sometimes when i try to sleep at night, if my heart is going fast i soon get a headache for some reason. Then, i cant fall asleep because its like some zapping is occuring in a circuit through my body, from my heart to my brain. I find it really uncomfortable, not painful though. Its like some nerve thing to wake me up.

Yes the fast heartbeat symptom was a mystery to me but they eventually went away on their own. For me this symptom appeared out of the blue like all the others and only appeared after I ate something (around dinner time). This was one of the very first symptoms to rear it's ugly head before I went totally wacko. I wanted a beta-blocker sooo bad. It really scared the you know what outta me. I felt like a creature from that Will Smith movie - I Am Legend. Huffing and puffing and freaking out. I then would get these panic attacks that would last for hours on end and I would go and walk for hours until I passed out of exhaustion. But even this symptom eventually went away. Why? I have no clue.. But.. I did stop eating all food and just drank Ensure all the time. Was that why they stopped? I really really wish I knew the answer to that question. It's a complete utter mystery to me. Doctors look at me like I have 3 heads when I explain these symptoms... I had this one ENT doctor want to prescribe me an SSRI after telling him all my symptoms.

The zapping thing was a later symptom I acquired and was one of the last to go away. Again the doctors think I'm out of my mind. I probably would think I was crazy too I guess if I were them. But these zaps ranged from full body zaps to zaps in my heart and chest area. Again, another mystery symptom that suddenly went away.

BTW, I had those two symptoms for about 2 1/2 months.. maybe 3...

[dfresh88]

Todd

It really sounds to me like you have some sort of intolerance, whether it is gluten or anything else, but definitely tell your GI about how your symptoms were abated by avoiding gluten and were intensified by reintroduction. I don't know how quality your GI is but I would hope that would lead him/her to order the test even w/o your request, but obviously you should request it regardless.

The problem is that doctors tend to favor uncommon presentations of common disorders rather than common presentations of uncommon disorders. Although mathematically this is probably a favorable move, it tends to narrow the scope of the differential diagnosis and that is why so many people (including my grandmother) are thrown into the IBS bin when really there is probably a variety of things going on, one of which is Celiac.

Please let me know how your results turn out, I'm very interested.

btw, is Ensure gluten free? or does anyone know of good liquid gluten free products? I found a very good protein shake that is very easy on my stomach called American Whey (it is locally distributed) it is both lactose and gluten free. It is good for breakfast but I need some carbs for lunch/dinner. Any advice would be appreciated.

Regarding the Zaps, one reason your ENT probably wanted to start you on the SSRI is because those are a common symptom of patients with clinical depression or gen anxiety disorder. Don't react negatively to that all that's really saying is that your body's nervous system is malfunctioning (probably because of your gut pathology) and these drugs have shown great efficacy in normalizing that nervous function. I personally am going to start an Antidepressant (not an ssri cause I get migraines) for these symptoms.

Paradoxically, a cardiospecific beta blocker has done nothing for my palpitations, I can't increase the dose very much b/c I'm a runner and my resting HR gets below 40 w/o it and I'd rather not die in my sleep, at least not till I'm old and have dementia. But I doubt it would have any drastic effect, it really just slows my hr and lowers my bp.

[ToddZ]

Todd

It really sounds to me like you have some sort of intolerance, whether it is gluten or anything else, but definitely tell your GI about how your symptoms were abated by avoiding gluten and were intensified by reintroduction. I don't know how quality your GI is but I would hope that would lead him/her to order the test even w/o your request, but obviously you should request it regardless.

I definitely will discuss all of this when I see him next month.

Here's a link to a Walgreens gluten free product list:

Open Original Shared Link

Ensure is listed as a gluten free product on that list so it's a safe bet it probably is. I found that the vanilla shakes were tolerated without any issues during my course of self "treatment" with it. The chocolate I found to be a little irritating to the stomach. All in all though - I found it to be a life saver. It costs a lot but I would have paid much more for it.

If you look on amazon there are a ton of different brands that are supposed to be gluten free. Who knows if they are though.

Other products that I found helpful were AloeCure Aloe Vera Juice. Very effective! I also found DGL Licorice root effective once I could tolerate it. I am still taking the chewable kind. Mastic gum: excellent anti-inflammatory properties and still use as needed.

I was on all sorts of PPI's and none worked when things were totally out of control... I ended up settling with Nexium 40mg. I still take it ever other day. I also take Carafate liquid sometimes. I hoping to be off all meds one day but I need to figure out and stick to a solid diet first that I can live with that doesn't freak my system out.

I will let you know the findings of my test results. I should know by late May.

Good luck

[Aleshia]

Additional symptoms are dental erosion in all 4 quadrants and white spots on teeth, abnormal flatulence and constipation

I have erosion in pretty much every tooth in my mouth and it came on suddenly, I also have white spots on my teeth which I just got repaired (can still see them but they aren't as noticable as they were) I'm constantly gassy and I have been perpetually constipated bordering on obstipation for the last at least 5 years... I have many other symptoms that you will find in my other posts...

I haven't been able to get a dr. to give a diagnosis of ANYTHING other than depression (which I am not other than just from the sheer frustration of the dr.s around me) I have lost 2 inches of height... that is clearly not depression! I can't get anyone to even consider celiac disease as a possibility because I don't have diarrhea and I 'm not losing weight... I don't know if that will help you at all since I haven't been diagnosed... I am on my 5th day gluten free and have noticed a big difference in some symptoms, no difference in others, and some have even gotten more severe.