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Doctors' Answers to "Frequently Asked Questions" - Stomach Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Persistent Upset Stomach [posted 1/13/99]
Question: I have been taking prevacid for about eight months before I was taking prilosec. In June of 1998 I had GERD surgery. I am very happy with the results. However, after I stopped taking the prevacid I am back to being very sick to my stomach and sometimes just want to lay down and die. I am 47 years old and don't want to feel this way forever. I had the surgery for my heartburn and was hoping it would also cure my sick stomach.

Answer: Have you been checked for H. Pylori? This is a bacteria sometimes responsible for gastritis, ulcers, etc. However, if negative, you may just produce too much acid and need some kind of medication along with the surgery.

Peculiar Stomach Problems [posted 11/19/98]
Question: I have been having gastrointestinal problems for the past five years. I have noted some very peculiar symptoms. When I breath out (especially when I breath shallowly) I get a feeling in my stomache like that of going over a bump in a car at high speed or encountering a dip on a rollercoaster. Often after experiencing these sensations I get (muscle ?) spasms in my lower left abdominal area and around my bottom rib.   This often causes me to feel the need for a bowel movement almost immediately.   I have very poor motility. My stools vary from extremely loose to small pellet like bits. I have a great deal of pain after eating, not burning pain but the feeling that something is stuck and causing pressure. If I push out my belly after eating I get a pulling kind of pain on my left side that seems associated with my bottom rib and often times a couple hours after eating I feel pain directly in this rib area. I have had full GI workups and no problems were found. I have seen several doctors over the years about my problem and no one has helped me diagnose these problems or solve them.  After eating I can feel my can feel my heart beating in my lower abdomen and 'see' a pulse on the left side of my belly. There is very little 'noise' that accompanies my digestive processes. If I lay down, relax and breath out VERY calmly ,regularly and deeply things feel like they start moving again and the digestive noises increase. This may sound crazy, but the nearest I can describe this is that my stomache is 'glued' to some nearby organ and causing pulling pain, pain after eating, and pain, strange sensations and spasms on breathing out. At this point after five years my basic tactic is to eat a meal and then lie down and go to sleep for a couple hours because I cant stand the pain, fullness and drowsiness that come from eating any meal. When I wake up I seem to feel better, but am hungry again almost immediately.  Thanks for reading this and offering any suggestions you may have.

Answer:  Sounds possibly like irritable bowel, this sometimes is improved with SRI antidepressants like Zoloft, Paxil etc. Also, occasional patients have weird symptoms with giardia infections. Hard to diagnose;but, easy to treat-metroniadazole 500 mg three times a day for a week.

Chronic Gastritis with Pylori [posted 11/10/98]
Question: I've had stomach pains for quite awhile now. I've been taking prevacid for about 2 years. Latest endoscope indicates mild chronic gastritis w/ the pylori count at about 24. Prevacid worked pretty good for awhile, but lately it has been less and less effective in reducing the pain. The question is, is there no relief in sight? Is it possible for the body to turn resistant to the medication since I've been a prolonged user? Also, I've had an antibiotic treatment for about 2 weeks to get rid of the helico bacteria, and it doesn't seem to be helping. Any suggestions would be appreciated.

Answer: Helicobacter Pylori is hard to eradicate. It often needs 3 or 4 antibiotics plus a drug like Prevacid. Even then we cannot eradicate about 10-20%. Use more drugs for longer periods.

Bile Reflux [posted 10/21/98]
Question: My mom is suffering 'bile reflux' (Bile enters stomach.). The doctors let her take medicine to neutralize the bile in the stomach. But since she began to take the medicine, she had very loose bowel (seven or eight times a day). The doctor told her that it was the side effect of the neutralization medicine and she had to stop taking that medicine. But without the neutralization medicine, she can not eat because of severe pain in the stomach. She had been seen by many doctors. But it seems that no one can give her a really good suggestion at this stage. One doctor even told her that "You might have to live like this for the rest of your life". My mom is 52 years old. She lost about 20 pounds in last two months. I m very worried about her. Since she is not in the States, I don't know what's the equivalent medicine she was taking. Does gallbladder removing help? (Mom said she is considering this). What kind of food is good for her situation? Any recommendation is appreciated.

Answer: Try carafate. This usually does not give diarrhea. Or give a drug like Immodium with the drug she is taking(probably propulsid or some motility drug). Get the name of the drug if you can and I can help more. The gall bladder will not likely help.

Electrolyte Imbalance due to Stomach Problems [posted 10/8/98]
Question: This might sound crazy, but my mother has been taking Prilosec for 8 years. She has crohns and an ileostomy. She has major problems with hyponatremia, hypomagnesia. She is losing it through her stoma not urine. We believe that because she has so little acid in her stomach to break down her food much of it is excreted without breakdown through the stoma, therefore she does not absorb adequate amounts of these electrolytes and experiences the need for IV replacements. Please advise or send me any resources you might have. Thank you.

