Acute Epsiodes Bloating - two weeks now

[seeker22]

Brief background: - M-38-good physical shape. Long term history of panic-anxiety disorder.  Three years ago - was not getting proper treatment for panic.  I was under a lot of stress from pa disorder and driving was a particular issue.  I started having episodes of extreme stomach bloating w/hard to expel air - made one trip to the ER - thought I was having a heart attack.  GI doc did endoscopy - found small ulcer at base of esophigus and some stomach inflammation.  Prescriped PPI's.  Went on Paxil - this controlled my PA disorder.  Acute symptoms went away - though still had night time/early a.m. feelings of "empty stomach" or gnawing - especially on Paxil - that were relieved with food.  Never felt PPI's really worked or any anti acid products for that matter.  I have had frequent trouble swallowing food - especially when stressed or nervous. This existed years before first endoscopy and seems to be more frequent now.
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Present:  Off Paxil for two months.  Lot's of stress, job relationship, etc. Taking Prilosec OTC for last year on/off. About one month ago started taking GNC Colon Flush - took prep part of kit on/off - with only some stomach upset.  Two weeks ago - took last dose of prep - went to work.  Had episode of acute bloating - air was trapped felt like heart attack. Almost couldn't walk.  Went to doc, EKG ok. Started having nightly epsiodes of extreme bloating and abdominal pain so severe-made trip to ER. Blood work ok for Lipase,Amylase,CBC, etc.  Went to GI doc - had Endoscopy - initial results - no ulcer, but stomach inflammation.  BM's have become less frequent-softer-smaller. Few epsiodes of loose stools. Also have pressure/numbness in lower back, left leg - which has been getting worse last few months and seems worse with bloating. I do a lot of driving/lifting and initially wrote it off to that.
I'm starting to think that I have a tumor or enlarged organ-though blood test were ok.
Other factors are: Often encounter unsanitary conditions doing yacht repair.  Pet cats with tape worm, other worms - being treated.
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Q: Can swollen stomach (assuming Gastritis) be severe enough to cause this kind of bloating/pain?
Q: Can bloating put pressure on Sciatica or nerves in back?
Q: Is it possible long term PPI treatment can cause inflammation?
Q:Is it possible two little stoamch acid is problem?
Q:I'm also taking an O&P - how likely are parasites?
Q: What test should I do next?

[Kevin Pho, MD]

To answer your questions:
1) Yes, it is possible for gastritis to lead to the symptoms you are describing.

2) I am not aware of bloating or other causes of bloating leading to sciatica.  If sciatica is an issue, an MRI of the lumbar spine can be considered to evaluate for disk herniation.

3) I am not aware of long-term PPI treatment leading to inflammation.

4) A 24-hr pH study can be considered if this is suspected.

5) Parasites would atypically lead to these symptoms.  Testing the stool for parasites or obtaining cultures via the endoscopy can be considered.

6) I would consider some imaging - such as an abdominal CT scan or ultrasound.  More specialized tests of the upper digestive tract can be considered - such as a 24-hr pH study or gastric emptying scan.

These options can be discussed 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.
kevinmd_

[yoshi]

Too little acid production can give you problem-stomach acid after saliva ,kills some of the bacteria in your food when it enters your stomach,plus it is also needed to digest your food.
If half digested food is past on to  large intestines,it mingles with the bacteria and ferment,creating gas and bloating.
Some medical researchers are looking into PPI and lung infections.

[auv]

Have you ever thought about Celiac Disease?  Your symptoms sound like it could be.  I would check Celiac Sprue Disease.  It is an autoimmune disease which there is no cure but if you are diagnosed and then start a gluten free diet you will improve.

[nancib]

Ditto on the Celiac. One important thing to know about Celiac disease is that, while not curable per se, all signs of having had it are usually erradicated as long as one adheres to a strict gluten free diet. One might wonder why after all the testing and probing, the doctor rarely comes up with the diagnosis of CD.  (Celiac Disease is a relatively easy condition to discover through blood testing and/or a simple biopsy during scoping of the small intestine.) Consider this: Doctors would not make much money if they gave people this diagnosis because  people would then no longer need their services; in addition, and in all probability, people would wind up keeping all the obviously necessary organs with which they were born.
   NOTE:  Celiac has no "classic" symptoms
          It can, and eventually does affect all organ systems.
          A conservative estimate is that 1 in 200 people have
          Undiagnosed CD--some experts believe it's as high as
          1 in one-hundred.
          If gluten is not removed from the diet, celiacs have
          twice the mortality rate of the general population.  

[gwarren]

I had a very similar thing happen to me about 10 years ago.  I had severe bloating and stomach pain.  The first night I did not sleep and went to the E.R..  They did the usual treatment EKG and gave me $800 worth of Mylanta.  Anyway, the pain was localized right at the location where my esophogus enters the stomach.  I slept on my back for six months because I was too bloated to lay on my stomach or sides.  I had all the test catscan(sp?), ultrasound, endoscopy, etc.  Six months later I finally had a 1st year resident suggest that I get off caffeine.  I eliminated caffeine from my diet and three days later all the symptoms went away.  I have not had any caffeine sense then.  Allergy to caffeine?  Seems so.

I have an identical twin brother and the same thing happened to him.  His doctor first tried all the test and then put him on anti-anxiety drugs; which he says did actually help.  However, he ultimately eliminated caffeine from his diet and his symptoms also went away.

My two cents.

