Sudden Stomach Fullness

[alexandria]

Hoping you can help. I am a 36-year old woman with a history of chronic constipation-related IBS, redundant colon, mild gastritis/reflux, moderate high BP and moderate generalized anxiety. For the past year, I've experienced a drastic change in my bowel habits. I've gone from mild constipation to severe, chronic constipation. Doctor has run the following tests: abdominal x-ray, cat scan, blood work, small bowel series, lower GI and colon transit study. All were negative. Have been on many meds over the past year including Prevacid, Zelnorm, Miralax and Senekot S to promote motility. Only other thing that improves motility is OTC Phazyme (3-4 per day) or antibiotics that typically cause diarrhea (I found this out after a bout of bronchitis). Recently, I developed new symptoms. Started with moderate bloating in upper stomach area, reflux, and intense sensation of heat and burning in esophagus and upper stomach. After burning started, the doctor tried me on Nexium, Aciphex and Carafate solution which seemed to make things worse. I'm now back on the Prevacid and since stopping the Carafate, the burning has subsided slightly. Of geater concern is the following: Stomach symptoms have increased over past week. I'm getting premature fullness in stomach area - left side just below rib, bloating and severe pressure cramping after eating small meals. Only able to eat about 10 bites of food before cramping and fullness begins. Cramping is the gripping type - like an over full stomach or inflammed feeling. Have now lost 3 lbs. in one week. This has also been accompanied by an increase in bad breath (my husband says it's very acidy). There is no nausea, vomitting or fever but there are mild waves of heat or burning in middle chest and stomach after eating and throughout day. Not like reflux that I've experienced before. Doctor just ran upper GI which turned up mild reflux. Now, I'm referred back to my general doctor and everyone is stumped. Finally, I've struggled with mild, ongoing anxiety over the past year - mostly due to my concern with health issues and because there has not been an answer to my symptoms. The upper GI symptoms are like nothing I've experienced to date and are adding to my fear. Since I've struggled with colon problems, does the upper GI problems signify a complete digestive system functional breakdown, or motility problem, or am I just overthinking this? Does this signify a stomach emptying problem or stomach infection? Can severe, constant anxiety and worry cause these symptoms. Any advice on what questions I should ask my general doctor? Any advice would be greatly appreciated.

[Kevin Pho, MD]

You have been through a variety of comprehensive tests for your symptoms.  The upper GI series suggest reflux.  

I would next suggest some sort of endoscopy for a more comprehensive evalation.  Since the upper GI symptoms are more recent, an upper endoscopy should be discussed.  This can evaluation for more common causes of the burning such as an ulcer, inflammation of the stomach or esophagus or a mass.  I would also test for H Pylori, which is a bacteria associated with inflammation and ulcers.  

If negative, a 24-hr pH study can also be considered to evaluate the degree of reflux.  Another study to consider would be a gastric emptying scan - this can evaluate for gastroparesis which can certainly lead to stomach fullness.

Regarding the chronic constipation, there was no mention of an endoscopy.  This would be the best test to look for any anatomical lesions or strictures that can cause the constipation.  If all the medical approaches do not work, you may want to consider surgery such as a colectomy which may help.  

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.