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Mysterious and severe gastric pain causing patient to passing out after eating breads/pasta, all tests normal.
Adult Asian/Russian native mix female, athlete, no history of any medical problems or allergies. Non-smoker and non-drinker. Postmenarcale, last was 2012 Jan 15. No history of passing out or seizures.
Day 1, suddenly develops severe pain in abdomen after eating a meal on Christmas, passes out from pain and sent to ER.
Doctors first suspect bacterial gastritis, (h.pyloric antibody test positive) treated with antibiotics (Amoxil and Cyclomyacin) for 14 days.
Day 14, during antibiotics treatment course patient passes out from severe pain 4 more times. Healthy stool (no diarrhea), no pain/burning from urinating. Patient only eating fruits, liquids, rice, and eggs and boiled avian meats (chicken, turkey). Not able to eat normal 2000 calories per day, lost 30 lbs.
Each time patient is admitted to ER, tests show CBC normal (neurophiles slightly low), liver panel, kidney function, urine, EKG, BP, all normal.
Ultrasound is normal, sparse concentrations of calcium in kidneys but still within normal range.
Day 22, patient's own observations noted that she only passes out from pain after eating any amount of breads or pasta. Patient passes 2 hours from pain after eating a piece of wheat bread (plain).
Patient subsequently on morphine for pain as needed, 4 times normal dose, not helping.
Avoiding breads or pasta seems to avoid recurrence of pain. No prior allergies or reaction to breads or pasta.
Patient noted slight increase of burping after each meal.
ROs: Allergies ruled out (prior tolerance to glutine and breads). Parasites/tapeworm ruled out (normal ultrasound and no signs of seizures), bacteria infection ruled out (antibiotics finished course), stomach virus ruled out (only breads seem to trigger pain). Physical injuries ruled out by exams from 3 different ER doctors.
Need suggestions on other possible diseases/causes for severe pain reaction to breads/pasta with no prior history?
Day 1, suddenly develops severe pain in abdomen after eating a meal on Christmas, passes out from pain and sent to ER.
Doctors first suspect bacterial gastritis, (h.pyloric antibody test positive) treated with antibiotics (Amoxil and Cyclomyacin) for 14 days.
Day 14, during antibiotics treatment course patient passes out from severe pain 4 more times. Healthy stool (no diarrhea), no pain/burning from urinating. Patient only eating fruits, liquids, rice, and eggs and boiled avian meats (chicken, turkey). Not able to eat normal 2000 calories per day, lost 30 lbs.
Each time patient is admitted to ER, tests show CBC normal (neurophiles slightly low), liver panel, kidney function, urine, EKG, BP, all normal.
Ultrasound is normal, sparse concentrations of calcium in kidneys but still within normal range.
Day 22, patient's own observations noted that she only passes out from pain after eating any amount of breads or pasta. Patient passes 2 hours from pain after eating a piece of wheat bread (plain).
Patient subsequently on morphine for pain as needed, 4 times normal dose, not helping.
Avoiding breads or pasta seems to avoid recurrence of pain. No prior allergies or reaction to breads or pasta.
Patient noted slight increase of burping after each meal.
ROs: Allergies ruled out (prior tolerance to glutine and breads). Parasites/tapeworm ruled out (normal ultrasound and no signs of seizures), bacteria infection ruled out (antibiotics finished course), stomach virus ruled out (only breads seem to trigger pain). Physical injuries ruled out by exams from 3 different ER doctors.
Need suggestions on other possible diseases/causes for severe pain reaction to breads/pasta with no prior history?
Best Answer
Thanks everyone, her doctor (I believe) ordered the IgA-gliadin test... waiting on results.
Anyone know *why* this allergy sometimes does not show up until later in life?
Anyone know *why* this allergy sometimes does not show up until later in life?
I'd like to back-up FurballsMom's comments on celiac issues. My husband had no 'outward' problems until he hit about 50 years of age. Then suddenly developed symptoms. He had eaten gluten-containing items (wheat, rye and barley) his whole life without any problems before this happened.
It took us a long time to figure out what was going on because the blood tests came up negative on everything including possible gluten issues. We finally pinned it down by using the fecal antibody tests via Enterolab.
If blood tests are used (not the genetic test but IgA-gliadin), make sure her total IgA level is checked. If the total level is low (suggesting the ability to generate a response to gliadin might be impaired), and the test for IgA-gliadin comes back negative, move toward doing a fecal test and make sure the fecal test is one of the ones that uses a 'fresh' or frozen sample. If the sample is put into fixative, it can render the sample somewhat changed and the results may turn out to be a 'false negative.' In the medical setting I am in, we have seen that happen again and again.
It took us a long time to figure out what was going on because the blood tests came up negative on everything including possible gluten issues. We finally pinned it down by using the fecal antibody tests via Enterolab.
If blood tests are used (not the genetic test but IgA-gliadin), make sure her total IgA level is checked. If the total level is low (suggesting the ability to generate a response to gliadin might be impaired), and the test for IgA-gliadin comes back negative, move toward doing a fecal test and make sure the fecal test is one of the ones that uses a 'fresh' or frozen sample. If the sample is put into fixative, it can render the sample somewhat changed and the results may turn out to be a 'false negative.' In the medical setting I am in, we have seen that happen again and again.
Thanks, we're going to have a genetics test for that, however patient has been eating a regular to high wheat/gluten/bread/pasta diet all her life without any complaints.
It was actually in recent months (past 10 months) she had been eating LESS gluten (before onset). So Celiac's disease is not clear up, but will be investigated.
It was actually in recent months (past 10 months) she had been eating LESS gluten (before onset). So Celiac's disease is not clear up, but will be investigated.
Could be celiac - if she's finding that wheat/gluten is causing or adding to her symptoms, she definitely needs to tstick to a gluten free diet. You can find gluten free diet guidelines online - it's not going to be easy and you'll have to read or have her read EVERY label, but there are more and more gluten free items out there every day, so it'll be eaiser than it might have been 20 years ago.
And yes, this can develop even if she's never had it before - same as an allergy can suddenly appear to something that you've never been allergic to before.
Best of luck!
And yes, this can develop even if she's never had it before - same as an allergy can suddenly appear to something that you've never been allergic to before.
Best of luck!
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Also, while it does sound more like actual Celiac, many who don't have Celiac are still intolerant to gluten. I still don't have a clear diagnosis myself, but everyone in my brother's household and myself are all gluten intolerant at the very least and one person has a clear diagnosis of Celiac. So, at least the person with Celiac doesn't have the usual family conflicts over what to eat, since no one else in the family can eat gluten either.