DIGESTIVE DISORDERS / GASTROENTEROLOGY
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Chronically sensitive stomach--Why and what can be done?
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by Cathy__0__0, Jan 15, 1999

  I have a couple of medical questions to ask... Please bear with me, I have a
  fairly long and non-specific symptom history, without many test results to
  refer to (New Zealand has a chronically stressed health system so
  doctors tend to treat on the basis of probability, just in case, rather than
  bother with ordering tests....)
  Since 1993 I have had upper left quadrant pain, radiating through to
  my mid back. In Jan 93 an ultrasound showed nothing. Symptoms
  worsened with food, antacids helped a little, there was some diahhorea
  and weight loss at that time, but this improved as the years went on.
  In 95 was given ranitidine which didn't help, so then was treated for
  gastric ulcer (zantac + 2 antibiotics concurrently). This stopped the
  pain, but only for about 3 months. (During this treatment I lost
  weight--not a bad thing, as I am clinically obese, apparently...--and
  passed a lot of mucous.)  When the symptoms recurred, a
  gastroscopy revealed inflamation of the stomach lining.
  (Gastritis??) Symptoms were precipitated by spicy food
  and asparin. I kept it more or less under control by gulping down
  gallons of mylanta (antacid containing magnesium hydroxide & aluminium
  hydroxide).
  In 1997 became pregnant and suffered quite bad hyperemesis, during
  which I couldn't actually eat anything with any flavour at all (there were
  three weeks where I ate lemonade flavoured iceblocks and digestive
  biscuits and nothing else.) The morning sickness involved vomitting bile
  several times a day during the worst bouts.  The bile became obviously
  darker as time went on. Then during the third trimester I became
  of a sensation that at the time I identified as the baby's foot putting
  pressure under my ribs at the right. I also had quite a bit of sharp
  but sustained right quadrant pain (which my midwife and ob.
  attributed to the pressure from the baby).
  About six months after my daughter was born, the kicking sensation
  under my ribs on the right side came back. Ultrasound showed up
  several small gallstones. There wasn't any pain at that stage-just pressure, and
  I could usually get away with eating fatty foods without any problems.
  I am currently pregnant again. While the morning sickness is less
  of a problem, this time around the gallstones are giving me weekly
  pain, my stomach has become so sensitive that any food with any
  flavour whatsoever precipitates stomach pain. This time I am able
  to hold down the standard bland foods (incl. mashed potato, but not
  bread for some reason, and who knows why but meat pies
  in the morning go down and stay down....) But I seem to have
  problems just about daily with either gastritis + backpain,
  heartburn (which feels higher up) some chest pain + palpitations
  and panting, gallstone ache with shoulder pain...  Any food with
  any flavour at all irritates my stomach, as does anything with any
  acid content whatsoever--pickled food, tomatoes, standard table
  pepper, soft drinks & colas, lemon etc. I get reflux burning the back of
  my throat for no apparent reason.
  I just don't know what to do while I'm pregnant, what procedures
  are possible, how much is just pregnancy symptom, how much is
  linked with the existing long term problems, and what, if anything
  I can do about any of it. I'm only about 18 weeks gone and it's so
  uncomfortable already, that if there were anything I could do
  to alleviate some of the problems I would jump at the chance.
  Specifically:
  a. Is there any way of treating small gallstones that is compatible
  with pregnancy and doesn't involve removing the gallbladder?
  b. What are the possible causes of my long term gastric problems?
  Is there any way I could ever expect to be able to eat Indian
  food again :-)
  c. Is any of this serious, or should I self treat for the rest
  of my life....
  Thanks in advance,
  Cathy.
_________
dear Cathy,
treatment of gall stomes during pregnancy ( or for that matter almost any condition) can be difficult.  Patients who have cholecytitis or cholangitis may be offered surgery or ERCP but the benefits/risks must be weighed carefully before any decision is reached.  IN your case, your symptoms may be due to bo;iary colic.  I would avoid fatty/greasy foods as much as possible.  
The causes for your gastric problems are not evident from the information that you provided.  Gastritis and possibly impaired gastric emptying must be considered.
During your pregnancy, you should be watched closely by your doc.  The physician should order tests after delivery to look for treatable causes.
This informatrion is provided for educational purposes only.  Ask specific questions to your personal physician.
HFHSM.D.-rf
8keywords: pregnancy, gall stones
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