Q: I am a diabetic whose blood sugar levels are uncontrolled despite taking insulin injections. Since about 3-4 weeks I am having chest pain and pain on the upper left arm. The doctors here suspect unstable angina. I am also having stomach bloating and constipation. My chest pain is noticed more so after meals and stays for about an hour. Could you please give me detailed information on GERD as I suspect some gastric problem causing the chest pain?

A:Your chest pains as you have described would fit in with angina and angina is a known complication of diabetes. Abdominal bloating and constipation are unlikely to produce chest pains as you have described. The bloating after a meal sometimes be due to delayed gastric emptying which occurs in patients with long standing diabetes. Symptoms of gastro-oesophageal reflux disease (GERD - as we call it in Europe) are predominantly heartburn and acid reflux but can mimic angina. In your case angina has been diagnosed and your pain should respond to treatment. If however your symptoms fail to respond to anti-anginal drugs you would need an endoscopy which in any case will help you to exclude the possibility of two conditions coexisting. Constipation on the other hand is entirely different and can cause bloating, in which case you should go on a high fibre diet as well as laxatives if need be.