Abdominal pain-Fear and anxiety after eating

[usteve529]

Dr-

My wife will undergo a simple Upper GI series tomorrow AM at Northwest Regional Hospital, Margate, Florida.

In six months she has lost 52 pounds, due to anxiety and fear of eating. She is hungry but eating causes distress. At her worst she presents with acute pain in the chest and the mid right quadrant of her abdomen. We first had her admitted three years ago with heart symtoms that turned out to be neagative. Also had angiogram-- checked out by a cardioilogist at Cleveland Clinic , Fl.---also Negative.

In the past year and a half she has been admitted five or six times for the same symptoms. She had a endoscopy/colonoscopy in March'04,with 4 benign polyps excised at that time and was diagnosed with anxiety related spasm.

She does not respond well to the new gerd drugs at any dose, and has had them all. We have been told that her problems may be emotiional, due to stress and anxiety, for which she has been to a psychiatrist and is currently using a very caring psychologist/therapist.She has gotten some relief from Xanax in very small dosage (< 0.25 mg).

Her labs are normal. She also had a CT scan and an ultrasound of the gall bladder, in the last week that were unremarkable.

She describes her pain as wrenching, that "works its way down" from esophagus to small intestine. Lot's of eructation for relief (takes GasX) no flatulence. Much pressure.

Right now she's the worst I've observed and is discouraged and depressed due to a lack of a diagnosis.

Can ths be entirely emotional? The pain is real and was relieved this morning in the ER with dilaudin.

My wife is also a steroid dependant asthmatic. Her only meds are 5mg prednisone od,combivent as needed and nebulizer(infrequently), She's also taking 10mg Ambien to sleep.

What's your opinion?

Steve

[Kevin Pho, MD]

There has already been a thorough workup done - including upper and lower endoscopy, CT scan, ultrasound and a cardiac workup.  If there was something serious present, it would have been found with thse tests.  Obviously, the symptoms are continuing - so you may want to consider more specialized tests.

This would include a 24-hr pH study to evaluate for GERD along with an esophageal motility study to look for esophageal dysmotility.  A gastric emptying scan can be considered to evaluate for gastroparesis and delayed gastric emptying.  

If everything is negative, irritable bowel syndrome is a definite  possibility and antispasmodic agents can be considered to treat this.  

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.
Medical Weblog:
kevinmd_b

[Aaronb]

Dear Steve,

I am deeply sorry to hear about your wife's condition. I am 25 and have gone through stages of depression during my life, which are almost always accompanied by stomach pain and anixety-related spasms. Given that I am currently between jobs, they are flaring up again. While they are not to the severity of your wife's, maybe it will comfort her to know that she is not alone in terms of people experiencing these kinds of issues. I currently take Donnatal to help my stomach. I don't know if you have heard of it, but it is a stomach sedative and has provided me some help.

Wish you and your wife the best of luck.
Aaron

[kwag]

Sounds like dysbosis to me.  With the use of the steroids it could be extreme.  There is help for this.  The dysbosis (including yeast) causes the emotional symptoms.  There is a lab that has published info on dysbosis www.kirkmanlabs.com and www.mercola.com definitely has info on this.

[ShoeLover1979]

Hi Steve, I am 25 and I can relate somewhat to your wife. In Jan of this year I went in to anaphylactic shock from  a Quiznos sandwich , dont know what gave it to me, but it scared me off of food, lost 107 lbs, I was severly obese at the time. I only eat cheese sandwiches and slim fast shakes for nutrition. I recently was told that i had to stop eating eggs cause i was allergic. Im desperate to have normal life again. I have GERD, IBS, and now pain all the time in my upper left quadrant of my stomach, I feel full all the time, have horrible gas pain. This also makes me not want to eat. My Doctor just gave me Zelnorm today, I hope it helps.  THe ER didnt do anything but blood work. The doctor wants me to do an endoscopy and im terrified, I woke up during an operation once, so I hate anesthesia or anything near my throat cause of the allergic reaction. My boyfriend and mom want me to go through with the procedure anyways, but my feeling are the same. But I hope your wife can find some solice in the fact that shes not alone.

[ShoeLover1979]

I forgot to add, tell her never feel that it is "all in her head" I hear that all the time. I know my body. I am sure she knows hers. I have anxiety disorder as well. My excrusiating pain is real and not in my head. I hope your wife feels better.  Good luck to both of you.

[rell20]

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[RMClarke]

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