Possible Ulcer Causing Chest Pain - not responding well to treatment

[Alexa501]

Hi - I'm totally nervous and miserable and am hoping you can help me. Here is the best go at a chronology:
- I'm a 35 year old female, 123 pounds (after losing 5 in last week)
- Currently 24 days pregnant since last period March13.
- Presented with chest pain three weeks ago - It almost feels like something goes into spasm in my chest that sets it off.  It it extremely and unbearable constant yet the primary hot spot seems to move - goes from sternum to just left of it to neck to back.  Seems worse after meals but not sure.
-Tests: EKG, Chest X-Ray, basic blood work, ultrasound of gallbladder, pancrease, liver normal, all blood work normal.  
-Tested positive for H Pylori.
- No sensitivity to touch chest. GI Cocktail inneffective - pain meds at ER and hydrocodone worked well. Took Ramididine.
- After two weeks chest pain subsided.
- Then my stomache got so bad I couldn't eat for a few days - spasms just above my navel and below my ribs and a general pain just above belly button.  
- My stomach felt better on Previcid for a few days but now my chest pain is back for the last two days.
- Taking Previcid and being treated symptomatically because pregnancy.  No antibiotics until after baby - allergies.
- Same or worse with Mylanta - nauseeated
- Gastroenterologist can't see me for consult until May:(

Questions:
1.  Can this be an ulcer even though the antacids don't seem to help? are the risks of a bleed low since I have been on acid blockers for several weeks?  when should I expect to feel better?  I have quit all the "bad food", caffeine, etc.
2.  If not an ulcer, what else could this be?  Is there much chance this could be cancer - what would the odds be - what other symptoms might there be?   My concern is that I'm not responding well to therapy for ulcer but have H Pylori.
3.  Is it likely they will scope me while pregnant if this persists?  At what point?  
4.  Any advice?  

[Alexa501]

Thank you for your response.  I am now on Nexium and I believe it is causing some additional chest pain - like muscle spasm but when I didn't take it the burning pain in the center of my chest was unbearale so I took it anyway.  It seems that after four weeks on different acid blockers, etc. I should have some improvement - do you still believe it is possible it is an ulcer?  Are they just that stubborn?  They are considering scoping me - a little nervous being pregnant but feeling a little desparate.  Do you believe it could be anything much worse than an ulcer?

[Kevin Pho, MD]

To answer your questions:
1) Yes, an ulcer is possible.  I cannot predict the possibility of a bleed without knowing the severity.  Although radiation from an x-ray is not preferable, you may want to discuss with your OB whether an upper endoscopy or upper GI series is feasible.

2) Gastritis from the H Pylori is possible.  Also, a low gallbladder ejection fraction can lead to refractory upper abdominal discomfort.  

3) I would say no under normal circumstances, but if an upper endoscopy is truly needed (i.e. for a persistently bleeding ulcer), then it can be done.  

These options can be discussed with both your GI and OB physicians.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd