Persistent Gastrointestinal Issues: When to Seek Further Medical Help

If you have been experiencing gastrointestinal discomfort for nearly a year and have already undergone an endoscopy with no issues found, it is advisable to seek further medical evaluation. You may consider consulting a gastroenterologist for a comprehensive assessment. They may recommend additional tests such as imaging studies, blood tests, or a review of your dietary habits and lifestyle to identify any underlying causes. Additionally, discussing your symptoms in detail, including their frequency,

Since my school years, I have often experienced diarrhea, but it would resolve quickly.
However, after entering the workforce, my gastrointestinal discomfort has worsened.
A few years ago, I had inexplicable nausea that made it difficult to eat.
After undergoing an endoscopy, no issues were found.
Recently, starting in March of this year, I began experiencing severe abdominal pain after exercising post-meal.
Since then, I have had intense abdominal pain at least once a month, which requires me to lie down and use the toilet to relieve it.
Eating has become increasingly painful, and I often feel the urge to have a bowel movement immediately after eating, with at least three bowel movements a day.
Each time before a bowel movement, I feel quite uncomfortable and nauseous, but I feel somewhat better afterward.
My stools are often unformed and mushy.
Due to this, I frequently lack appetite and feel bloated and uncomfortable after eating just a little, leading to a weight loss of about 5 kilograms over six months.
I have seen three gastroenterologists and had an abdominal ultrasound, all of which indicated no issues, attributing it to gas and irritable bowel syndrome.
However, my condition has not improved with medication.
Last month, I underwent a colonoscopy and endoscopy, which revealed slight inflammation on the surface of my stomach and that my intestines (including the rectum and cecum) were normal.
The doctor stated that my gastrointestinal system is fine and recommended a CT scan of my liver (though I previously had an abdominal ultrasound that showed no issues).
Should I continue to pursue further examinations with a gastroenterologist, or should I seek help from a mental health specialist?

Tòng tòng rén, 20~29 year old female. Ask Date: 2019/11/14

Dr. Chen Shidian reply Gastroenterology and Hepatology

If there is continuous weight loss or a positive fecal occult blood test, further specialized examinations of the small intestine and other areas are necessary, and a visit to a medical center specializing in small intestine diseases is required.

Reply Date: 2019/11/14

More Info

When dealing with persistent gastrointestinal issues, it can be challenging to navigate the healthcare system and determine the appropriate next steps. Your symptoms, which include recurrent abdominal pain, changes in bowel habits, and a general sense of discomfort, suggest a complex interplay of factors that may be both physiological and psychological in nature.

Given your history of gastrointestinal distress, including episodes of diarrhea during your school years and more recent severe abdominal pain after meals, it is crucial to consider both functional and structural causes. Functional gastrointestinal disorders, such as Irritable Bowel Syndrome (IBS), are characterized by symptoms like abdominal pain, bloating, and altered bowel habits without any identifiable structural abnormalities. On the other hand, structural issues could include conditions like gastritis, ulcers, or even more serious concerns that may require further investigation.

Your recent diagnostic tests, including endoscopies and ultrasounds, have not revealed any significant structural abnormalities, which may point towards a functional disorder. However, the persistence of your symptoms, especially the severe abdominal pain and changes in bowel habits, warrants further evaluation. It is not uncommon for patients with IBS to experience significant discomfort and changes in their bowel habits, but the severity and frequency of your symptoms suggest that a more comprehensive approach may be necessary.

In terms of next steps, here are some recommendations:
1. Follow-Up with a Gastroenterologist: Since you have already seen multiple gastroenterologists, it may be beneficial to return to one of them or seek a second opinion from a specialist who focuses on functional gastrointestinal disorders. They may recommend additional tests, such as a CT scan, to rule out any underlying conditions that may not have been detected in previous evaluations.

2. Consider Psychological Factors: Given the chronic nature of your symptoms and their impact on your quality of life, it may be worthwhile to explore the possibility of a psychological component. Stress, anxiety, and depression can significantly exacerbate gastrointestinal symptoms. Consulting with a mental health professional, particularly one with experience in gastrointestinal issues, could provide valuable insights and coping strategies.

3. Dietary Modifications: Keeping a food diary can help identify any potential food triggers that may be contributing to your symptoms. Some patients with IBS find relief by following a low-FODMAP diet, which involves reducing certain types of carbohydrates that can be poorly absorbed in the gut. Consulting with a registered dietitian who specializes in gastrointestinal health can provide personalized dietary recommendations.

4. Symptom Management: Discuss with your gastroenterologist the possibility of medications that can help manage your symptoms. This may include antispasmodics, laxatives, or medications specifically designed for IBS. Additionally, over-the-counter remedies for gas and bloating may offer temporary relief.

5. Lifestyle Modifications: Regular physical activity, stress management techniques (such as mindfulness or yoga), and ensuring adequate hydration can also play a significant role in managing gastrointestinal symptoms.

In conclusion, while your symptoms may suggest a functional gastrointestinal disorder, the persistence and severity of your condition warrant further investigation. Collaborating closely with healthcare professionals, including gastroenterologists and mental health specialists, can help you navigate this complex situation and develop a comprehensive management plan tailored to your needs. Remember, it is essential to advocate for your health and seek the care that aligns with your concerns and experiences.

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