extreme cramping with 'feces smelling' vomit

[jesuslover3]

My daughter,age 25, is experiencing extreme stomach cramps about once per week.  At that time her belches and vomit smell like feces.  It is mostly undigested food from the previous evening meal mixed with brown nasty-looking stuff (looks a little like feces too).  She had her gall bladder out 5 years ago and she says this feels like gall bladder but more in the center, than to the right.  She also has hypermobility syndrome. She has three pre-schoolers to look after and this is pretty disabling.  The doctor is blowing it off and wanting to wait--but it's been going on about 6 months now.  Any ideas?  She is also losing a lot of weight (not on purpose)and is very skinny now. Thank you for your time and help.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Regurgitation is the effortless return of gastric or esophageal contents into the pharynx without nausea, retching, or abdominal contractions. Patients typically regurgitate acidic material mixed with small amounts of undigested food.  This is a common symptom of GERD.  

GERD needs to be distinguished from gastritis, infectious esophagitis, pill esophagitis, peptic ulcer disease, non-ulcer dyspepsia, biliary tract disease, coronary artery disease, and esophageal motor disorders.  This is why further tests need to be done.

If there is some trouble swallowing, it known as dysphagia which is common in the setting of long-standing heartburn. Slowly progressive dysphagia for solids with episodic esophageal obstruction is suggestive of a peptic stricture.

These symptoms in the setting of weight loss is concerning.  I would suggest followup with a gastroscopy to make a more definitive diagnosis.  If the gastroscopy is unrevealing, a 24hr pH study to evaluate for GERD may then be considered.  

I strongly suggest followup with your personal physician or gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

severe cramps and fecal vomitting suggests bowel obstruction. This can sometimes be intermittant, caused by any of several things, including scar tissue from previous surgery, inflamatory bowel disease, etc. Severe cramps and fecal vomitting don't really suggest GERD, although it's not impossible. She certainly needs further evaluation; it might need to include a CAT scan or small bowel xray to check for signs of obstruction.

[kevinmd]

I agree with surgeon - bowel obstruction should be considered as well.  Given the history of previous bowel surgery, she is at increased risk for this.  

I would strongly suggest follow-up with your personal physician.

Thanks,
Kevin, M.D.