Subject: Re: possible causes of symptoms
Forum: The Gastroenterology and Liver Diseases Forum
Topic Area: Gastroenterology - General
Posted by HFHSM.D.-ym on January 05, 1999 at 13:36:06:
In Reply to: possible causes of symptoms posted by Adam on January 05, 1999 at 04:09:32:

For the past three years I have suffered from abdominal pains which seem to persist for a few hours after eating, and sometimes (although rarely now) would wake up in the night and need to vomit.

I never considered this to be a serious problem, until just over 12 months ago when I started experiencing these aches more often, and more worrying symptoms appeared, including:
- total inability to gain weight.. (currently 6'1", 55kg)
- insomnia
- the sense of being in a "fuzz" .. this has persisted for the full year with no lapse. i feel uncoordinated and unbalanced and my eyes will not focus properly.. at any distance.
- occasional vomiting with no possible reason behind it.
- constant abdominal aches, usually not severe.
- severe flatulence.
- diarreha and strangely-formed stools.

I'm not worried about most symptoms, but the fuzzy feeling is absolutely horrible, and my vision is terrible, with an inability to stare at something and focus on it.. it just makes me feel nauseaus.

The GI problems and all symptoms seem to be linked, because when I feel worst (most "spaced out") is when my stomach aches are at their worst.

So far, I have had the following tests:
- CT scan of the head
- Ultrasound of the neck (blood vessels)
- Various blood tests including full blood count, and those that indicate various nutritional deficiences. Also tested for Celiac disease (antigliadian).
- Xray of the abdomen (no contrast). The results of this showed a "thickening of the mucosa on the bowel wall".. but my doctor said this form of x-ray is very unreliable... however, a Barium meal was recommended.

I then had the Barium meal recently which it seemed to me was rushed (it took 1.5 hours total for the barium meal and small bowel series)... and the doctors basically said "i think that's enough".. there seemed to be no problems indicated by the barium meal.

My question is, what do I do next? I've been referred to a neuorologist (but that is more than 2 months ago) and I believe this is _not_ where my problem lies, considering the persistent GI symptoms.

I'd like to follow up on the GI problem with further tests, but don't know what possible tests there are left.

I have a gastroscopy scheduled for the 17th of this month in which they will be doing a biopsy of the duodenum, testing for celiac and whipples disease.

Any ideas on what else I can do to follow up? I had hope that this Barium meal would've indicated the problem -- it doesn't seem like there is much else to do.

Thanks.

-Adam

Dear Adam,

You sound like you've been having a rough time. I would have to agree that your symptoms are suggestive of a malabsorption syndrome with malnutrition. Some ot the symptoms you describe are associated with nutritional deficiencies. Inflammatory bowel disease, celiac sprue or Whipple's disease, eosinophillic gastoenteritis or even certain intestinal infections (such as Giardia lamblia) are just some of the possible causes. Although anti-gliadin antibodies can be positive in celiac sprue, a more accurate test to rule out this disorder is the endomysial antibody test. It is also a blood test. The upper GI endoscopy with small bowel biopsy will certainly be helpful in excluding some of these disorders. However, other tests to rule out small bowel causes of malabsorption, pancreatic insufficiency and colonic disorders may also be necessary. If you have any risk factors for HIV infection you should be tested. Unfortunately, given the complexity of your problem, you may not get the answer with the first few tests. Nevertheless, I believe that a thorough GI work-up is necessary to exclude the disorders described above as well as others. Good luck to you. I hope you find this information helpful.

This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.

HFHSM.D.-ym
*Keywords: abdominal pain, diarrhea, weight loss, malabsorption, work-up

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