I have been experiencing these issues for about
a year and I was very surprised to find that I am not the only one. Especially reading about
people describing their "internal burps" was very fascinating.
During this time, I have been creating hypotheses and doing medical tests in order to get to the bottom of this mystery. Thanks to all the reports on this forum, I think that I have found the root cause of these issues for a major subset of people.
I will start by briefly stating my personal symptoms, then explain their surprising interrelations.Symptoms:Sudden onset with almost an exact date
It was a normal day in my life like any other. I had no stress, didn't eat anything special. There was no upcoming exam or anything. Despite this normalcy, the following happened on that day:
I was on my laptop watching Youtube – like often. And out of nowhere my heart rate increased – it just kept getting faster and faster over the span of a few hours – I suspect that I had about
150 bpm at the peak. After some time I really started to get anxious because it wasn't getting better. The following day my heart rate was normal again – but I could feel that something was different.Roemheld Syndrome
To describe the following 2 weeks horrific would be an understatement. The main symptoms here were that I had extreme pain in the region of my diaphragm, I also couldn't breathe in deeply, I had heart aches, allodromy (heart skipping beats) and a bloated stomach. The worst thing was my inability to eat anything or even drink water. Doing so would cause my symptoms to increase massively. I also noticed that my symptoms got better when laying in certain positions.Inability to burp like a normal human being and secondary issues
This symptom is plaguing me to this date and is very bothersome. My stomach is bloated, my intestine is filled with more gas than normal and I have a pressure feeling in the base of my neck. When I actually do burp, it's not really a burp. It is mostly an “internal burp” meaning that I can feel how most of the air wanders back down into my stomach while only a fraction of the air actually makes it out of my mouth.My Hypothesis:
I hypothesize, that the inability to burp is causing Roemheld-Syndrom related issues. But what is causing the inability to burp in the first place? And how does this tie in with a sudden onset?
I am very confident that the inability to burp is caused by a “mild” stenosis of the esophagus in most cases.
When no sudden onset is present, the most likely cause is due to a paraesophageal hiatal hernia, a tumor/lump in the superior mediastinum or due to struma.
If a sudden onset is present, the following scenarios are likely:
Zenker, Killian–Jamieson, or other diverticulum.
If the onset is tied to some kind of illness( a cold, fever or related), the thymus or lymph glands in the superior mediastinum can be enlarged. There is especially little room in the region of the Manubrium sterni.
If the onset is tied to a sudden appearance of anxiety, nervousness, feeling tense, heart rate going crazy, increased sweating in any way shape or form it is plausible that the stenosis is caused by an enlarged thyroid (Struma). This sudden appearance of these symptoms is caused by a sudden release of thyroid hormones into the blood stream (see Hashi-toxicosis (there is a bug, preventing me to type the word)). Morbus Basedow and Hashimoto thyroiditis are the typical candidates that come to mind. The release of hormones goes hand in hand with a swelling / enlarging of the gland, thus causing the sudden stenosis.What can you do?
Getting rid of the symptoms tied to Roemheld Syndrome (heart aches, difficulties breathing etc.) is fairly simple, albeit expensive. Go on a SIBO specific diet (to decrease gas build up) and take FLUID simeticone. Tablets or capsules release the simeticone too late inside the body – hence I found them to be ineffective. Fluid simeticone works exactly there where we need it most: in the esophagus. “Lefax Pump liquid” or “Sab Simplex” work (I personally like the taste of Lefax more). Forget the standard dosage for your case – you can toss the pump nozzle into the bin. Drinking (yes drinking) about
20 ml works like magic. If the symptoms are still present after 6 hours you can take another chug. You don't need to worry about
overdosing since simeticone is inert and cannot harm your body – even in prohibitively expensive amounts.
If you have an enlarged thyroid, thymus or tumor in the region of the superior mediastinum, only an operation to decrease the size of it will provide a permanent cure, in my opinion. In some cases of enlarged thyroids it could also be possible to decrease the size by taking Iodine. (WARNING: Do not take Iodine if you have Hashimoto thyroiditis!) This you should discuss with your doctor.How to Diagnose?Barium Swallow Test
A normal Barium Swallow Test is sufficient and should show a diverticulus, however, most people will suffer from a mild stenosis which let's fluid pass easily (because it is a fluid and also has the gravitational force on its side). To see a mild stenosis, it is helpful to take some bread (or something similar) and soak it with the barium contrast fluid and swallow that. This will give you a much higher chance to see where the issue lies. Even if you have already done a barium swallow without bread, you can gather some clues to where the stenosis may lie. Due to the nature of this illness, your stomach will be pressurized with gas – and therefore your esophagus will also be pressurized until the point where the stenosis lies. Hence you should be able to see some bulging of the esophagus due to gas in the barium-swallow video. This however will merely tell you that the stenosis is located above the area that bulged – but it won't tell you exactly where the problem is located.Blood Tests
To rule out Morbus Basedow and Hashimoto, one must check: TRAK, TPO-Ak, Tg-Ak. Also one can check the other blood parameters of the thyroid such as TSH, T3, fT3, T4, fT4 to see if there is some other general thyroid issue.
