Chronic Stomach Pain in a 32-Year-Old: Seeking Medical Guidance

Elder brother has been suffering from chronic stomach pain?

Hello Dr.
Chen, my brother is 32 years old.
He has a smoking habit and an unhealthy diet (he enjoys fried foods and late-night snacks).
For the past two years, he has been experiencing "stomach pain (severe enough to keep him awake at night), often radiating to his back," "fatigue," "loss of appetite," and "recently he has also started to experience some dry mouth." These symptoms have persisted for almost two years.
We have taken him to various hospitals for "colonoscopy," "gastroscopy," "ultrasound," "CT scans," and various outpatient clinics, but no definitive cause has been found.
We hope Dr.
Chen can provide us with guidance based on your medical experience.
Thank you very much!

Mr. Zhou, 30~39 year old female. Ask Date: 2020/11/01

Dr. Chen Jiaming reply Surgery

Based solely on your description, it seems that you often experience pain while "sleeping." If the pain symptoms resemble gastroesophageal reflux (such as chest discomfort, nausea, and burning sensations), you might consider trying antacids or acid reducers to see if there is any improvement.
If the endoscopy does not reveal any significant ulcers or inflammatory lesions that could reasonably explain these symptoms, it would be advisable to perform an abdominal ultrasound to check for gallbladder issues such as gallstones, sludge, or other lesions.
If any are found, it may be necessary to address gallstones with associated gallbladder colic (which commonly presents as nighttime pain that radiates to the back).
The preferred treatment in such cases is laparoscopic cholecystectomy.
If the ultrasound shows no gallbladder problems, you may need to consider modifying your diet, smoking habits, and sleep patterns.

Reply Date: 2020/11/01

More Info

Chronic stomach pain, especially when accompanied by symptoms such as back pain, fatigue, loss of appetite, and dry mouth, can be quite distressing and warrants thorough investigation. Given your brother's age and lifestyle factors, including smoking and a diet high in fried foods and late-night snacks, there are several potential underlying causes to consider.

Firstly, it's essential to recognize that chronic stomach pain can stem from various gastrointestinal issues, including but not limited to gastritis, peptic ulcers, gastroesophageal reflux disease (GERD), or even functional gastrointestinal disorders like irritable bowel syndrome (IBS). The fact that he has undergone extensive testing, including endoscopies and imaging studies, is a positive step, as these tests can help rule out serious conditions such as malignancies or significant structural abnormalities.

1. Lifestyle Factors: Your brother's smoking habit and dietary choices are significant contributors to gastrointestinal distress. Smoking is known to exacerbate acid reflux and can impair the healing of ulcers. A diet high in fried and spicy foods can irritate the stomach lining and lead to gastritis or exacerbate existing conditions. Encouraging him to adopt a healthier diet, rich in fruits, vegetables, whole grains, and lean proteins, while reducing processed foods and alcohol, could help alleviate some symptoms.

2. Stress and Mental Health: Chronic stress and anxiety can significantly impact gastrointestinal health. Conditions like stress-induced gastritis or functional dyspepsia may not show up on standard tests but can cause significant discomfort. If your brother is experiencing high levels of stress, it may be beneficial for him to explore stress management techniques such as mindfulness, yoga, or counseling.

3. Medication Review: If your brother is taking any medications, it's essential to review them with a healthcare provider. Some medications, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate the stomach lining and lead to ulcers or gastritis.

4. Further Evaluation: Since initial tests have not yielded a diagnosis, it may be worthwhile to consider additional evaluations. This could include:
- pH Monitoring: This test measures the acidity in the esophagus and can help diagnose GERD.

- Gastric Emptying Study: This can assess how well food is moving through the stomach and may identify gastroparesis, a condition where the stomach empties too slowly.

- Food Intolerance Testing: Sometimes, food intolerances (like lactose or gluten intolerance) can cause chronic gastrointestinal symptoms.

5. Follow-Up with Specialists: If not already done, consulting with a gastroenterologist who specializes in functional gastrointestinal disorders may provide further insights. They can offer tailored treatment options, including dietary modifications, medications, or even psychological support if stress or anxiety is a contributing factor.

6. Self-Monitoring: Encourage your brother to keep a symptom diary, noting when the pain occurs, its intensity, dietary intake, and any stressors. This information can be invaluable for healthcare providers in identifying patterns and potential triggers.

In conclusion, while the search for a definitive diagnosis can be frustrating, it is crucial to continue working closely with healthcare providers. Lifestyle modifications, stress management, and possibly further testing may lead to better management of his symptoms. It’s essential to remain proactive and advocate for his health, ensuring that all potential avenues are explored.

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