Stomach Discomfort

[Riasan]

I am a 21 year old female who has been seeing my physician for an undiagnosed GI issue for close to two months.

Timeline of symptoms, tests, and medication:

Feb 4th:  Saw my doctor for reoccuring chest pains.  EKG was normal.  

Feb 6th:  Had my wisdom teeth pulled.  Was on percocet for one week and did not experience chest pain.

Mid Feb:  Chest pain returns and regularly wakes me up in the middle of the night. I begin to experience sharp adbominal pain and frequent burping. I test positive for H. Pylori and am slightly anemic, other blood tests to show liver, gall bladder, and pancreas function all come back normal.  Chest x ray also appears normal.  

Late Feb:  Start taking the prevpac.  It does not help the chest pain or gas.

Early March:  Have an upper GI series.  Shows mild positional reflux, but otherwise normal.  

Mid March:   Chest pains are still a problem.  My doctor prescribes zantac which stops the chest pain. A few days after taking the zantac I begin to experience upper abdominal cramping and bloating.  I also experience sharp pains under the middle of my breast bone when walking.  Weight loss is apparent.  I decide to stop the zantac, thinking it it's causing my new symptoms. The pain under my breast bone gets worse and my doctor recommends resuming zantac and start taking prilosec.  I stopped experiencing pain when I walk, but still have upper abdominal bloating and cramping.

Late March:  Ultrasound shows normal gall bladder, kidney, and spleen.  Cramping and bloating still present.  Cramping wakes me up at night.

I am concerned that my doctor may be missing something serious.  This pain has not been completley unbearable and I have been able to work and maintain my social life, but it is consitently on my mind.  I have an upcoming appt with a GI specialist, but get more concerned as each day passes.  My doctor thinks this may be stress related, which I can accept, but I do not have a history of stress related illness or have reason to feel stressed.  My health is the only thing making me anxious right now.  Would the upper GI have shown stomach cancer, obstructions, or a hernia?  What tests should I be looking at now and what should I be asking the GI specialist to consider?  I work in a hospital and have been told by nurses I work with to consider an upper GI endoscopy, but it is in invasive procedure and with all the tests I've had thus far I'm not sure if it's needed.

[Kevin Pho, MD]

To answer your questions:
1) An upper GI should show any major masses or lesions - such as an ulcer or cancer.  The more comprehensive study is the upper endoscopy - which should be considered if it hasn't been performed yet.

2) In addition to the upper endoscopy, I would consider a 24-hr pH study.  This latter test is the definitive test to evaluate for GERD.

If the GI route is not revealing (i.e. all the tests mentioned above are negative), you may want to consider cardiac causes of your chest pain.  This can be discussed with your personal physician.  

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.

[yoshi]

are you on prilosev and zantac now?
have you been able to move your bowel regularly??
when you said upper abdomin,what area are you referring to??
prepac consists of prevacid and 2 antibiotic twice daily for 14 days,it could lead to yeast infection as the antibiotics upset the flora in your body.

[Riasan]

I am still taking prilosec and zantac.  I called my doctor today and she said to try pepto bismol for the discomfort.  By upper abdomen I refering to below my breast bone, above my navel.

[yoshi]

i have similar experience.
at first i thought i have a heart problem but it turns out to be acid reflux and h pylori .
so i took prevpac for 14 days and i ate a lot of yogurt with live cultures to restore the flora in my body.
i have tried nexxium.zantac,prilosev.prevacid,mylanta,alka selzer,galvecan to stop my acid reflux.
but most of these medication contain either aluminium or magnesium and it makes me constipated.
galvescan also contains a lot of sodium .so does alka selzer
at night,besides the acid reflux problem,i have strange sensation in my abdominal area,i would describe mine as expansion and it will pressure my temples and cause a headache.
in the morning i take extra strenth GAS-X to neutralise the gas in my body and make my headache goes away.
these days,as long as i am on prilosev or prevacid or zantac,i have problem moving my bowel.
i have a hypothesis ,i cannot prove it,that the chemical in these medication is interfering with the feces in the lower abdomin area and cause fermentation and the expansion which occur at nite is caused by the gas created by such fermentation coming from the lower abdomin area moving upwards.
when i finally move my bowel after taking laxative,the feces has a strong odor,it is not the same texture and odor like normal feces.
i have to be careful what i eat after 5 pm,i pay attention to whether the food is acidic or alkaline,i dont know if this helps but i found out many food i ate have been considered acidic such as seafood,yogurt,meat,flour etc.
there is a site which classify food as acidic,very acidic,alkaline and very alkaline for acid reflux purpose.