Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Question Title: Pain just below sternum

Forum: The Gastroenterology and Liver Diseases Forum
Topic: Stomach Conditions


I'm a 41 yr old male 5'10" 140 lbs with chronic stomach pain( medium intensity ache that waxes and wanes. (5 to 10 seconds bad, then 5 to 10 better) located just below the sternum, Slightly to the right of dead center. I have had a upper endoscope, Upper GI with small bowel series, a colonoscope, and an abdominal ultrasound. I also had my thyroid biopsied, because it is enlarged. All the tests showed nothing. (normal) Thyroid function was also ok. (blood test) The pain subsides as I drift off to sleep at night, and apon awakening in the morning, it is much better, but proceeds to progressively worsen throughout the day. There is more pain when the area is pressed on when standing, but usually no added discomfort when pressed on while lying down. Sometimes when I shift positions (turning over in bed ) The ache momentarily worsens. (sharper pain). The pain when pressing on the stomach is definitely more apparent on an empty stomach.
I have virtually no sensation of hunger, (only pain) , and I have lost 10 lbs since october. When I try to force myself to eat a large meal, I have a sensation of pressure (along with the ache) that lasts at least 2 hrs. sometimes longer.
I had a few codeine with tylenol pills that helped dramatically, when tylenol by itself did virtually nothing. I never use aspirin or Ibuprofen, or Alieve. Since the Codeine worked so well, and the transit time of the barium was only 35 mins., my Dr. is dismissing the possibility of gastroparesis. They are both stumped, except to say it could possibly be a hiatus hernia or adhesions.
History: Crohns disease, resection, 10 years ago of the terminal illium. (8 inches of small intestine were removed along with 1/2 of the asending colon. The asastamosis was able to be viewed with the recent colonoscopy, and looked fine.

All testing was ordered by, and reviewed by a gastroenterologist.

I am currently taking Prilosec 20 mg. once a day. Seems to help a bit.

Any light you could shed on this problem would be appreciated.
Scott.

Dear Scott,
I can not provide any suggestions to explain your symptoms based on the posting that you sent. I would emphasize that barium meals are not good tests to exclude gastroparesis. Barium is a liquid (although it can be quite thick)and liquids exit the stomach via a different mechanism than solids. In order to exclude gastroparesis you should have a radioisotope study in which solid emptying is measured.

This information is presented for educational purposdes only. Ask specific questions to your personal physician.

HFHSM.D.-rf
*keywords: gastroparesis
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