Intermittent nausea, gas (burping, incontinence), stomach disomfort

About 10 months ago I started to feel mild intermittent nausea, especially at wake up time; nausea typically subsides after eating/drinking.  Few weeks later, other on and off symptoms started appearing: stomach churning, burping, incontinence, burning in esophagus.  All of these symptoms, along with nausea, were intermittent with some days worse than others.  GI doctor performed stool tests, blood work, sigmoidoscopy, endoscopy, however everything came out normal or as expected.  I was put on Aciphex for 3 months but it did not help.  I was later put on Ranitidine for 3 months (300 mg-2x/day) and it helped a lot, leading to many symptomless days.  After Ranitidine, I was told to take Zantac (75 mg) whenever symptoms re-occur.  
My GI doctor (whom I respect and like tremendously) says he believes this is stress-induced, however I stronly feel and believe that there is more to this than just stress.  The symptoms are too real and they are too disruptive to normal life.  I have always followed and continue to follow a very healthy diet and  excercise routine, but symptoms persist anyway and I feel so helpless and frustrated.  Zantac helps treat some symptoms, but it is not the treatment to this serious annoyance.  
Two side comments: first, my mom (born in the Phillipines but lived in the Middle East most of her adult life) always had GI problems, including an amoeba infection that continuously annoyed her  and forced her into strict and miserable diets to avoid the recurring cramps and diarrheas. Could my symptoms have to do with some ameoba (amoeba) infection?  Although not that frequent, I also do experience occasional lower GI cramping and "loose bowels".  
Second, I live in the US, but I was born in the Middle East (Lebanon) and I believe that my current symptoms started right after my last visit to Beirut in August 2003.  Could this be some parasite that is not being detected by the above tests?

I am desperately seeking help and perhaps some helpful recommendations that might help me go back to my doctor with some suggestions/comments/pleas/etc.  I really need to find the reason behind this so I can treat the real reason (the disease) and not just the symptoms.  Your help will be much, much appreciated.
With kind and thankful regards.
N.M.

[Kevin Pho, MD]

Before considering parasites, there are several other considerations.  In addition to the tests you already had, I would consider a gastric emptying scan to evaluate for gastroparesis (delayed gastric emptying), as well as a 24-hr pH study with esophageal motility studies to evaluate for GERD and motility disorders.  If negative, an ultrasound can be considered to evaluate the liver and gallbladder - where diseases  can be causing your symptoms.  

You can discuss these options with your personal physicians.  If there is suspicion about parasites, stool tests can be considered to evaluate for this.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[yoshi]

you did not mention testing for H Pylori bacteria??

[kmasri]

Sorry about that, H. pylori tests were negative.  Also, I underwent an ultrasound (gallblader (gallbladder) and surrounding area) but nothing showed up out of the ordinary.

[sunny_one]

How many stool tests did you have? I've had experience with parasites and you should have at least 3 on alternating days. You also have to have the right kind of perservative - I know mine only showed with the red colored preservative, but not the clear. Before diagnosis I was also told that my symptoms were because of stress or depression (neither of which I had - stress came later from this absurd assumption which delayed treatment). Don't know why GI docs (and others too) would rather assume it's all in your head when parasitic infections are quite common, even in the US. Excuse the brief rant...

In the end I elected to have my gallbladder removed because of reduced function. This was the best thing I ever could have done. No more nausea, gas, burping, stomach pain, limited diet, reflux, etc. You may wish to have a hidascan to test gallbladder function if you can't find any other cause.

[kmasri]

Sunny_one; thank you for your advice, I truly appreciate it.  I was out of town for a while, hence my late response.  I have an appointment with a new primary physician today, so I will bring up all of the issues and/or recommendations that were given to me so far, especially yours.  Thank you again.  If and when I do find out anything, I will post to this group for information sharing and humble appreciation.
Kmasri.