[2youngtobesick]

Sounds fairly similar to my symptoms.

I'm only 30 in good physical condition, been under an extreme amount of stress this year, with the new job, lost my dog that I was extremely attached to and it was my fault, girlfriend, extended family illnesess, and built new house.

My symptoms started out as just pressure/slight difficulty breathing.  Just became uncomfortable cuddling, like it was cramping my air space.

Progressed to severe abdominal pain, flushing, nausea during a vacation of all things. Went to doctor and was thought to be having altitude sickness....right.... I go there every year. After 6 days, pain subsides for unknown reason.  Heck with the doctors at yellowstone.

2 months later, abdominal pain and symptoms are back, although not much nausea.  I thought ulcer for sure considering the stress.  Tried zantac at first for a week then went to doctor and was on 4 different proton pump inhibitors.  Doctors just assumed I had an ulcer, they were wrong.  I also started getting pain in my arm/leg on my left side, like nerve pain.  Deep back of my leg, usually calf, back of knee, or hamstring.  The arm was in the inner bicep and up by my wrist.  Also starting getting pain in upper left quandrant but kind of think it's above breast bone.  Seemed to have bad circulation on both sides, easy to get pins/needle feeling.  Had ekg because I was panicked.  I never had a panick attack before, but found myself not knowing what to do with myself the pain was so bad and I ended up walking around town at 4am trying to settle down.  All I could think about was how everybody was in bed cozy asleep not understanding how lucky they were while I was feeling worse than anybody in the world. I've never felt this low and sympathize with anybody that has the experience, I can't think of anything worse.

This was very difficult to deal with and the ER had given me hydrocodone for the pain (bad for stomach problems).  The pain is so intense most times I won't leave the house and get easily irritated and don't want to do anything.  If I had to leave for groceries or doctor appt I would take a pain killer an hour before.  Seem to get me through, then the pain would get worse, I presume because what it was doing to my stomach.  

During this time I cut back to a very restricted diet, mostly peanut butter sandwiches.  After getting to a gastroenterologist, got an endoscopy immediately to find nothing. I was bummed big time.  Also quit pain meds. The following tests were chest x-ray, ultrasound, and barium study. All normal.  I was given a low dose anti-depressant to help suppress pain, seemed to work a bit in my stomach, but other symptoms were worse.  In fact, the slight amount of light headedness turned into almost passing out everytime I got up.  Doctor didn't recomment, but after 7 days, I quit.  The next day the light headedness went away.

So 2 1/2 months into this constant pain we do a breath test for stomach bacteria/fructose intolerance.  POSITIVE.  By the results they thought fructose intolerance.  Then I do another breath test with glucose? to test just for the bacteria. NEGATIVE.  Bummed again.  So I quit absorbing fructose products (eliminated all fruits/veg) and changed bread, symptoms improved some.

It is really hard to figure out what to eat.  I could nearly get by now, by no means could I work or let anything stress me out as they aggrevate big time.  Started eating yogurt for the probiotic factor incase I had the bacteria and also some other milk products. BAD IDEA.  I've had a VERY difficult time for 2 days/nights.  I always have lots of gas, but this made it worse.  Thought heart attack again it was so bad.  I would constantly get woken up with racing sensations, elevated heart rate. Scary.

That was the last couple days, I feel a little better tonight so hopefully I will sleep better.  I don't have the answers as of yet, but seem to be on the right track.  I think I have IBS with gasious problems and anything high in fat or things that product gas kill me.  I've know some things like fruit juices/maple donuts/syrup really bothered me so the fructose thing I think is real to atleast some extent.  But I also think I may have celiac or something because my condition has been better but not cured by any means without the fructose.  My grandpa has celiac and chronic diarrhea.  But I never have diarrhea so its kinda strange.  I also think the arm/leg pains are from malabsorption.  I have lost 12 pounds the last 3 months, I was only 150 to begin with and don't fluctuate but 2 lbs usually.

They want me to take another low dose anti-depressant.  I've never taken drugs before these problems, not even tylenol.  So I'm against it unless I'm desperate.  I think I'll try the gluten diet and see what happens.  I also have anxiety drugs in my drawer, but didn't take them either.  What has helped immensily with the anxiety is deep breathing and an acceptance of my position in this world.  I just decided if I die, I don't have kids to support and It would be a burden on my family, but I'm not afraid myself.  If God says it's my time, I'm ok with it.

Hopefully this helps somebody.  I know reading other people's symptoms has eased my fear of heart attack and realized that IBS and food allergy's/intolerances can cause SIGNIFICANT problems that need addressed immediately.

[HookedOnFiber]

I feel the pain.  Some months back I started experiencing episodes of pain that awakened me at 3:00 AM.  It felt like the pain I experienced when diagnosed with an ulcer.  I went to the trouble of scheduling a 'scope.  Because of some scheduling issues, the endoscope and a previously scheduled colonoscopy occurred in the same week.  So, twice that week I was out under anesthesia

Three days after the second scope, I passed something that looked like a small clump of "brain tissue" (lumpy, with an appearance of being coiled).  Did some Internet research, collected another specimen, had it analyzed, results showed nothing abnormal, got frustrated, collected another sample, and dropped it on the doctor's desk.  "You've got a roundworm infection", he exclaimed.

My point is, don't overlook the possibility of intestinal parasites contributing to some of the symptoms you are experiencing.  There are approximately 4 million undiagnosed roundworm infections in the U.S.  BTW, one treatment did NOT clear it up.