Gas pain/diarrhea

I am a 33 year old male.  I have always had a "nervous" stomach.  I have been taking Prevacid for about 1 1/2 years for a reflux.  I also have diarrhea about once or twice a week.  When it occurs, I will have a bowel movement as often as 5 or 6 times in an hour with stomach cramps.  This happens mostly in the morning or late at night.  Sometimes the cramps are mild and sometimes they are more severe.  I take Levicin for the stomach cramps as needed.  I also have pain in the back of my lower right shoulder and pain in the right side ribs front and back (this comes and goes).  I have pain just below the chest bone (this comes and goes).  I have to relieve myself of gas frequently by belching but more recently by passing it though the intestines.  On occasion, I have light colored, floating stools with an abnormal odor.  Just this evening, I had clear mucus when I passed gas.  I have had an upper GI, abdominal ultrasound, a hidascan, and blood work.  Other than the reflux, nothing shows up.  The gall bladder seems to work ok.  Gall bladder disease is some what common in my family and my symptoms fit what the others have expierenced.  Any ideas?  Should I seek a second opinion on the gall bladder?  I have almost accepted that it is IBS and nothing can be done.  Thank you for any help you can give.

[Kevin Pho, MD]

IBS can certainly be possible if every test is negative.  There are some further tests to evaluate before settling on that diagnosis.

A lower endoscopy - either colonoscopy or flexible sigmoidoscopy - can further evaluate the lower GI and eliminate causes like inflammatory bowel disease or other causes of chronic diarrhea.  An abdominal/chest CT scan can evaluate for other causes of abdominal and chest pain (i.e. a mass).  

A 24-hr pH study can be done to quantify the severity of the reflux.  If the symptoms continue despite Prevacid, you may want to consider surgical therapy to control the reflux.  

Regarding the gallbladder, if an ultrasound and HIDA scan are negative, it would make disease less likely.  If you are having light-colored stools, an MRCP can be considered to evaluate the biliary ducts.

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.
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