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Gastroenterology (Expert Forum)
What's up? IBD? Bilary colic ? Help!
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
What's up? IBD? Bilary colic ? Help!
by Sarah100, Apr 10, 2004 12:00AM
Can you help me? I have been having severe stomach pain and I wonder if this sounds like an inflammatory bowel disease?
For starters I am an overweight female in my late 30’s. Irritable bowel syndrome was diagnosed 10 years ago after a sigmoidoscopy. Over the years, I have learnt to put up with persistent diarrhoea and pain before opening bowels, but this is better now I take loperamide I also have urgency to open bowels (without loperamide was 5-6 times a day). Even taking two loperamide a day I still have diarrhoea most of the time and am never far from a loo.
I have a pain in my upper left side, more of a nagging pain but it is not there all the time, though it has been getting worse. I also feel something popping in and out behind my ribs on the left side. If I twist the wrong way I get a sharp pain, always in the same place and have to stretch out to relieve the pain. I was diagnosed with a large hiatus hernia. This causes gastric problems (I take lanszoprazole), and I wonder is that is what I feel popping in and out? My GP sent me for a abdominal ultrasound and it came back OK.
A year back, I developed a peri-anal abscess then a complex fistula, I have just had fourth surgery, and this seems solved (yeah!).
But my main issue is a severe stomach pain. It only lasts half an hour or so and comes and goes suddenly. The pain is persistent but cramp like. It is centralised, below my ribs. I also feel very clammy/sweaty and very faint. The last time I ended up on the floor very scared. I was close to calling an ambulance but it began to ease off. This type of severe pain has only has happened four times over last year (it began before I started taking loperamide regularly). It did seem related to bowels. I seemed constipated but within no time was also back to having diarrhoea (i.e. within half an hour). I also get a similar feeling (but not quite as bad) after an enema (needed one before each fistula surgery) hence again thinking it is bowel related.
So my questions..…does this sound like colitis or crohns? The severe pain is very short lived. Is that how it is with crohns or colitis? Is the hiatus hernia someone related? Is it not bowel related but gallstones? Biliary colic? Or is this simply bad constipation!? I am waiting for an appointment for a colonoscopy. I haven’t seen a gastroenterologist (since seeing one 10 years back). I have a great GP who wrote to the surgeon who did the last fistula surgery and she said that she would get them to send out a colonoscopy appointment. A history wasn’t taken. The surgeon said that they would do the full colonoscopy because of the pain and fistula but thought it highly unlikely that it is crohns or colitis and is just irritable bowel syndrome.
I also wonder if it is not actually bowel related but something like gallstones, but know that that would have been picked up by the ultrasound scan.
Many thanks for any advice or suggestions.
For starters I am an overweight female in my late 30’s. Irritable bowel syndrome was diagnosed 10 years ago after a sigmoidoscopy. Over the years, I have learnt to put up with persistent diarrhoea and pain before opening bowels, but this is better now I take loperamide I also have urgency to open bowels (without loperamide was 5-6 times a day). Even taking two loperamide a day I still have diarrhoea most of the time and am never far from a loo.
I have a pain in my upper left side, more of a nagging pain but it is not there all the time, though it has been getting worse. I also feel something popping in and out behind my ribs on the left side. If I twist the wrong way I get a sharp pain, always in the same place and have to stretch out to relieve the pain. I was diagnosed with a large hiatus hernia. This causes gastric problems (I take lanszoprazole), and I wonder is that is what I feel popping in and out? My GP sent me for a abdominal ultrasound and it came back OK.
A year back, I developed a peri-anal abscess then a complex fistula, I have just had fourth surgery, and this seems solved (yeah!).
But my main issue is a severe stomach pain. It only lasts half an hour or so and comes and goes suddenly. The pain is persistent but cramp like. It is centralised, below my ribs. I also feel very clammy/sweaty and very faint. The last time I ended up on the floor very scared. I was close to calling an ambulance but it began to ease off. This type of severe pain has only has happened four times over last year (it began before I started taking loperamide regularly). It did seem related to bowels. I seemed constipated but within no time was also back to having diarrhoea (i.e. within half an hour). I also get a similar feeling (but not quite as bad) after an enema (needed one before each fistula surgery) hence again thinking it is bowel related.
So my questions..…does this sound like colitis or crohns? The severe pain is very short lived. Is that how it is with crohns or colitis? Is the hiatus hernia someone related? Is it not bowel related but gallstones? Biliary colic? Or is this simply bad constipation!? I am waiting for an appointment for a colonoscopy. I haven’t seen a gastroenterologist (since seeing one 10 years back). I have a great GP who wrote to the surgeon who did the last fistula surgery and she said that she would get them to send out a colonoscopy appointment. A history wasn’t taken. The surgeon said that they would do the full colonoscopy because of the pain and fistula but thought it highly unlikely that it is crohns or colitis and is just irritable bowel syndrome.
I also wonder if it is not actually bowel related but something like gallstones, but know that that would have been picked up by the ultrasound scan.
Many thanks for any advice or suggestions.
Doctor's Answer
by Kevin Pho, MD, Apr 10, 2004 12:00AM
, Apr 10, 2004 12:00AM
It is possible that the inflammatory bowel disease is present. Other possibilities would include irritable bowel disease (which is characterized by the varying bowell habits you describe) as well as dyspepsia.
I would suggest an upper endoscopy, which would evaluate for the more common causes of stomach pain - including GERD, inflammation as well as ulcers. An ultrasound to evaluate the gallbladder as well as a 24-hr pH study (to evaluate for GERD) can be considered as well.
To diagnose inflammatory bowel disease, a colonoscopy would evaluate for ulcerative colitis and possibly Crohn's disease. If Crohn's disease is suspected, an upper GI series with small bowel follow-through can be considered.
If all the tests remain negative, then treatment for irritable bowel syndrome should be optimized.
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.
I would suggest an upper endoscopy, which would evaluate for the more common causes of stomach pain - including GERD, inflammation as well as ulcers. An ultrasound to evaluate the gallbladder as well as a 24-hr pH study (to evaluate for GERD) can be considered as well.
To diagnose inflammatory bowel disease, a colonoscopy would evaluate for ulcerative colitis and possibly Crohn's disease. If Crohn's disease is suspected, an upper GI series with small bowel follow-through can be considered.
If all the tests remain negative, then treatment for irritable bowel syndrome should be optimized.
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.
Thank you. I know you can't reply to this but thought I would add a bit in case anyone is following this tread.
I had an upper endoscopy last year (as I had been on ulcer type drugs for 10 years and my GP wanted to check how my stomach was. I wasn't getting much pain) and they said it was very inflammed with ulcers etc and to continue with the lanszoprazole. To be honest, one of those a day works wonders. They also said about the hiatus hernia. When I had my fourth op for the fistula I was told the hernia caused problems (I had already mentioned it, so they were prepared) and they had to tip the head of the bed and aspirate(?). The anaesthetist said to always mention it.
Before the endoscopy I had to stop my meds for two weeks and ended up in extreme pain – but a different type of pain to the one that is troubling me. It was sharp and focussed and didn’t cause the more systemic problems (feeling faint/clammy/BP down etc).
I will talk with my GP about gallstones and whether the ultrasound scan checked for that. To be honest I would prefer this to be gallstones as, from what I can ascertain, it will be more readily sorted.
To end on a good note – a year back I was learning all about ischiorectal abscesses and complex fistulas and now that is behind me (literally!) so onwards and upwards! Just the colonscopy …….
Thanks again.
K