upper abdominal pain / recurring

  my girlfriend, aged 23, has been suffering from upper
  abdominal pain. the problem seems to recurr every 1-2 months,
  and began when she was 13 or 14 years old.
  she describes the pain as lying just at the costal margin, in
  the center of the upper abdominal area, and extending from just
  behind the ribs, through to her back. the pain persists for about
  3 days at a time.
  the pain is initially of low intensity, and seems occur (or peak)
  mainly at night. the pain often causes her to wake at night.
  she feels that the pain may correlate with consumption of caesar
  salad (but not vinegar by itself), salad with italian dressing,
  pizza (sometimes pepperoni pizza).
  no problems with eggs, bread.
  raw vegetables and fruits seem to exacerbate the problem if her
  stomach is
  already upset. from her descriptions, her stomach seems to be
  extremely sensitive during these periods, and she tends to prefer
  relatively bland foods, such as boiled, unseasoned chicken and
  bread with butter.
  she reports vomiting at some times, though she does not actually
  feel nauseated. rather, she induces vomiting because it seems to
  relieve the symptoms.
  any ideas?
  thanks.
  michaelc cohn
______________________________________________
Dear Michael Cohn,
Unfortunately, it is difficult to determine the cause of abdominal pain on the basis of history alone.  It is routine to order a variety of tests to exclude the different possibilities.  Based on the information that you provide several diseases are raised.  If the pain occurs monthly, it is possible that it might be related to menstruation, although the location would be unusual.  Nevertheless, it would be appropr1ate to exclude the possibility of endometriosis.  The location of the pain in the center of the abdomen with extension to the back makes me also consider pancreatitis.  Does your girl friend drink acohol and is the pain related to alcohol use?  Is there a family history of pancreatitis?  Another possibility is that the pain is related to acid secretion e.g. gastritis or esophagitis.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician. If you wish to be seen at our institution, Henry Ford Hospital, please call our PHYSICIAN REFERRAL LINE at(313) 876-2393 and request consultation with Dr. Fogel, one of our experts in the evaluation of abdominal pain.
HFHSM.D.-rf
*keywords: abdominal pain, endometriosis, pancreatitis
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