What Now?

[rjsick]

I will start from the begining.  I have never had stomach problems prior to this.  I am 21 years old with an athletic build, and very healthy prior to all this.  After eating out one night in early March I came down with food poisoning and spent the next 8 hours throwing up some 25 times.  By late the next evening I was fine.  The next day I left on spring break to Cancun, Mexico.  I was fine for the first 3 days.  The 4th through the 6th day I became very nauseated at dinner.  The nausea eventually subsided after a couple hours and i was normal. I figured it was probably from being in the sun all day.  Anyway, that was that- so i thought. In Cancun I contracted herpes simplex virus-1 (oral herpes or cold sores) and became very sick for about one week from the initial infection.  After recovering from that I was better for about 3 weeks.  Then, in mid-april I would occasionally get nauseated while working out or after eating, the feeling would subside within about an hour.  Then, in early may i became very light-headed and sick to my stomach- this lasted for the next day and half.  Then i was fine again.
The real problems started a couple days after that in mid-may. After i would eat, i would get very nauseated (no vomitting). Then came cramping in my abdomen along with nausea and heartburn. For three weeks the nausea lasted.  After the nausea subsided i was still having cramps and abdominal pain.  In the midst of this i had an upper GI done.  The results found minor GERD, and a slightly distended loop in my jujenum that went back to normal during the test. I was put on Nexium. I was referred to a Gastroenterologist.  He didn't feel a need to pursue the problem in my small bowel. 2 weeks later I had an ultrasound on my liver,gallbladder, and pancreas. I also had an endoscopy with a biopsy taken from my stomach where there was some redness.  Everything from both tests turned up normal exept for some minor gastritis.  
My symptoms over the last 3 weeks or so have improved, but have also seemed to change.  I have become very bloated and burp alot, it usually starts about 3 hours after i eat and lasts for about an hour.  I still have pain in my stomach, but it has been easing up a bit and hasn't improved in the last several days.
Currenlty I am only on Nexium, which does help- no heartbutn problems.  I have been eating a lot of yogurt and am taking acidophilus.  
1.) Could all of these events be related?
2.) Is it possible that I may have picked up an infection in mexico that was gone before the biopsy- but am still experiencing the effects of it?
3.) Should the matter with my small bowel be looked into further if I don't continue to improve?
4.) Should I have bloodwork done? (im not sure what that would reveal- but i really don't know what the next step is) My gastro doesn't feel the need to do anything else.
5.) Is there any medicines I can take to ease the gastritis and my other symptoms?
6.) What should I do next?

[rollercoaster1]

Your story sounds a bit like mine.  I am still trying to figure out what is wrong with me, but I can suggest a few things that might help you in the meantime.

First, if you are constantly experiencing nausea, you may want to try a modified diet.  It takes time to react positively to a change in diet, so you have to commit to it for at least several weeks.  You could try a diet that takes out the most common allergens like sugar, grains (including potatoes and corn), and dairy.  If you're desperate enough, eating a limited diet is far better than feeling like vomiting after every meal.  Sometimes our systems just get stressed out from illness, and it can take a lot of nurturing to help them back to health.

Second, you could try an elimination died, to find out if your reactions are food related.  Some diseases are triggered by intense stress to the body (ie. multiple serious illnesses, major life stresses).  Celiac is one example of this (though, if you had an upper endoscopy and they didn't find abnormalities with your upper intestines, then that's probably not your issue).

I had been a relatively healthy 25 year-old who had a stomach of iron.  I never felt sick and I had never met a food I couldn't eat.  My problems started on April Fools' Day of 2001.  That was the day I unexpectedly lost my job.  I began to have some gastro issues.  Nothing too bad- I just attributed it to stress.  Not long after, like you, I contracted food poisoning (much more mild than yours, though).  From there, it was all down hill.  First, I started feeling sick when I went to bed.  Then, I started feeling nauseous shortly after meals.  Before a month was up, eating made me feel miserable almost all of the time.  Like you, too, my nausea would go away after an hour or at the most two.  Then, I would start the cycle all over again.

By June, I couldn't eat or drink without feeling like I wanted to immediately vomit.  I never did, but I sure did want to sometimes.  At one point, I was living on 3 foods.  I lost about 25 pounds in about 2 months.  At the same time, I developed enlarged lymph nodes in many places on my body.  My doctor ran blood tests, and everything came up negative.  Because of insurance issues, I was unable at that time to see any specialists.  So, my doctor said she wanted to keep tabs on me.

