10 month long stomach ache

[zonia]

For the past 10 months, I have been experiencing daily stomach discomfort in the form of gnawing, burning, belching, etc.  An upper GI and an esophogram(sp) were both negative.  Gallbladder was also checked and is fine.  Had an endoscopy done which showed a hiatal hernia as well as Schatzki's ring in my esophagus.  My doctor also says that there is a piece of my pancreas in my stomach but that this should not be causing the pain.  No signs of GERD, though.  My doctor says that it may be non-erosive GERD.  Either way, I've been taking everything from Protonix to Nexium to Prevacid and nothing has worked.  Now I am taking 2 Prevacids daily and I don't feel any better.  Rather, now I am having dizzy spells and I don't know if it is from such a high dosage of Prevacid.  

What strikes me as odd about this is that before the day the pain began 10 months ago, I had never experienced any heartburn or reflux-like symptoms.  From one day to another my life changed and has not gotten better.  I like my doctor.  He is a sharp guy.  But I wonder if some oter condition is being overlooked.  Thanks for your help.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You are describing dyspepsia - simply described as upper GI discomfort.  You have had a thorough exam, including endoscopy and upper GI series.  You stated your gall bladder was "checked" (I assume via ultrasound - this should be done if not already).  No signs of GERD.  Endoscopy showed a hiatal hernia and Schatzki's ring.  You have taken a variety of anti-acid medications without success.

A couple of considerations.  I would first check the pancreas with a CT scan and amylase/lipase to make sure chronic pancreatitis is not present.

With a documented hiatal hernia, I would also consider a 24-hr pH study to make sure that GERD isn't present.  If there is evidence of GERD and is not being treated with the medications, the surgical treatment should be considered.

I would also check for a bacteria called H Pylori that is assicated with dyspepsia.  If positive, antibiotics can be given.  

If all the tests is negative, then functional (i.e. non-ulcer) dyspepsia may be discussed.  This is simply upper GI discomfort without a clear cause (i.e. all studies are negative).  Unfortunately, no medication has been shown to consistently work in these cases.  Anti-acid medications, anti-depressants, pro-kinetic agents (i.e. Reglan), and hypnotherapy have all be tried with varying success and should be discussed with your doctor.    

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]

have anyone ever considered their lifestyle,esp their eating habit and what they eat and drink??
i know japanese learns it the hard way,raw fish,raw urchin,raw squid and raw god knows what,then wash it all down with that sake and then comes a bowl of hot noodles from the vending machine loaded with preservative.as if this is not enough,here comes brine soaked and salt preserved turnips etc,and you wonder why stomach cancer is so prevalent in the land of rising sun.
prevacid is a japanese drug,think of it.
and what about the land of good cheap eating-all the all you can eat buffet,they throw a few bad pieces with the fresh pieces,chinese boasts 100 dishes in one setting,how about the mexican dishes-you like it hot ugh??hot spices hide the bad rotten meat,so you wont know.talk about what you dont know WILL HURT YOU.
Gulp it all down with that powder mixed ice tea??
so wise up,and eat sensibly.
it does not hurt to fast and meditate every now and then??must we all eat and drink to oblivion!!!!!!!

[zonia]

Okay, that comment does not really help me.  I am 5'6 and 120 lbs.  I don't think my problem is too much eating.  I do not indulge in raw anything.  In fact, I am allergic to all seafood and have not eaten any since I was 4.  I would like help in finding out what is wrong with my stomach.

[yoshi]

2 prevacid a day??
i am taking one a day for 2 days now and before that i took nexxium,prilosev,zantac,gas x extra,alka seltzer and soda .
i keep some cranberry juice in my fridge and also fruit popsicles.they help me especially  after i eat.
pineapple juice has acid too,but i dont know if the calories are higher.

[Philip1815]

.

[zonia]

I didn't realize this was a board used for expressing one's political and social views.  Maybe I'll seek help for my stomach on the C-SPAN page.

[yoshi]

we are what we eat.
some folks eat red meat,some like sushi,some like it HOT.
i am just pointing out the diferences.
all food goes to our stomach!!

[yoshi]

i hope you are not offended by my candid speaking.
most of the postings are made by people who have already seen doctors and undergone exams and tests,it must be frustrating to find that their problem has not gone away.
please delete my prior posting as i dont want to offend any person or group of persons.

[bwstone21]

First- I just wanted to say that comments should be made in a considerate manner, since those who post questions are somewhat vulnerable.  They make their lives and medical history public searching for help for themselves and those with similar problems who may benefit from reading these forums.

Second- Zonia, not being a phisician I dont know what your diagnosis might be, but I do know that it might be helpful to Dr. Kevin or others to know some of the doses of the PPI's you have tried (as well as the strength of the Prevacid, 15mg or 30mg) and any other medications you may currently be taking just to rule out possible adverse drug reactions.  Like you mentioned above the dizziness may possibly be related your current Prevacid therapy, since that is a possible side effect of this medication.  These drugs, however, have shown to be relatively well tolerated.  In fact the doses can be pushed much higher than usual when the are used for hypersecratory conditions.  I personally know a couple of people who have tried most other PPIs for their GERD and have only found success with 80mg/day of Prilosec.  Hopefully Doctor Kevin will have some insight to help direct you.  Don't lose hope, just keep following up with your MD, and if need be ask for a referral to a specialist (if you haven't done so already).  I wish you well.

B

[tessa0825]

Please do't get discouraged, just wait and see what Dr. Kevin advises you to do....I would think that with the hernia and shatzki ring that you would be having reflux...Otherwise, Im not sure what they would have you on all the different PPIs? I agree that if you arent seeing a Gastroenterologist you should ask to be referred to one.......Most people are compassionate and try to be helpful, focus on that!!!Take care, Tessa

[TLynn]

I too experienced upper stomach pain for 6 months.  Also had all the tests and everything was ok.  I got really frustrated as I can hear you are.  The final diagnosis was dyspepsia and possible stomach spasm.  I started taking Levsin and it all soon disappeared.  However I have had two days of reoccuring pain but it subsided that day.  Don't give up.  I kept pushing my Gastro. Dr. to not give up because I was so unconfortable and I lost 40 lbs in the 6 months, because I could only eat a couple of bites of food at a time. Good luck, you are not alone.
TLynn

[TLynn]

Just an after thought.  I also tested postive for HPylori and went through the 14 day antibiotic series which took care of it.
Have you had the test?  TLynn

[Asvab]

A related discussion, never ending stomach ache was started.