What is my problem?

About 10 years ago my symptoms began. They were predominantly excessive belching which could make me feel nauseous although I never vomitted. A dr diagnosed a giardia infection based on no tests. The drug treatment appeared to settle my symptoms. In the next year these symptoms developed into an intense gnawing feeling between meals in the centre of my abdomen a few inches above my belly button which if I did not eat something made me feel very light headed as if I was about to pass out. I then  had an upper endoscopy which found nothiing abnormal and I helicobacter negative both by biopsy and antibodies, So I was placed on Tazac. I was never positive it helped. Over the next few years the pain has become more constant and every now and then is quite intense. In one patch recently I could only sit up very straight for relief and it lasted for 2 days. THe pain was relieved after a case of diarrohea. About a month afterwards I had been to the ladies room and was constipated. WHile sittin on the toilet I became very hot and heard a rushing noise in my ears and the epigastric pain became painful and then I fainted. This lead to another endoscopy (about 5 years since last) which showed flattening of my villi but closer examination showed they were ok. I was also shown have slightly below average lactase leves. I was left to my own devices after this. I tried a dietiain who placed me on a low carb diet. I do not think this had a big affect on me however I devloped terracotta coloured stools other than help reduce belching. Following this I tried a food chemical elimination diet. I felt reasonably ok (belchinh mostly stopped and pain reduced) but still with some symptoms - no obvious intolerance. I am now seeing another dr who thinks I may have leaky gut syndrome probably caused by my GI ttract not working in synch. Lastly I have tried a lactose free diet twice and each time by the end of the first week I felt great but half way through the following week my symptoms had comeback 2-fold.

My symptoms generally are a epigastric discomfort which intensifies between meals, constipation and when I have ahad a bowel movememnt of late they are light yellow/brown stools, as well as bloating especially after big meals and belching.

I am at the upper end of the normal weight range for my height and age. In the last 5 years I lost 12 kilos by weight watchers and have mostly kept it off. I am not very active and I work long hours as I am working fulltime and finishing my phd in the evenings. I am a non smoker and drink 1-5 glasses of alcohol a week. I am also an asthmatic (controlled with medication) and have rhinitis.

If you think you know what maybe causing my symptoms could you please make a suggestion that I can take to my Dr. Thankyou.

[Kevin Pho, MD]

With changes in bowel habits, accompanied by a negative upper endoscopy (thus ruling out ulcers and inflammation), irritable bowel disease is a possibility.  If constipation is the predominant symptom, you may want to discuss whether Zelnorm is appropriate for you.  

Regarding the epigastric discomfort, you may want to consider a 24-hr pH study (along with accompanying esophageal motility studies) to definitively rule out GERD as well as esophageal motility disorders, which can cause the symptoms you describe.  

These options can be discussed 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

[cavewoman]

Hi Dr Kevin,

I have a followup question - what would be the followup treatment if I had an esophogeal motility disorder or gerd? Also can you explain the result I had with the lactose free diet and is there any chance I could have a gall bladder problem (I had an US which was clear of gall stones) as my mother had her gall bladder removed when she was 17 and my grandmother had unknown stomach problems.

Thankyou