However, it is often the case that people have an enlarged thyroid without any anomalies in the blood parameters. Because the reason the thyroid swells in the first place is specifically to compensate some deficiency and bring your blood parameters into the normal range. Sonographic Measurement
This is NOT a good way to have the size of your thyroid determined. Especially if it is enlarged. It is impossible to give reliable results by this method. Please check out this paper and make sure you understand it: https://link.springer.com/article/10.1007%2F
A normal thyroid has 10-20 ml of volume. Everything above this is enlarged. The maximum allowed size without it being pathological is 25 ml. The above study shows that the error by sonography is (6.8±7.5) ml. That is an insane relative error. Try to fathom the fact that this is standard practice – I find no words for this. Sonographic measurement for determining thyroid size is a guessing game.Physical examination
If your thyroid is causing a stenosis of your esophagus, then this is a very cheap and effective method of determining whether or not it is potentially too large. From my experience, doctors are usually not qualified to to do this. If you go to your average doctor – I assure you that he hasn't touched a single thyroid in decades and doesn't have a clue how to properly examine a thyroid.
The thyroid is usually so small, that an unqualified person will not be able to locate it if it is not enlarged. Neither by physically palpating and especially not by mere visual examination. The thyroid is located between your adams apple (laryngeal prominence) and the base of your neck.
To examine it stand in front of a mirror and face upwards towards the ceiling. Now swallow a couple times. If you see 2 bulges between the adams apple and base of your neck moving, then you at minimum have a class II Goitre – meaning that your thyroid is seriously enlarged. If you cannot see it then try palpating in the area for some soft jelly like structure around your windpipe. If the structure is not jelly-like but rather hard (and you're sure it is the thyroid) then you likely have an inflammatory disease of the thyroid such as Hashimoto. If possible, try this out with a family member or a friend to have something to compare it to.MRI or CT
A best method for both determining the size of the thyroid and finding any anomalies in the region of the superior mediastinum are MRI or CT scans. As you all know, CT scans are inherently dangerous due to the strong X-Ray exposure and should only used as a last resort. Hence, I would recommend an MRI with the contrast medium Gadolinium to better visualize the thyroid and other structures. From my knowledge, Gadolinium is one of the safest contrast mediums on the market, however, even it can have some risks that you should read about
and talk to your doctor about
Radiologists will generally be competent enough to locate any tumors or lumps in the mediastinum. If you are very paranoid you can show it to another radiologist to get a second opinion. If you have a malformed thyroid they will also easily see it. However, if your thyroid is too big overall, they will most likely miss it because it is NOT possible to simply look at the image and know if it is too big or not – one must actually measure it. And even if they do measure it, they will most likely merely approximate via ellipsoid method which is not reliable – but quick. If you really want to be 100% certain about
the size of your thyroid you should request the MRI images (DICOM files) and do the measurements yourself. (And yes, any non-professional can do this – however it takes some time and time is the reason that doctors will not do this the correct way – they usually get paid per patient and not by accuracy or time invested.
If requested sufficiently often, I could make a small tutorial for thyroid size determining via the DICOM files.
If you have any questions, feel free to ask. If you have discovered something factually wrong in my text, please point it out so I can correct it. Thank you.TL;DR
- Try drinking large amounts of Simeticone fluid.
- Put yourself on a SIBO diet to decrease gas build. (Because you cannot expose of it properly)
- Check diverticulum and esophagus stenosis via barium swallow test with bread dipped in contrast fluid.
- Check that you don't have anomalies in the superior mediastinum.(via MRI)
- Check that your thyroid is not enlarged (either physically/visually) and/or via MRI scan – not via Ultrasound.
DISCLAIMER: The Content above should be taken as fiction and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something that was written above.
Post Edited (physics101) : 2/18/2018 9:38:32 AM (GMT-7)