Is It Gallbladder Disease, Heartburn or Acid Reflux?

Is It Gallbladder Disease, Heartburn or Acid Reflux?

Patrick from Pasadena sent us this question:

Dr Darido,

The answers in your blog are so informative and in detail. I am a 28-year-old living in Pasadena, TX. For the last 1 year I used to experience excessive gas, bloating and flatulence every morning but never had any heart burn or acid reflux even after having a heavy spicy meal or binge drinking night. But Since March,2020 I started experiencing severe heart burn, with some episodes of unable to swallow food. The symptoms keep changing. Sometimes it’s the feeling as if the food is struck in my throat and chest, pain in my back and shoulders and sometimes its lot of belching. But one consistent symptom every single day I notice is constant throat clearing, burping, flatulence and bloating. I have been extremely strict with my diet (no fatty, spicy, tomatoes, onions and what not). In this process I lost 35 lbs. in 10 weeks. I used to weigh 155 lbs. before (not obese). They have performed an endoscopy and ruled out hiatal hernia or ulcers. They found mild chronic gastritis in the reports.

Currently I am on 40mg Omeprazole in the mornings and 20 mg Famotidine in the evenings

Recently in an ultrasound they even found echogenic sludge and multiple small gallstones in Gallbladder. I strongly believe this is because I lost 35lbs in such short time. Now the doctors here are recommending me to get my gallbladder out. So far, I haven’t experienced any gallstone pain or episode with the exception of very minimal dull pain in right upper abdomen which is sensitive to touch.  I am extremely scared that Gallbladder surgery would only worsen my Gastritis and GERD symptoms.

Can you please advise if I should get my gallbladder out or should I wait till my GERD is cured? Also, can I use Urso to treat my gallstones meanwhile or while that aggravate the GERD symptoms too? I know stress can only elevate GERD, but this whole gallstone diagnosis is making me lose my sleep and making things worse. Would really appreciate your advice.

Thank you,

Dear Patrick,

Thank you for your question. Your situation and presenting symptoms are quite common. Unfortunately, many acid reflux patients undergo unnecessary gallbladder surgery every year in Houston. You have typical acid reflux symptoms and zero gallbladder related symptoms. I wouldn’t even order a gallbladder ultrasound. 30% of the population in Houston and Pasadena have gallstones and sludge in their gallbladder; If they are asymptomatic, gallbladder surgery is not indicated. Gallbladder related symptoms may overlap with acid reflux symptoms like bloating, maldigestion, and abdominal pain. Sore throat, difficulty swallowing, heartburn and food regurgitation are classic acid reflux symptoms and highly indicative of GERD.

You had an upper endoscopy that did not show acid reflux, yet you are being treated with high dose antacids. Unfortunately, we encounter many patients like you at Houston Heartburn and Reflux Center with severe acid reflux symptoms and presumably negative endoscopies. We invariably repeat the upper endoscopy with ambulatory pH testing and find clear evidence of hiatal hernia and acid reflux.

My recommendation for you is to get evaluated by a competent acid reflux specialist in Houston before you commit to any surgery. Unnecessary gallbladder surgery may exacerbate your acid reflux symptoms. Ursodiol decreases the chance of gallstone formation especially when losing lot of weight. I don’t think it is helpful for you at this point. Stress and anxiety exacerbate GERD symptoms but do not cause acid reflux to develop.