Unexplained nausea and severe sharp abdominal pains

[Hannammm]

      
Hi,my name is Hanna. I am 17 years old, and a senior in HS.

     I was diagnosed with Juvenille Arthiritis four years ago. I was placed on methotrexate and I began to take anti steroidals (NSAIDS) around the clock with no breaks. I was told if I followed the instructions on the bottle and didn't overdose that I would not have gastro problems. After a few months of methotrexate and NSAIDS, I developed persistent nausea. I had told my rheumatologist and called over twice a week with stomach complaints. 8 months later there came a point to where I was doubled over in pain. I couldn't sit still and my stomach had severe pains and nausea. I was advised not to go to the hospital unless in dire need (we didn't know what exactly dire need meant- but our nurse told us to never go to the hospital because I have an autoimmune disease) (now looking back I realized that I should have gone to the ER). For 6 days I was doubled over in pain, everything I ate was quickly thrown back up and I couldn't get comfortable, not even to sleep when I was exhausted. Finally, we went to my pediatrician and she immediately got us into a GI doctor and we had a upper GI scheduled that week. My rheumatologist still believed it was nothing. He explained that the results looked what looks like extreme celiac disease. My atrius villi was off the charts inflamed at the beginning of my small intestine and he found an abundance of ulcers. Later, he told us that he believes it was the side effect of methotrexate. We finally swapped rheumatologist a because he still recommended that we take methotrexate... I was then placed on high levels of prednisone and in 6 months I was rescoped and he was pleased with the outcome! (Possibly due to the prednisone?)
     A year later (currently) I am experiencing persistent nausea, severe lower (sometimes upper) abdominal pains, and heart burn. All of my symptoms seem to get worse at night and it wakes me up 2-3 times a night. It seems that whenever I get hungry it gets worse- but then when I eat something it gets worse anyways. I went to the ER for extreme nausea a few weeks ago, with sharp abdominal pains and extreme nausea; they took ultrasounds of all of my main internal organs and thought everything looked fine, diagnosed me with gastritis, gave me medicine for the nausea, and that was it. (I Normally have to take 16-24 mg of zofran to get the nausea to calm down which I know is against the directions but I am unable to sleep and function normally without it and no one can provide answers.) I do not have diarrhea but I have had chronic constipation my whole life.
     This week I had a salad with acidic dressing and somewhat spicy chicken, and within an hour/hour and a half I was doubled over in extreme nausea and extreme sharp pains with 9 bouts of diarrhea in an hour time span. It had been the worst pain I had ever experienced in my life. I was blacking out when the pain became unbearable and my whole body began to shake. (I'm not sure if I was dehydrated because I drink 2 quarts of water before 12:30 when I get home). And this pain cycle only seems to be getting worse. (It could be coincidence but when we decreased the prednisone this past month I did have a flare with my nausea, but we reduced it a few weeks later and it wasn't as bad). I do have lots of had an cramping, (I've had a belching problem since I can remember) I have migraines but they are treated with amitriptilyne and are at ease for now. The more nauseous I get the worse I get, the more I eat the worse I get, and at night it peaks. I do have a hand tremor which causes my hands to shake all the time and sometimes occurs in my whole body. I do not vomit, as I try everything in my power to prevent myself from vomiting I absolutely hate it. I treat my constipation with miralax so my constipation is at ease and my other symptoms still persist. I also take nexium for acid reflux, and am on 7 mg of prednisone.
     I have done many many tests: a gastric emptying study which turned out fine. I did a contrast MRI which turned out that he was worried about something at the beginning of my small intestine that I cannot pronounce nor spell. They have done blood tests of all sorts of things, and everything comes back fine. I eat a grain free, dairy free diet and excersize daily.( I take actemera the biologic- and I have gone through many many biologics without a good impact on my arthritis but actemera seems to be working for me.) All of my tests come back normal and it seems like I am out of options and solutions, but I am getting way worse. I love school and do very well- I hate to miss it and I am late at least 2 times a week because I am doubled over in pain.
Any suggestions would be so greatly appreciated.
     Thank you for reading; I appreciate it so much. If you have symptoms like this please let me know, anything can help right now.

[jemma116]

Sorry to hear that you have had these awful symptoms and on the most part by the sounds of things, damage to your stomach as a result of using anti-inflammatory drugs.  I am glad that you changed the rheumatoid specialist.  It is well know that anit-inflammatory drugs can damage the stomach as well as the liver and kidneys.  People have been known to die from using these medications even when taken as prescribed.   I suffered from an adverse reaction (not related to stomach issues) from taking Ibuprofen as prescribed.  

