Stomach pain/ discomfort

[Steve_m]

This is somewhat a follow-up to a previous question. I did not word the original very well.

I have been having upper central abdominal pain, epigastric discomfort and nausea for nearly three weeks. The pain  is worst right after eating. The pain is not constant, but there is always a sense of discomfort. The entire stomach area is tender. There is some nausea but no vomiting or diarrhea. I’ve also had some chills/ shivering/ tingling but I think it is due to fear/ anxiety. I had a night sweat but it was a night where my anxiety was very high and has not occurred since.

I have been taking Nexium 40 mg for a week with little effect. Prior to the Nexium I took Prilosec 20 but there was a week where I did not take it. I have a history of GERD.

Physical exam was normal including no palpable masses. All blood work was normal.

I have seen a G.I. and have endoscopy scheduled but it is a ways off. I was unable to get all my questions answered by the doc. and would like to state them here.

1) Is it possible to have an ulcer despite being H.P. negative and having been on 20mg omeprazole? There is a history of non-h. pylori ulcers in my family.

2) I  have used significant ibuprofen in the past but stopped  several weeks ago. Could stress and too much coffee have aggravated a condition originally caused by the NASAIDS that long ago? How long should it take to heal?

3) I read a report stating that there are at least 24 species of bacteria that can cause ulcers and most are not detected by the H.P. antibody test. True/false? Should I be on an antibiotic as a precaution?

4) Could I have some type of gastritis? I’ve read that gastritis usually causes no symptoms.

5) What does it mean that the entire area feels inflamed to the touch?

6) Is it wise to wait three weeks for an endoscopy or should they be trying to fit me in on a more pressing basis?

I guess I’m trying to ease my mind in the mean time until the endoscopy that this may not be cancer, as that is obviously my worst fear. Thanks for any input.

[Kevin Pho, MD]

To answer your questions:
1) Yes, it is possible to have an ulcer despite taking a PPI and being H Pylori negative.

2) That scenario is possible.  Previous NSAID use can lead to gastritis and stress can exacerbate this condition.

3) H Pylori is the bacteria most commonly associated with inflammation and ulcers.  We do not routinely test for other forms of bacteria as studies do no suggest eradication of these other species leads to healing.  

4) It is possible that gastritis is present.  The endoscopy can tell for sure.

5) Difficult to say without examination.  Certainly many forms of dyspepsia can lead to this symptom.

6) Again, cannot say without examination - you need to discuss this 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

[versute]

Hi Steve, what you are describing is what I am experiencing, almost identical.  I've been on Prevacid for 6 weeks now, 30/mg x2/day.  I've attempted to moderate that dose down to 45mg/day, but I guess I'll stay on 60mg until my doctor thinks I'm ok.  

I have the same swollen abdomen feeling, with pain in the cental portion of my upper abdomen.  I am very frustrated with the medical community I've been seeing, as all they have done is take tests and they "pass" ok.  But that doesn't change that I am in pain.  My liver enzymes tested normal, but I am now suspecting gallbladder.  

Because the doctors weren't able to diagnose, and therefore, treat my initial complaint, I am now suffering from ancillary conditions, precipitating down from the original, undiagnosed condition.  I've lost a lot of weight in a short amount of time 20lbs/month.  I've read where rapid weightloss can exacerbate the gallbladder and lead to stones.  That is what I am suspecting.  My gastro told me, after telling him about it, that I should just go to the ER and get tested, because they couldn't see me anytime soon.  What kind of care is that??

Good luck.  I hope to hear if you've found a solution, because it might be what I need also.

[ltpainsuf4rrrr]

I've had a similar problem going on 14 years now. After 5 colonoscopies, 5 endoscopies, 3 small bower follow-thoughs, 10 CT-scans, 3 MRI's, 2 surgeries and a barrage of other studies, I am still living with this problem.

In 1994, I was diagnosed with "motility disorder of the gut" by a prominent GI doctor at a large teaching hospital. He told me I was one of the worst cases he has seen. Over the years I’ve been given over 60 different medications, most didn't help. There is one that did help and I am still taking it today. That medicine is Xanax. I take 0.5 mg before any big meal and anytime the pain flair's up. I helps more often than it doesn’t.

After my initial surgery in 1996, this was an exploratory laparoscopy and then a full cut from my bellybutton down about 4 inches. Nothing was found. When my GI doctor found out about the surgery, he told me no chance would this help my pain as motility disorders can’t be cured. Wish I checked with him first!

