elusive diagnosis?

  Dear G.I. forum,
  Please refer me to a previous post-reply if this issue has been addressed.
  I have a friend that is experiencing a G.I. problem with an elusive diagnosis.
  She is 27 years old, normal BP, normal BMI, exercises regularly, does not consume caffeinated drinks, and very little OH- (<2 drinks per week).  She eats no meat, virtually no fried (fatty) foods and has a very high level of raw and cooked vegetables and fruit intake.  She eats small meals and infrequently, consumes them too quickly.  She is on a BCP, using no NSAIDS, asprin, or other drugs, has no none allergies, and is a non-smoker and otherwise healthy.
  Her symptoms are immediate post prandial belching, abdominal distention and early satiety.  While the unusual hearty belching brings relief and subsides shortly thereafter, abdominal distention remains for a few hours.  Dietary CHOs may somewhat intensify these symptoms.  She has reported these symptoms for nearly a year and they have had variable degrees of intensity.  She has, however, responded well to PPI treatment.  Enzyme supplements were ineffective.  She frequently reports urgency upon bowel movements, which are followed by a painless gnawing feeling in her stomach area.  I guessed that this was a function of accelerated gastric emptying.  She does note high levels of phlegm after milk products intake.
  Colonoscopy -normal limits
  Endoscopy- very small hiatus hernia with possible Barrett's Disease and mild gastritis and duodenitis. Negative for H. Pylori and celiac disease as assessed by biopsy analysis.
  This analysis may suggest GERD?  However, she reports no heartburn, dysphagia, regurgitation, and no change upon recumbency.
  IBS/crohns?  However, stool is normal (and devoid of blood) and she reports neither constipation, nor abdominal pain. Mild, infrequent diarrhea is reported (And normal colonoscopy).
  This analysis may suggest peptic ulcer?  However she was negative for Heliocobacter Pylori.   She is not well suited for the risk profile: alcohol, NSAIDs, asprin, analgesiscs, smoking, aged. She is not blood type O. The symptoms do, however, support this diagnosis?
  Are there other lifestyle/genetic factors worth considering?  
  Proton pump inhibitors may be effective in relieving symptoms but they don't offer much in the way of prevention or understanding the etiology.  I'm am skeptical about the exogenous alteration of gastric pH as a healthy long term solution to this problem.
  Your comments are appreciated,
  kind regards,
  Dave O

[HFHSM.D.-rf]

_
Dear Dave O,
the investigation of subjective symptoms is frustrating for physician and patient.  The initial focus should be directed towards the excusion of structural problems using barium and endoscopic studies to assess esophagus, stomach, entire small intestine and colon.
If a structural problem is not seen, then one must look for abnormlities of function.  Delayed gastric emptying (gastroparesis) may explain the symptoms of belching, early satiety etc.  A radioisotope study to assess gastric emptying is indicated.  IF normal, then tests to rule put impaired intestinal motility are needed.
This information is presented for educational purposes only.  Ask specific questions to your personal MD.  If you wish a second opinion, we would be happy to see you at the Division of gastroenterology of Henry Ford Health System in Detroit.  You can arrange an evaluation with dr. Fogel, one of our experts in the diagnosis of gastrointestinal
diseases, by calling our Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: gastroparesis, abdominal pain, early satiety
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[carl_graf]

A related discussion, Abdominal Pain was started.