Severe Persistant Epigastric Pain-39 yr old

[lesley anne]

I would be grateful for any consideration from you regarding my disabling problem.I have been ill for 8 weeks with no relief. I cannot work it is so bad.
1st wk: uncontrollable burping only .(no hiccups,no belching.)
2nd wk: nausea, cold sweats, dizziness, headache ( no fever, no vomit,no diarrhea except for one day only)
3rd wk: Extreme, severe epigastric unrenting pain that would only cease when lying flat.  2 E.R. visits- no answers.
4th wk: Epigastric pain unrelenting but now onset of small bowel pain ( Gas? but no expelling of air/gas from rectum at all.) no real large bowel pain per se. Bowel movements light colored.
Hx: s/p Lap. Chole 4 yrs ago but Epigastic pain the same.
Hx: Father died 6 months ago from GBM within 3 weeks of Dx.
The man I was to marry died at 35 2 years ago.
Tests: Abd. x-ray ( mild Ileus/told no big deal) Abd U.S. ( exteral hepatic bile duct dilatated 8.3/ told sometimes normal s/p lap.chole). Pelvic U.S. ( normal) Flex-sig 60 cm. (normal)
Barium upper GI and Barium Enema ( normal). CT Scan clear.
CBC, TSH, UA, LFT's, H.pylori, stool for parasites and Occult blood all clear.  
Told excessive secretion of Hydrocloric acid and IBS by GI doctor and put on Protonix and Pepcid. I have no heartburn or GERD sx. No lower abd. pain.  After 4 weeks of protonix BID and pepcid at bedtime I was STILL in constant debilitating epigastric pain.
I do not fit the Rome11 Criteria for IBS sx, but I read about the GUT-BRAIN connection and I decided that I was in a state of constant ""Fight or Flight" mode, perhaps stress finally threw my system into a permanent state of delayed shock. I found some Ativan that was prescribed to me when my father died but never took because I don't like MEDS>  And do you know that 12 mins. after I took 0.5 mg. all my epigastric pain subsided. Until I can get to a doctor on Monday I am taking 0.5 mg BID and I have no pain. No pain. No IBS Sx, just tiredness and weakness due to being sedentary for 7 weeks.
My questions are: Do you think i should still have an Endoscopy?
Why wouldn't a GI doctor investigate the underlying REASON for Hypersecretion of Hydrocloric acid instead of treating the Sx and putting me thru the barium enema and flexi-sig .....etc.
Given this info-  do you think my own Dx is most probably the answer or can you suggest any other tests to rule out the reason for the epigastric pain.
Thank you so much for your time and opinion--I know this is really long but I tried to get everything in.
Thanks, Lesley

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note epigastric pain.  Upper GI and barium enema normal.  You had a cholecystectomy, CT scan normal, ultrasound non-revealing.

Before attributing your symptoms to IBS, you should definitely have an upper endoscopy.  Causes for your symptoms include inflammation of the esophagus or stomach, ulcers, or a mass.  I know that you have had an upper GI series, but an endoscopy would be the definitive test.  

I would also suggest tests for your pancreas (amylase and lipase).  As for the reason for the hypersecretion of acid, you may want to consider gastrin and secretin stimulation test to evaluate for a gastric tumor known as Zollinger Ellison syndrome (which is manifested by hypersecretion of acid).  

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.

[lesley anne]

I forget to mention that I have not lost weight, nor does it disrupt sleep, I feel perfectly fine upon waking.
The GI doctor says that I don't need an endoscopy nor a colonoscopy.
Thanks again.

[krisg]

I have suffered severe episodes of upper gastric (right and left sided pain) since having my gallbladder out 5 years ago.  It took a couple of doctors and my own self determination to finally find out what was going on.  I was having these severe attacks of pain where I could barely breathe,talk or move.  It would come in waves (peak and then let go for a minute).  These attacks would last for about 5 hours on average.  I searched and searched (especially on this site) and am finally diagnosed with biliary colic.  I had a biliary sphincterotomy done in Feb 03.  It was my only option to try to find relief.  Unfortunately I only have some relief and I still get the colic sometimes.  When the dr. did the ERCP he had to pre-cut the sphincter just to gain access to my bile duct.  Then he had to do a generous cut to drain and open up the duct.  All x-ray tests showed nothing (no dilated ducts or anything)prior to the surgery.  I now know that I have a high grade of stenosis (narrowing) of my bile duct.  My only saving grace was that my liver enzymes were elevated during the severe attacks.  I had to get the ER visit reports to prove to the doctors that something was going on.  Otherwise they chalked it up to IBS!  I have had many endoscopies and that is a great place to start.  Keep trying to find answers.
Good Luck

[lesley anne]

Thanks for your input, Kristin.
My GI Doctor STILL says that I don't need an endoscopy.
He tells me that I have severe Gastritis and IBS and that I must keep taking Protonix for 4-5 more weeks. And Pepcid.
It makes no difference to the constant pain whether I take the meds or not.
The only thing that works is Ativan and/or Vicodin, but I don't want to rely on those as they just "mask" the problem.
But whats strange is that I feel perfectly fine when I wake up in the morning-no pain...I feel absolutely normal...for about a hour and then the pain starts all over again. It doesn't matter if I eat something or not--everyday is the same.
Perhaps this is a "functional" problem--although the Barium Upper GI didn't reflect this.                                          I certainly hope not because I can't imagine going thru life with this constant pain.
Anyway, thanks again for your input.

