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Re: Upper Stomach Pain & Nausea

Posted By HFHSM.D.-rf on May 16, 1998 at 17:15:28:

In Reply to: Upper Stomach Pain & Nausea posted by Linda Marchio on May 12, 1998 at 11:04:36:

About 3 months ago I was a healthy 35 yr old woman.  Then one morning I felt very sick to my stomach.  I figured food poisioning from the hotdog the day before, or the flu.  I then felt nausea and pains in stomach, which seemed to get worse as I rode in the car. (Now Car sickness?-never had it before)  I seen my doctor, he tested me for H. Pylori due to the burning in my stomach, lose of desire to eat, it came back in my blood very high.  He put me on Prilosec, which to me made my stomach feel worse, but he said it wasnt the Prilosec making me sick.  He sent me to a gastro doctor who did a colon and stomach test. ( The one they go down with a tube and take samples) H. Pylori came up negative from the stomach. I refused the Prilosec and started to feel a little better, but still had the burning,nausea and no desire to eat.  I lost 15 pds in the 3 months.  Had pains in the chest between the breast that moved to the back.  Doctor did ultra sound, no Gallbladder stones, but when the doctor pushes on the stomach where the gallbaldder is, its tender.  Today 3 months later, on no med's except Tagament when I feel I have heartburn, I'm starting to eat again, not all foods, mild foods, have slight nausea when stomach emptys, and still have mild lower rib pain.  Doctor wants to do CAT scan, I'm waiting a week to see if I keep getting better.  Some days are much better then others. I feel presure in the upper chest area sometimes, maybe heartburn?  It sure dont feel like the heartburn I remember. Any ideas? Can this still be Gallbadder??? Heartburn??  Oh, When they went into my stomach, Doctor said the stomach valve dont close all the way.  Can this valve cause so much trouble?

Dear Linda Marchio,
Your e-mail appears to describe a common clinical problem as evidenced by the number of people who have responded.  Usually, individuals who have a sudden onset of nausea, abdominal pain and weight loss will follow one of two courses.  Either a definitive diagnosis is  made or symptoms resolve in a relatively quick time.
Your symptoms are not related to gall bladder disease.  It is conceivable that you have some esophageal reflux but it would be unusual for reflux disease to produce a clinical course like the one you describe.
I wonder if some of your symptoms could be related to delayed gastric emptying. There are a number of possible causes for delayed gastric emptying, which can be sought by your physician if you have this problem.  This diagnosis of delayed gastric emptying can be made by doing a gastric emptying study.  
It would also be necessary to exclude disease of the pancreas as well as other intrabdominal conditions.  If your symptoms do not improve and the gastric emptying test is normal, you should have the CAT scan.
Heartburn is a common symptom with 10% of the population having this complaint.   To eliminate consideration of reflux disease as a possible cause of your medical problem, you should follow lifestyle modifications (see below) and also receive appropriate therapy [this can include Prilosec and a prokinetic agent e.g. Cisapride]. If there is still a question regarding reflux, you should have the manometry and pH studies that several ofthe other respondents describe.  This information is necessary for the physician to decide the cause of symptoms as well as whther to continue with other tests.
I would also suggest that you avoid any alcohol.  Alcohol could be contributing to your problem by causing reflux or by affecting other organs e.g. liver, pancreas.  If you have headaches or new onset problems with balance, you should ask your physician for a neurology evaluation.  
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital and perform the appropriate investigations after we have had the chance to meet you and to review your history in greater detail. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of abdominal pains, by calling the Henry Ford Physician Referral Line at (800)653-6568.
What you can do  to reduce symtoms of esophageal reflux:
a) eat 3 meals but avoid snacks
b) avoid coffee, alcohol, cigarettes, peppermint
c) do not lie down for 4 hours after eating
d) sleep with the head of your bed elevated 6 inches
e) chew gum or suck candies during the day
*keywords: reflux, disease, esophagus, weight loss

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