If you are still using anti-inflammatory drugs, you should be prescribed with a stomach protecting medication like Omeprazole or stronger to protect the stomach.  Unfortunately, it does appear that you have ulceration of the stomach due to using the anti-inflammatory drugs, but having said that, bacterial like Helicobacter Pylori can also cause stomach ulcers and bowel problems with severe stomach pains.  A blood test is not a reliable test for this - A breath or stool test is nowadays done.  Sometimes the ulcer is examined to see if has been caused by the bacteria.  Treatment for Helicobacter Pylori is by 2 different antibiotics as well as a stomach remedy.

Because you still have problems and experience severe constipation with cramping, have you had a stool sample or a breath test done to check for Helicobacter Pylori?  Blood tests are not reliable when testing for Helicobacter Pylori (see above)

Avoid ALL fried and highly spiced foods. Boil, poach or steam your foods, you may be fine with roast foods as long as there are no fats.  You may be OK with coconut oil.  You can eat this oil, cook and bake with it as well as use it for cosmetic purposes.   Keep a written diary of everything that you eat and drink and write down how you feel and any symptoms that you experience.  This may help you to find the foods or drinks that aggravate your stomach so that you can avoid them.

Even inflammatory diseases can be affected by what you eat and drink too.
There is a book available called "Foods that Harm and Foods that Heal".  You may find lots of information on the web about the foods to avoid that are known to trigger off inflammation.  

Eat small amounts of food, little and often, rather than 3 meals a day.
You probably already know about the foods that you can and cannot eat to avoid your symptoms getting worse.  If you eat bread, biscuits and cakes, even though they may be suitable for you, I would personally avoid these for a few weeks or more to see if your symptoms subside.

Cut out ALL processed, sugary and junk foods.
Eat the fresh fruits and vegetables that are OK for you.  For example, avoid oranges and orange juices and fruit sqashes, you may be fine with diluted apple juice.  You may find apples OK for you.  Avocado pear may be OK for you.  Avoid all strongly flavoured foods like garlic and onion.  

You may find herbal teas and especially camomile tea soothing.  Use arrowroot for thickening instead of corn flour.

Never eat too late into the evening and before going to bed.  And do not lie down or bend after eating and drinking anything, wait at least a couple of hours.  These things will create the acid reflux to come up into your throat.  That is not a good thing as it can corrode the throat tubes and cause damage to the vocal chords.

Have you ever had a barium swallow test done to see if your acid reflux is caused by other issues other than the ulceration of your stomach lining?  If not, it may be worth getting that done.  I suffered from acid reflux a lot, especially being woken up in the middle of the night trying to avoid vomiting.  Mine was found to be a deviation of the oesophagus.  My husband's problem was found to be a hiatus hernia.

If the stomach remedies that you are taking are not helping you, there are other medicines.  My husband takes Pantoprazole as prescribed and Gavascon if he needs something extra when he has indulged.  The change in way I cook has also helped a lot too.

The doctor can prescribe stool softening medications to help relieve the constipation.  Be aware that if you get severe pain, that sometimes can be due to a blocked or inflamed diverticula pouch.  So do get checked out if your pain is severe.

The balance of you gut does not sound very healthy and you may benefit from the good bacteria that is found in natural yogurt.  I do not know if you are OK with yogurt, if not, you may be OK with sauerkraut cabbage, which can be eaten straight out of the jar, or cooked.  Not to everyone's taste though!

If you are prescribed with antibiotics, do ask your doctor to prescribe Itraconazole or other antifungal medication to take by mouth.  Antibiotics not only kill off the bad bacteria, but also the good bacteria.  Not only will you gut flora be not good, you can also end up getting fungal infections.

You can purchase capsules that contain the god bacteria, but your doctor may be able to prescribe these for you.  Talk to your consultant about this, before buying it yourself.

Do remember too, that stress and anxiety can play havoc on your health too.  Sometimes, stomach problems can be caused by stress and anxiety.  

Ensure that you do some form of physical activity when your arthritic problems are not acute and also ensure that you get plenty of rest and sleep.  I find that if I overdo things and get too tired, everything gets so much worse.

Let me know how you get on.

Best wishes.

[AndRynne]

Given the combination of medications that you have been on it is almost inevitable that you would develop either duodenal ulcer or chronic gastritis or both.