Intermittent Stomach Problems Now Chronic?

[rider_cslsx]

I am a 33-yr old male who has had intermittent stomach problems over the last 5 years or so, particularly after a night of heavy drinking or eating right before bed.  Symptoms would be burning, nausea, and gnawing in the upper abs.  I took myself to the ER because the pain was so bad.  I was hit severe nausea and cramping on these occasions but never any vomiting though.  I saw a gastro doc who performed an endoscopy but found nothing.  Over the next two years I would have a bout of diarrhea that coincided with a general feeling of malaise and achiness every month or so.  Recently, however, I have experienced constant symptoms that include: cramping, bloating, nausea, much gas, gurgling, diarrhea, burning, gnawing and frequent BMs.  These have persisted for approx. three months.  I eat a healthy diet and exercise regularly.  I have cut back drinking (previously I consumed approx. 12-15 drinks per week).  The only explanation that I have for the sudden “chronic” nature is that I was diagnosed with Herpes Simplex 1 (whitlow – on the finger) right before the symptoms occurred.  I went to another gastro doc that took another endoscopy but, again, was unable to find anything (save a little redness).  Biopsy came back negative.  Seems my symptoms are most consistent with dyspepsia or IBS.  It seemed odd to me though that the symptoms came shortly after the infection…which led me to gastroparesis.  I also read about something called visceral hypersensitivity that can account for chronic stomach problems after an infection or disease.  So I am left unsatisfied with the docs diagnoses and ongoing GI problems.  Stress levels have been up over this period due to not only the symptoms but a variety of other reasons, including a recent move, family issues and the very fact that I was infected with HSV1 (from a gal with genital herpes, I never contracted an STD before).  Any help or guidance is greatly appreciated here as my quality of life has been diminished.

[Kevin Pho, MD]

The upper endoscopy would rule out many of the major upper GI disorders, like an ulcer, GERD or inflammation of the upper digestive tract.

More specialized tests like a 24-hr pH study, esophageal motility test, or gastric emptying scan can be considered to further look at your symptoms.  

The liver and gallbladder can also be imaged with an ultrasound, since diseases here may lead to your symptoms.

If the tests remain negative, irritable bowel syndrome can be considered.  Treatment in this case would involve increasing the amount of fiber in the diet, antispasmodic agents, or the antibiotic Rifaximin.

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_

[yasseramir]

Dear Mr.
After those multiple negative endoscopes, may be attention ll be directed to the hyperacidity although it will not explain the diarrhea'chronic', IBD could be a differential diagnosis.
I recommend also considering FMF , depending on the original race.
Inaddition to NUD. so i recommend also Stool analysis with C&S, and colonoscope with biopsy specimen
please discuss such suggestion with your \physician.
Regards
Dr.Yasser M.Amir