In 2002, two incision sites from the 1996 laparoscopy, turned into “911” pain. Horrible pain, believe to be coming form the scar tissue. My doctors then decided my gallbladder needed to be removed and another laparoscopy using the very same incision sites. After the surgery, my pain was much worst. I was immediately turned over to a pain management doctor. Initially put on Oxycontin 10 mg twice daily and this helped with both my motility pain and my pain at both incision sites. Unfortunately, the pain at my incision sites caused me to take a higher dose of Oxycontin and then because I refused to keep taking higher and higher doses, I was given 4 more different opiates during the next few years. I did come to learn that just 60 mg of Oxycontin really raised havoc with my motility problem and in my third year of taking these opiates, I began to realize I needed to be on low doses only of Oxycontin. But for the most part, I felt little motility pain as it was easily controlled by the opiates. This wasn’t the case for my incision “911” pain. It was flaring out of control.

In July, my new pain doctor did a few trigger point injections a my 2 incisions sites. This “911” pain was melting away virtually as he was injection the anesthetic. I felt so good, I asked him to take me off of the Oxycontin 10 mg, 3 times daily I was taking. So, he started the process of giving me less and less of this medication over two weeks (this is happening right now). Unfortunately, the motility pain I haven’t experienced during the past 3 years started to return. As the blood levels of the Oxycontin got lower and lower, my motility pain got worse and worse. I am not sure what my doctor is going to do for me next, I don’t want to live with this pain again. I do know the steroid he injected at the two incision sites has given me almost complete relief from that pain. This is temporary, may last about a month.

My discomfort originally started (in 1991) in my stomach. Initially it wasn’t pain, but rather major discomfort. within months that discomfort turned to pain. Unfortunately, the surgery I had in 1996 made this whole situation much worse. It is almost unbelievable I am dealing with 2 very different pain syndromes both on the middle and left side of my abdomen.

My advice for anyone experiencing major discomfort or pain on the left side of the abdomen that is virtually goes undiagnosed, is to see a pain management doctor. I have found Xanax does give some relief from pain (on it 11 years now) and discomfort (this isn’t just an anxiety drug, it is also used as a pain medicine) and if this doesn’t help with the pain and discomfort, then Oxycontin 10 mg twice daily most likely will. One more thing, because a GI doctor found gastritis during an endoscopy exam, he prescribed Previcid that I was supposed to take for the rest of my life. Fortunately, I stopped taking it one month later. A year later at the Mayo Clinic, they discovered I have extremely low stomach acid and the GI doctor asked if I was taking huge amounts of Previcid. I told him no and he told me because of the low acid, I should never take Prevecid or any other similar drug. A lesson learned, when a GI doc does and endoscopy exam have him test the PH in your gut!! Having gastritis doesn’t necessarily mean you should take Prevecid or any other acid lowering drug. If your PH is low, DO NOT TAKE ACID LOWERING MEDICATIONS! Instead you need to take extra vitamin C and 1 tsp of apple cider vinegar in 4 oz of water about one hour before eating. You need the extra acid to properly digest your food and to kill any bad bacteria in your stomach. My gastritis obviously was there for many years and may have happened at a time my stomach acid was much higher.

Please learn from my experiences, I am in year 14 of this terrible illness.

[med123]

You may want to consider the possability of trigger points.  They really are no all that serious if treated properly by a physicaly therapist.  I had a similar problem in my groin, 20 dotors no answers, ct scans, ultrasounds.  Here is a website on it, http://www.triggerpointbook.com/index.html

I just started therapy, but I went from 90% pain to 20% in only 3 weeks.  So look into it.  Good luck.

[xtremerave11]

I started having stomach pain around 7 yrs old I am now 16 and I dont know what to do anymore.It seems as the days go by the stomach pains just get worse. Most the time hurting so bad I wake up in the middle of the night not know what to do anymore. I have seen my doctor and one says its from not eating breakfast and the other one said to stop drinking(never drank before). tonight i woke up a 1:40 am and it is now 3:13 am. I have takin tums rolaids pepto bismal ibprofen pepcid ac ive puked 3 times ate bread and drank two glasses of milk. My stomach feels like a cut with rubbing alcohol on it. I figured since the doctors dont know what the hell is wrong with me or they dont care to find out maybe someone on here could help me.If anyone knows how to help me Please email me at ***@****. I would appreciate it very very much.