Q. I am a research assistant at Baylor Medical University in Dallas, Texas. My friend has a perplexing problem. She is a 22-year-old female in good shape and on a well-rounded diet, but has upper gastroenterology problems. She has never burped or released gas orally. This has come to some what of a problem at times with upper chest burning and the feeling of vomiting. Would that be a hiatal sphincter problem?

A. Your friend would benefit by a medical evalution from her family doctor or a specialist to find the cause of the discomfort and nausea. An exam and some basic lab tests will give an overview of metbolism and specific tests might be done such as a test for H. pylori, the bacteria associated with most ulcers. A trial of medication might also be given based on results. The doctor will then determine whether imaging studies would be helpful, such as an "upper gastrointestinal series" (x-ray of the stomach and esophagus) or endoscopy (direct look in the stomach via an endoscope).

http://www.familydoctor.org/handouts/474.html

http://www.acg.gi.org/acg-dev/patientinfo/frame_giproblems.html

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