Gastritis or something else?

[Alisa__0]

  I'm a 32 year old female.  For a number of years, I've had intermittant trouble with irritable bowel syndrome, particulary under times of stress.  Last summer and fall, I began experiencing something like anxiety or panic attacks, during which I experienced palpitations, tightness in my chest, as well as stomach upset.  The heart and chest sensations have improved, but I have over the past six months or so noticed an increase in my GI symptoms.  
  The symptoms are perplexing to me:  I feel a gurgling or gassy or gnawing sensation on my left side from under my ribcage and down.  Sometimes I feel the urge to burp; sometimes I feel the urge to pass gas...sometimes both.  The discomfort is worse at night; it used to be worst at night when I'd lay down, but now I notice it throughout the afternoon and evening.  It's as though I coudl trace the food or gas or whatever bubbling from that point under my ribs downward.  It's generally not painful, just uncomfortable.  My abdomen is tender in that area--left sidejust below ribcage and slightly toward the center.  Loosening my clothes helps a little with the pressure.  I feel hungry all the time, and nibble a lot.  I've gained 5 or 6 pounds over the last few months.
  My doctor said it's gastritis, and prescribed cymetidine two weeks ago.  I've been taking that, and have also cut down on chocolate and sodas (a coke or a snack maybe once a day).  The symptoms don't seem any better.
  What is this?  Does it make sense that I feel both the burping and flatulence symptoms?  Do I need a different medicine, or more dietary changes, or more tests?  Is it stress related?
  Thanks.
Dear Alisa,
Your questions address a common clinical problem.  As we have discussed
in this Forum previously, abdominal pains, gas and often irregular bowel
pattern are frequent symptoms of irritable bowel syndrome.  (This
diagnosis is made after other diseases that can cause these symptoms
have been excluded).  The goal is to regulate your bowel pattern.
Towards this end, it is necessary to increase the amount of fiber that
you ingest by either changing your diet (more salads, whole wheat bread
etc ) or by taking a commercial preparation such as Metamucil.
Increasing the fiber in your diet will exacerbate your problem with
gas.  In many patients, the resolution of the pain is so beneficial,
that the slight increase in bloating and gas is not considered a serious
problem.  To treat your gas problem, separate from the other abdominal
pain, I suggest the following.  I would stop all soda and see if the gas
problem improves.  Also, I would cut back on the use of milk and milk
products because many adults can not appropriately absorb the sugars in
these products resulting in gas and bloating.  I would also try
over-the-counter remedies such as charcoal or simethicone.  If these
approaches did not help, I would ask my physician about a trial of
Propulsid, a prokinetic agent that has been shown in some studies to
improve gas/bloating symptoms.
Based on your symptoms, I would be more likely to diagnose irritable
bowel syndrome than gastritis.
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 want, we would be happy to see you in the Division of
Gastroenterology at Henry Ford Hospital, in order to review your records
and investigate your symptoms.  You can arrange an appointment with Dr.
Fogel, one of our experts in the treatment of abdominal pains.  He can
be reached by calling the Henry Ford Physician Referral Line at (800)
653-6568.
HFHSM.D.-rf
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