Answer: Have motility or emptying studies been done to see how long food stays in her stomach? There are drugs to slow motility if this is the issue.

Stomach Pain [posted 10/6/98]
Question: My stomach seems like it is always hurting. I am lactose intolerant and taking lactaid for that, but I don't think that that is the cause of my pain. My stomach seems to hurt the most when I am stressed or upset emotionally. My question is could I have a serious problem, and if so what could I possibly have. Also, what are the treatments or tests needed to be conducted to figure out what my problem may be??

Answer: First, determine if it responds to OTC drugs like Pepcid, Tagamet etc. Take twice what the package recommends and you will attain prescription strength. If this does not help in 3 weeks or so you need to see a physician for a physical and further testing. Most cases of abdominal distress are either due to acid related causes or everything else. About 85% is related to acid and will usually respond to these drugs.

Stomach Pain in Children [posted 9/29/98]
Question: My 4 year old daughter is having bad stomach cramps every day and they last about 2 hours. The pains last about 10 seconds and are about 2 minutes apart. She does not have gas, and we stopped giving her milk. She is short of breath when they come and she grabs for her stomach, pain is about where her bellybutton is.

Answer: Time for a visit to your doctor - chronic GI pain is very uncommon in children without a problem.

Stomach Ca [posted 8/11/98]
Question: My father is 69 years of age and was diagnosed 2 years ago with stomach Ca and it has metas to other areas. However, he clings on with medications. What are the things we should watch for? The main other metas is in the spinal column with bone Ca.

Answer: Changes in mental or neurologic functioning. New onset of pain, especially in bones. Difficulty with appetite or bowel movements.

Morning Upset Stomach [posted 8/7/98]
Question: What causes the stomach to be overly acidic (beside factors such as alcohol, greasy foods, genetic food intolerance, ulcers, etc.) and to develop queasiness during waking hours.

Answer: Most of the acid production seems to be genetic and there is a strong genetic predisposition to ulcers and excessive acid. The most potent stimulus for acid production is nicotine. As to the nausea, hard to know why this occurs with high acid levels.

Gastrointestinal Problems [posted 7/23/98]
Question: I have had bloating, burping, vague pains, diarrhea, and fatigue for well over a year. I have been seeing a doctor for the last 5 months. I am on prevacid and propulsid and have radically changed my diet. I have lost 20 pounds. My symptoms have not improved at all. In fact, they are slowly getting worse. So far, all the drugs and treatment I have been given seem to be targeted at relieving heartburn, which has never been a symptom in the first place. Should I be considering another doctor? I am not sure my doctor understands the affect this is having on my life. They don't even know what's wrong yet.

Answer: The weight loss along with your GI symptoms is very bothersome. You need diagnostic x-rays and a diagnosis-soon. I do not know what has been done so far, but one year with 20 pound weight loss is abnormal. Request a GI specialist or see an Internist-someone is not listening.

Muscle Spasms in Stomach
Question: For the past 6 months I have been experiencing what feel to be muscle spasms in the area above my stomach. It seems only to occur after being in bed for approximately 6 hours. I have seen a Chiropractor, 3 Internists and also an Gastroenterologist (I even bought a new mattress). I've been tested for ulcer, gall bladder, and other gastric problems, and all results have been negative. I've also had a Sonogram and a CAT scan with negative results. The pain continues. My doctors, though sympathetic, can offer no diagnosis. Could you please provide some clues or where I may look next.

Answer: I'll need to know a little more, like what did the GI person say, and have you been treated for anything? This sounds GI, so have you tried antispasmodics or acid inhibitors? Have you had tests to see if you have acid reflux spasm?

Stomach Pain
Question: Recently released from the hospital for difficulty breathing and a low hematocrit count, I was given Norvasc (to replace Atenolol) and Ranitidine. I immediately started to suffer intense stomach/abdominal pain. I think it's due to these new medications. Is this possible? Could it be due to discontinuing the Atenolol?

Answer: I suspect it is something intrinsic to your stomach - hence why you lost blood. Neither would be expected to do this, although Norvasc would be more likely than Ranitidine.

Stomach Gas
Question: I have a chronic problem with excessive stomach gas, sometimes accompanied by antacid stomach. The problem is particularly troublesome at night. Over-the-counter anti-gas medications don't seem to help much although I take them daily. Nor have I been able to identify anything in my diet as a problem. Do you have any suggestions as to what I can do to alleviate the problem? Is this condition of serious concern?

Answer: Abdominal gas whether upper or lower is one area that medicine isn't very good at fixing. Usually it doesn't represent anything of consequence. Two possible exceptions are gall bladder dysfunction and H. pylori infection of the stomach. Both of these conditions produce excess gas and are treatable. Gall bladder disease will usually be present with fatty food intolerance, occasional right upper quadrant pain, and difficulty with digesting foods such as apples and cabbages. H. pylori is a bacteria which is associated with ulcer formation, but in some patients produces excess gas(often foul tasting, odor). This is tougher to diagnose, but pepto-bismol usually improves things temporarily. It is treated by a fairly complex antibiotic regimen. Other than these two, I'd put up with it since it probably doesn't represent anything of concern.

