Chronic Gastrointestinal Issues: A Young Adult's Journey

Gastrointestinal issues

Hello Doctor, I am currently 25 years old, male, and have been experiencing gastrointestinal discomfort for a long time.
Due to the numerous symptoms and questions I have, I will list them for your advice.
Thank you very much.
1.
I have had persistent abdominal pain since elementary school, often experiencing stomachaches and diarrhea in the mornings.
The symptoms improved during my university years but returned after graduation.
Recently, I felt better for a while, but now the discomfort has intensified, with frequent bloating throughout the day.
2.
I usually feel the most uncomfortable upon waking up.
The upper abdomen near the xiphoid process feels very bloated.
Pressing down on the upper abdomen below the xiphoid causes a bloated, stabbing sensation in the stomach, chest, and even armpits.
Pressing below the right rib cage also elicits a bloated, stabbing sensation in the stomach and chest, while pressing below the left rib cage does not.
Throughout the morning, the upper abdomen below the sternum remains bloated and tender to touch, sometimes accompanied by a feeling of fullness in the chest, mild nausea, and loss of appetite, which tends to alleviate as bedtime approaches.
3.
I often experience diarrhea in the mornings, especially after drinking water or eating breakfast, which is usually accompanied by bloating or cramping followed by diarrhea.
4.
My current condition involves bloating and pain sometimes located just below the xiphoid process, or slightly lower, around the center between the sternum and the navel.
When this area is bloated and painful, I often feel the urge to defecate (not diarrhea).
Pressing on the painful area also causes some tenderness in the chest.
Sometimes, pressing on the navel area feels slightly sore, but generally, pressing on the upper abdomen is less painful (it feels bloated while standing), while the area around the navel and about one centimeter below it is more painful (not painful while standing).
5.
I underwent gastroscopy in high school and again last November.
In both instances, the doctor noted mild gastroesophageal reflux and inflammation, prescribing medication.
After taking the medication, the symptoms seemed to improve somewhat, but they have persisted.
I also had urine and blood tests (which included liver function tests).
Initially, my liver function was slightly elevated, but it returned to normal three months later.
The doctor indicated that there were no major issues and suggested that, given my age and symptoms, a colonoscopy was not necessary.
6.
My stool is sometimes elongated and does not appear to be thinner, usually remaining quite thick.
However, I frequently experience diarrhea, which can be mild (short, irregular pieces) or more severe (liquid and mushy).
The color is typically yellow-brown or coffee-colored, with no visible blood (I have not undergone a fecal occult blood test), and I have not noticed any significant mucus.
Recently, the frequency of my bowel movements has slightly increased (including the morning bloating episode).
7.
I have been seeing a gastroenterologist and taking medication (for bloating, gastroesophageal reflux, and acid suppression), but the effectiveness seems limited, as I still experience bloating in the stomach and chest.
8.
I am unsure if my symptoms are due to psychological factors or lack of sleep (I usually sleep between 12:30 AM and 1:00 AM, averaging 6-7 hours per night) or other reasons.
Recently, I have been feeling dizzy and fatigued, which raises concerns about potential anemia.
The lower eyelids appear pale pink, not white, but slightly less red than others.
Additionally, I would like to know if a blood test for liver function will also check for anemia.
9.
Although the doctor indicated that my overall examination showed no significant issues and that a colonoscopy was not urgently needed, I am worried because my symptoms have persisted for many years and have recently worsened.
Since the medication does not seem effective, I feel somewhat lost about what to do next.
Living with these symptoms daily significantly impacts my quality of life, and I am concerned about any serious underlying conditions that may have gone unnoticed.
Therefore, I would like to ask the doctor what might be causing my symptoms.
Thank you for taking the time to read through my concerns and assist me.
I truly appreciate it!

Mr. Chen, 20~29 year old female. Ask Date: 2017/09/04

Dr. Chen Shidian reply Gastroenterology and Hepatology

Sir, you have been diagnosed with irritable bowel syndrome with dysmotility and gastroesophageal reflux disease.
Please follow your physician's prescribed medication and make adjustments to your diet and daily routine.
A stool occult blood test can also be performed initially.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2017/09/04

More Info

It sounds like you have been dealing with a complex array of gastrointestinal symptoms for quite some time, and I appreciate your detailed description of your experiences. Chronic gastrointestinal issues can be particularly challenging, especially when they affect your daily life and overall well-being. Let's break down your concerns and explore some potential avenues for understanding and managing your symptoms.

1. Chronic Pain and Discomfort: Your history of abdominal pain, particularly in the morning, and the sensation of bloating are common symptoms associated with functional gastrointestinal disorders, such as Irritable Bowel Syndrome (IBS) or functional dyspepsia. These conditions can cause a variety of symptoms, including abdominal pain, bloating, and changes in bowel habits. The fact that your symptoms seem to fluctuate over time is also indicative of a functional disorder, as these conditions often have periods of exacerbation and remission.

2. Bowel Movements: The variability in your bowel movements, including episodes of diarrhea and the presence of loose stools, can further suggest IBS, particularly if these symptoms are accompanied by abdominal pain that improves after a bowel movement. The appearance of your stools, such as the "short, hairy" consistency you described, may also reflect dietary factors or gut motility issues.

3. Gastroesophageal Reflux Disease (GERD): Your history of gastroesophageal reflux and mild inflammation noted during your endoscopies suggests that GERD could be contributing to your symptoms. This condition can cause chest discomfort, bloating, and nausea, particularly after meals. It’s important to manage dietary triggers (such as spicy or fatty foods) and consider lifestyle modifications, including elevating the head of your bed and avoiding late-night eating.

4. Dietary Considerations: Given your symptoms, it may be beneficial to keep a food diary to identify any potential food triggers that exacerbate your gastrointestinal discomfort. Common triggers include dairy products, high-fat foods, caffeine, and certain carbohydrates (like those found in beans and certain grains). Increasing your intake of fiber gradually can also help regulate bowel movements, but be cautious as too much fiber too quickly can lead to increased bloating.

5. Psychological Factors: Stress and anxiety can significantly impact gastrointestinal health. The connection between the gut and the brain is well-documented, and psychological stress can exacerbate symptoms of IBS and other gastrointestinal disorders. Consider incorporating stress-reduction techniques such as mindfulness, yoga, or cognitive-behavioral therapy into your routine.

6. Sleep and Fatigue: Your sleep patterns may also be contributing to your symptoms. Poor sleep can exacerbate gastrointestinal issues and lead to increased fatigue and cognitive difficulties. Aim for a consistent sleep schedule and consider sleep hygiene practices to improve the quality of your rest.

7. Blood Tests and Anemia: Regarding your concerns about anemia, routine blood tests can indeed check for anemia, including hemoglobin levels and hematocrit. If your healthcare provider suspects anemia, they may also order additional tests to determine the underlying cause. If you have concerns about your liver function, it’s essential to discuss these with your doctor, especially given your previous elevated liver enzymes.

8. Next Steps: Since your symptoms have persisted despite treatment, it may be worthwhile to seek a second opinion from a gastroenterologist who specializes in functional gastrointestinal disorders. They may recommend further testing, such as a hydrogen breath test for lactose intolerance or small intestinal bacterial overgrowth (SIBO), or even a trial of medications specifically for IBS.

In summary, your symptoms are complex and multifaceted, likely involving a combination of functional gastrointestinal disorders, dietary factors, psychological stress, and possibly sleep disturbances. A comprehensive approach that includes dietary modifications, stress management, and possibly further medical evaluation will be essential in improving your quality of life. Don't hesitate to advocate for yourself and seek the care you need to address these ongoing issues.

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