Persistent Stomach Pain and Bitter Taste: When to Seek Further Medical Help

Abdominal distension, bitter taste in the mouth, vomiting, and chest pain?

Hello Dr.
Chen, I have been experiencing stomach pain for three weeks now, which feels like a dull ache (similar to being punched).
I have undergone an endoscopy and consulted a doctor.
The results of the endoscopy showed no gastric ulcers or duodenal ulcers, but there is a bacterial infection.
Therefore, the doctor prescribed a week’s course of antibiotics, including Pariet, Klarith FC, and Amoxicillin.
However, after taking them for three days, I still feel no improvement and have not experienced the side effect of diarrhea that the doctor mentioned.
I am still unable to eat much at each meal, only about five bites of rice, crackers, or steamed buns.
After eating, I often feel nauseous.
Additionally, my mouth has had a bitter taste for the past 2-3 days, which lasts almost all day.
In the last couple of days, I have also experienced chest pain, daily fatigue, and back pain.
Every night after 11 PM (I have been going to bed between 9 and 10 PM), I wake up every hour due to pain, feeling very bloated (the area around my navel and below my ribs is tender to the touch), and my mouth is very bitter, making me feel like vomiting.
Last night, after falling asleep, I woke up and vomited twice, and the liquid I vomited was also very bitter.
The stomach pain typically lasts all day, varying in intensity.
If there is no improvement after finishing this week’s antibiotics, should I go to a larger hospital for further examination? Also, is it okay for me to drink more water now?

MOLLY, 20~29 year old female. Ask Date: 2018/08/16

Dr. Chen Qifeng reply Gastroenterology and Hepatology

In addition to completing the antimicrobial treatment, it is recommended to undergo abdominal ultrasound and liver function tests.

Reply Date: 2018/08/16

More Info

It sounds like you are experiencing a complex set of gastrointestinal symptoms that have persisted for several weeks. Your situation is concerning, especially given the combination of stomach pain, a bitter taste in your mouth, nausea, and other systemic symptoms like fatigue and back pain. Here’s a comprehensive overview of your condition and recommendations on how to proceed.

Understanding Your Symptoms
1. Persistent Stomach Pain: The dull, persistent pain you describe, especially if it feels like pressure or heaviness, can be indicative of several underlying issues. Given that your endoscopy did not reveal ulcers but did identify a bacterial infection, it’s possible that you are dealing with gastritis or another form of inflammation in the stomach lining.

2. Bitter Taste and Nausea: The bitter taste in your mouth, especially if it is accompanied by nausea and vomiting, can be related to several factors. One common cause is the presence of bile in the stomach, which can occur if there is a disruption in normal digestive processes. This can happen due to gastritis, gallbladder issues, or even side effects from medications.

3. Fatigue and Pain: The fatigue and pain in your chest and back could be related to your gastrointestinal distress. Chronic pain and discomfort can lead to fatigue, and sometimes, referred pain from the stomach can manifest in the back or chest area.

Recommendations
1. Complete the Antibiotic Course: It’s essential to complete the full course of antibiotics prescribed by your doctor, even if you do not notice immediate improvement. Antibiotics can take time to work, especially if the infection is significant.

2. Monitor Symptoms: Keep a detailed log of your symptoms, including the intensity of your pain, any changes in your appetite, and the timing of your nausea and vomiting. This information will be invaluable for your healthcare provider.

3. Hydration: Yes, you can and should drink water. Staying hydrated is crucial, especially if you are experiencing nausea and vomiting. Sipping small amounts of water throughout the day can help.

4. Dietary Adjustments: Given your reduced appetite, focus on small, bland meals that are easy to digest. Foods like bananas, rice, applesauce, and toast (the BRAT diet) can be beneficial. Avoid spicy, fatty, or acidic foods that may exacerbate your symptoms.

5. Follow-Up Care: If your symptoms do not improve after finishing the antibiotics, or if they worsen, it is crucial to seek further medical evaluation. A referral to a gastroenterologist or a visit to a larger medical facility may be necessary for more comprehensive testing, such as imaging studies or additional endoscopic evaluations.

6. Consider Stress and Mental Health: Chronic gastrointestinal issues can be exacerbated by stress and anxiety. If you find that your symptoms are affecting your mental health, consider discussing this with your healthcare provider. They may recommend counseling or other therapies to help manage stress.

When to Seek Immediate Help
If you experience any of the following, seek immediate medical attention:
- Severe abdominal pain that does not improve
- Persistent vomiting, especially if it contains blood or resembles coffee grounds
- Signs of dehydration (e.g., dizziness, dry mouth, decreased urination)
- New or worsening symptoms such as fever or jaundice (yellowing of the skin or eyes)
In summary, while it is essential to complete your current treatment, closely monitor your symptoms and maintain open communication with your healthcare provider. If your condition does not improve, further evaluation will be necessary to rule out more serious underlying conditions. Your health is paramount, and proactive management is key to recovery.

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