In the meantime, I also developed a lot of belching (I had been the kind of person who almost never belched) and bloating. I continued to struggle with every kind of food every day.  I began to have something like a panic attack when I ate and my stomach didn't agree with what I was eating.  My throat would feel like it was closing so that I couldn't even swallow what was in my mouth, and I would need to run outside to get fresh air and cool down.

I decided to take drastic measures.  I couldn't continue to subsist on a few bites of food every day.  So, I went on a candida diet.  I didn't have a candida diagnosis (my doctor wouldn't test me for it then, and have since found out I definitely do not have candidasis), but I had many of the symptoms and I figured it couldn't hurt anything.  So, for two months, I cut out almost all grains, most meat, all sugars (including most fruit), and lots of other stuff.  It took a couple of weeks, but I stopped feeling nauseous after meals and I started gaining weight back.  I went off the diet slowly, and at first I was able to eat pretty normally again.  

While the diet stabilized me quite a bit, I still have problems today.  Since that time, I have developed a mild case of GERD, which my meds sort of help.  I also developed other intestinal symptoms, which hadn't been an issue at all when things started. I also have received a diagnosis of Celiac disease (via blood work and a fairly positive response to a gluten-free diet, though my Gastro doc did not scope me for this, since in my frustration, I had already taken myself off of all gluten) and lactose intolerance.

Today, my health is like a roller coaster.  I feel pretty good for a few days, and then I feel all of the symptoms all over again.  I am going on another restrictive diet soon.  It's called the Specific Carbohydrate Diet.  It's designed for people who have stomach and intestinal issues that cause them to kind of pendulum back and forth between health and sickness.  Nobody has offered me much else to work with, so I continue to try things and to do research on my own.  And I pray that God will heal my body.  It's lousy to feel sick so often, isn't it?

Hope this was worth something to you.  And I hope the best for you as you seek out a better diagnosis and a way to restore your health.

[Kevin Pho, MD]

Hello - thanks for asking your questions.

1) It is certainly possible that all these symptoms are related.  
2) It is possible that a variety of viruses may be causing your symptoms that may not show up in the biopsy.
3) An upper endoscopy that you had would have evaluated the beginning (duodenum) of the small bowel.  You may want to consider a colonoscopy if you continue to have symptoms in the midst of negative tests.  
4) With negative imaging tests, there is not much bloodwork would add.  Your gastroscopy showed gastritis, and imaging of your liver, gall bladder and pancreas were non-revealing.  
5) Without examining you, I cannot recommend specific medications.  The Nexium you are taking is a good drug to treat GERD, ulcers, and gastritis.  
6) I would suggest a gastric emptying scan to evaluate for gastroparesis.  Another test to consider would be a 24-hr pH study to evaluate for GERD.  If you are documented to have GERD that is not controlled with Nexium, surgical options may be considered.  Another test to consider would be a HIDA scan with CCK stimulation to evaluate gall bladder function.

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.

Thanks,
Kevin, M.D.

[GI.PA]

Yes..they may all be related.  We hear this story quite a bit.  It seems that any virus or bacterial infection can have a lasting effect on the motility (how the gut contracts) of the upper and lower GI tract.  This may simply get better over time or may have "tilted you over the treshold" for irritable bowel syndrome (mostly lower GI stuff) or non-ulcerative dyspepsia (the upper GI equivilent).  Keep working with your GI if your symtoms are not improving at least a little every week.  If things are not going in the right direction, more evaluation may be needed.

Erin

[yoshi]

you did not mention testing for hector pylori bacteria in your stomach.
since you said you have food poisoning from eating in a restarant and then went to mexico,you should ask your doctor to test you for that bacteria.
if your count is high ,he would prescribe a 14 days medication .

[4gpact]

It is possible that the infecion, either from the initial food poisoining, something in Mexico, or the herpes, could have affected the nerves and muscles in your stomach. I suffer from a rather uncommon disorder called gastroparesis, and it is known to be caused by a number of illnesses, such as food poisoning and herpes simplex. Your symptoms are classic. Nausea after eating, heartburn, etc. One reason for the inflammation might be either from the infection, or the stomach contents remaining in your stomach too long, which will cause irritaion. There is a test called a gastric emptying scan that you should ask your doctor about. It is the best way to diagnose this condition. Basically, it means that your stomach doesn't process food properly, thus the fullness, nausea, heartburn, etc.
In the meantime, try to avoid foods that are spicy, contain a lot of fiber (such as raw fruits and veggies, they are difficult to digest) and red meat. Also foods that are high in fat. That should help, as it will give your stomach a break from working so hard.
Hope this helps.