What avenues should be explored next.

I seem to have a progression of symptoms that have developed over the last couple of years but have been unable to get a satifactory explanation. Initial symptoms were the occasional severe cramping and need for a bowel movement after injesting large meals and heartburn occasionaly The frequency increased over about a year. Last summer while moving my daughter into her dorm I experienced the sudden onset of exteme fatigue and nausea that lasted a couple of days before mostly going away. I proceeded to have a physical from my PCP and requested a colonoscopy, mostly because of my age (53). The occasional upset after eating continued but my energy level stayed a little low. In March after a week long bout with a respiratory bug (lung congestion and dry cough) The exteme fatigue and nausea returned and my stools became looser and orange/yellow. I visited my PCP again who orderd extensive blood work (normal) Endoscopy, Abdominal Ultrasound and Abdominal CAT. All showed no problems with the exception of "rashy look" to stomach lining in places. I was precribed Nexium for reflux and told that should take care of it and not to worry about it. The indigestion is reduced, the nausea is reduced but now my back is sore most of the time,I get a little lightheaded  and I've lost about 10 lbs. Probably from loss of appetite from the nausea, but still disconcerting. Some days I don't feel too bad but most I'm tired to can't hardly go. I've never had any illness other than colds and flu and maybe just am not dealing with this well but I feel my Dr. and The Gastroenterologist might not be connecting the dots. Any thoughts?

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note nausea and fatigue.  Colonoscopy, endoscopy (I assume upper endoscopy), abdominal ultrasound, blood work, and abdominal CT scan were all non-revealing.  You have been prescribed Nexium for reflux.  

Without examining you it is impossible to say what you have.  But here are some considerations.  

If you continue to have nausea, then one consideration would be delayed gastric emptying (known as gastroparesis).  Gastroparesis can be seen in association with many diseases including scleroderma, diabetes, and a variety of neurologic disorders.

You may also want to consider a 24-hr pH study to document GERD.  It is possible that your symptoms are caused by controlled reflux (even on Nexium).  If this is the case, then surgical evaluation for anti-reflux surgery may be considered.  

One last consideration is esophageal manometry.  This is a test that measures the motor action of the lower esophageal sphincter (LES) and esophageal body.

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.

[yoshi]

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