Heimleich Maneuver
Question: I need to know how the heimleich maneuver was invented?

Answer: Heimleich, HJ, is a life saving maneuver to prevent food choking. For extensive information try the Journal of the American Medical Association: 234:398. 1975.

Question: My problem has been going on for about 14 months. I've had to go to the emergency room and have been admitted to the hospital 5 times. The following tests have been performed and the end results comes out to “I don't know”. I get Nausea, then Vomiting and Diarrhea at the same time (cold and Clammy). They have taken the following tests over this period of time. 1. Standard X-Rays. 2. Proctoscopy 3. Endoscopy 4. Blood work each time 5. Stool and urine tests 6. CT-Scan of Stomach, Lungs, Kidneys, and Heart. On October 1, 1997 the CT-Scan found a Golf Ball size Tumor in my Right Kidney. The Right Kidney was removed on 10-10-97 (The Cancer had not spread) about 4 weeks ago. Three days ago (10-30-97), I had the same sick spell as I've previously described: vomiting, nausea, diarrhea. I was admitted to the hospital for 2 and 1/2 days and they can find nothing.

Answer: I understand your frustration, but this is too complex for the internet. One possibility is to check urine porphrins during a spell if this has not been done.

Carbonation - relief of upset stomach?
Question: Do carbonated beverages actually relieve an upset stomach? If so, how does the process work? Also, do any beverages work particularly well, such as ginger ale?

Answer: No, they're just easier to digest than fat or protein.

Stomach Problems
Question: I often get sharp pains in my upper abdomen which seem to begin most commonly (although not always) when I go several hours without eating. The only remedy seems to be to lie down and sip water. My doctor prescribed Zantac, which I've been taking for about 4 months, but it hasn't really helped. Any ideas?

Answer: Upper abdominal pain is a commonly experienced symptom, and is among the more frequent reasons for patients to see their physicians. Although there are many possible underlying causes of upper abdominal pain and discomfort, the specifics of the pain and any other symptoms may at times suggest which cause(s) is, or are more likely. For example, does the pain travel to any other part of the body, such as the back, or other parts of the abdomen? Is the pain associated with fever, chills, nausea, vomiting, diarrhea, or bloating? How severe, how often, and the quality of the pain are also important factors. Have you experienced any bleeding with your bowel movements, or pain with passing urine or stool? Do you experience abdominal symptoms after eating, or trouble with slow passage of food after swallowing? Have you experienced any weight changes?

In addition, knowledge of any medications you are currently taking, as well as any other medical problems you may have, may also be helpful in determining potential causes for the pain. Is there any history of pancreas or liver disease, gall bladder disease or stones, kidney disease or stones, prior surgery involving the abdomen, ulcer disease, "heartburn", or intolerance of spicy foods, caffeine, or dairy products? A thorough history and physical examination are therefore very important in the evaluation of a patient suffering from upper abdominal pain. Your physician has prescribed, and you have been taking Zantac for the past 4 months. This medication is known as an H2 blocker, which means it blocks one of the mechanisms by which the stomach produces acid. In turn this reduces acid production in the stomach, and has been shown to improve symptoms from ulcer disease, heartburn due to reflux of stomach acid into the esophagus, as well as stomach irritation from excess acid production, which may be due to dietary factors, physical or emotional stress, or other medical conditions.

If you have not experienced improvement in your symptoms after 4 months of Zantac therapy, you should see your doctor. In addition to considering other medications which are available, a discussion with your physician regarding what further testing he or she feels is warranted (be it blood work, radiologic (x-ray) evaluation, or further physical testing), may be beneficial. As always, close and regular follow-up with your doctor is key in determining whether any therapy has an effect.

Stomach Noises
Question: Such a silly sounding question, but here goes. I am a soon to be 50 year old woman who has had this problem for over 20 years. My stomach growls and gurgles ALL the time. There is no pain or discomfort (SOMETIMES I can tell it has to do with gas -- but other times that doesn't seem to be the problem), there is no pattern -- it happens when I'm full, empty, eating spicy foods, eating bland foods. The reason I'm asking for info is because it's embarrassing and I find myself hesitating to go anywhere I know is going to be quite. Does anyone have any suggestions? I've tried Gas X, but that doesn't really seem to help.

Answer: The medical term for this is borborygmi. (Somehow sounds like the problem!) Unfortunately, there is no real way to treat this problem since your gut is doing exactly what it is designed to do. Occasionally, taking Imodium before you go out socially(slowing the gut) will eliminate this problem for awhile. This is at the expense of potential constipation. Antispasmodics like bentyl (before social contact) are also occasionally helpful.

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