chronic belly pain

I'm having a flare-up of RUQ pain with generalized abdominal burning sensation like I'm very hungry.  It's chronic, 10 or more years, but nothing seems to get rid of it.  I go years with no pain then I have severe pain, nausea and sometimes diahrrea for several days.  Three months ago I had severe general malaise and tested 3plus for urine bacteria, took Levaquin for 10 days and all symtoms (symptoms) of belly discomfort left for three months.  Now it's back.  It doesn't matter what I eat or my activities when the pain persists. I may have severe pain for 24 hrs and then it's gone for a few days then back again. Over the years the tests have been normal except for a very small duodenal ulcer about 15 years ago which cleared after a few months.  I'm 61 yrs. 5'5" 122# in good health except this disorder.  I notice it more in times of high stress.  I have no gallbladder or appendix.  The longer it persists, the lower my tolerance becomes.  I also have lower (l/s spine) back pain.  Any connection?  Thanks.

[Kevin Pho, MD]

Tough to say without knowing what the workup you had was.  Things to consider would be the ulcer, inflammation of the upper digestive tract, liver disease, or possibly Sphincter of Oddi dysfunction.  The most comprehensive test to consider would be an upper endoscopy - which can evaluate for ulcers and inflammation.  I would also consider tests for a bacteria known as H Pylori - which is associated with ulcers and inflamamtion.  If positive, appropriate antibiotics can be considered.

Other tests to consider would be a 24-hr pH study to evaluate for GERD, as well as possible ERCP with Sphincter of Oddi manometry.  In regards to the latter test, this disease can present with gallbladder-like pain in those without a gallbladder.

If the GI tests are negative nor not-revealing, the pain may be orthopedic in nature - which certainly can have a relation to theback pain you are having.

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.
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