17 year old with chronic nausea/queasy stomach

Hello,

I have a 17 year old son who is 5ft 10in and weights 121 lbs. He has had a positive test result of hyper billirubinemial.  I don't have his numbers, but it was thought to be an innocuous elevation.  Other test results on the cbc were normal.  He has also had normal liver function tests. Stool tests for parasites were normal.

His clinical symptons are: two months of chronic nausea that episodically become severe and a queasy stomach which results in a moderate to severe anxiety response.  He also has episodic pain mid stomach below the sternum. He has lost 7 lbs durng this illness. During severe episodes, throwing up seems to help. Recently, eating seems to make him feel better. He has such an axiety response about the possibility of an episode occuring that the thought of leaving the house brings on an anxiety response. This appears to make him sick to the point that he can become incapacitated. He is has been of summer vacation and has not been under "stress".  

What differential diagnoses could arise from these results/symptoms?

Thank you very much

[Kevin Pho, MD]

Possible causes would be GERD, an ulcer, gastroparesis, inflammation of the upper digestive tract, gallbladder disease or esophageal motility.  

I would discuss an upper GI series or an upper endoscopy (a more comprehensive test) as an initial evaluation.  This can evaluate for an ulcer or inflammation.  Other tests to consider would be a 24-hr pH study with esophageal motility studies to evaluate for GERD and esophageal motility disorders respectively.  

If these tests are negative, a gastric emptying scan can be considered to look for gastroparesis.

You may want to discuss these options with your personal physician.

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