[krisg]

You might consider another gastro. doctor.  An endoscopy can put a definite diagnoses on many stomach ailments.  As far as I know, gastritis can only be diagnosed by endoscopy.  How did your doc. come up with that one? H. Ployri (sp?) is common also, and can be diagnosed with an endoscopy.  I usually have an endoscopy done every 2 years because of my history.  (SOD,Sphincter Spasm, Biliary Colic, whatever you name it)
IBS tends to be the diagnoses of choice, when all other tests come back negative.  Like I said,  I have been fighting this thing for 5 years now.  I finally came across a doctor who was willing to listen to me for more than 5 minutes.  Of course I had to have some kind of documentation also for backup.  

[carrieann]

I to have had severe pain .I have had my gallbladder removed, ercp,endoscopy,barium test and they still have now ideal what is wrong. They dont understand how bad the pain is. Sometimes it last for several hours. Pain medicines just make me sick. I understand how you feel, I wish i knew what was wrong or had a clue.

[carrieann]

I to have had severe pain .I have had my gallbladder removed, ercp,endoscopy,barium test and they still have now ideal what is wrong. They dont understand how bad the pain is. Sometimes it last for several hours. Pain medicines just make me sick. I understand how you feel, I wish i knew what was wrong or had a clue.

[shadie]

I'm wondering if anyone can help me, please.  I am 57 years old and female.  Within  the past couple of weeks I have started to have epigastic discomfort that feels like slight waves of nasuea several times a day throughout the day and even sometimes waking me up.  I feel fine otherwise; but, seem to feel the need to burp alot which is not associated with eatting and I have not had before.  Any ideas?

Thanks.

Shadie

[shadie]

I'm wondering if anyone can help me, please.  I am 57 years old and female.  Within  the past couple of weeks I have started to have epigastic discomfort that feels like slight waves of nasuea several times a day throughout the day and even sometimes waking me up.  I feel fine otherwise; but, seem to feel the need to burp alot which is not associated with eatting and I have not had before.  Any ideas?

Thanks.

Shadie

[Shannon Dawn]

I am a 31 yr old mother of 3....I have suffered for a year now with a pain in my upper middle stomach.  I have tried to get help from 2 doctors but they continue to treat me for acid reflux.  My symptoms are exactly as some of you have described. The only relief I feel is when I can lay flat on my back.  It is the same whether I eat or not.  I feel great when I wake up but within an hour I feel alot of pain.  Somedays are better than others.  I sleep fine each night.  I feel nausea throughout the day off & on.  I get severe gas pain but my body does not release any air.  This is a miserable feeling.  I have began to log how I feel through the day so maybe my doctor can see.  I have had a test for my gallbladder that came back normal.  The doctor has ruled out an ulcer.  I just feel constant pain in my upper stomach, gas & sometimes headaches.  Can someone help me figure out what to do next?  I cannot imagine living this way.  I am too young to feel this old!

[Shannon Dawn]

I am a 31 yr old mother of 3....I have suffered for a year now with a pain in my upper middle stomach.  I have tried to get help from 2 doctors but they continue to treat me for acid reflux.  My symptoms are exactly as some of you have described. The only relief I feel is when I can lay flat on my back.  It is the same whether I eat or not.  I feel great when I wake up but within an hour I feel alot of pain.  Somedays are better than others.  I sleep fine each night.  I feel nausea throughout the day off & on.  I get severe gas pain but my body does not release any air.  This is a miserable feeling.  I have began to log how I feel through the day so maybe my doctor can see.  I have had a test for my gallbladder that came back normal.  The doctor has ruled out an ulcer.  I just feel constant pain in my upper stomach, gas & sometimes headaches.  Can someone help me figure out what to do next?  I cannot imagine living this way.  I am too young to feel this old!

[B Aitch]

I am a 43 year old mother of 2 and have been suffering with upper left gastric pain for nearly 8 weeks now.  About 3 years ago, I was dianosed with acid reflux and have been taking Losec daily ever since.  I have had intermittent problems with indigestion pain over the past few years, but 8 weeks ago the 'indigestion' pain became very severe.  I felt as though I was going to pass out and then had heart palpatations, chest pain, and difficulty in breathing - yes, I thought I was maybe having a heart attack.  I saw a doctor and was sent through to the emergency department.  They did ECG's and heaps of blood tests, all results normal.  I have been to the emergency department 3 times with the same symtoms.  I have had a CT scan of my abdomen, a scan of my heart, and a gastroscopy - all normal.  Now, I feel that I have a 'baloon' under my left rib cage, I have burning in my mid and upper chest, a lot of pain around my collar bone, right sided cramp feelings, upper arm tingling, and pain between my shoulder blades.  I often feel light-headed and that I may be going to faint (although I never have).  I am very sensitive to cold, I am often fatigued, and have lost 5 and a half kilo's in 7 weeks.  I've been back to my G.P several times and am now being teated for stress and am on Clonazepam to help me feel calm.  The thing is, I am stressed ... but this is because of the pain (real pain) and not knowing what the heck the cause of it is!  I have run out of sick leave, but still find it really hard to work a full day, so it's affecting us financially as well.  One other thing - about 3 months ago, I had a scan of my thyroid.  I have nodules and some sort of lesion, but am still waiting for a biopsy on this.  The thyroid function tests came back normal, but thought I should mention this too.  Please, any idea's or thoughts on what else I can do would be very much appreciated.

Bev.

[dawn53]

A related discussion, Epigastric discomfort with gas and occasional cough was started.