Abdominal Pain: Insights into Gastrointestinal Issues

Abdominal issues?

Hello Doctor, I have been experiencing pain in the upper right quadrant of my abdomen for the past six months.
I underwent an ultrasound which revealed fatty liver and gallbladder polyps, and an endoscopy indicated mild gastritis.
A few weeks later, I suddenly developed difficulty swallowing.
Over the past six months, I have had an esophageal X-ray, esophageal manometry, abdominal CT scan, colonoscopy, and another endoscopy, which only showed gastroesophageal reflux disease (GERD).
Now, I can only eat half of a lunch box before feeling full, and I experience abdominal bloating and occasional belching.
At night, my stomach makes noises as if I am hungry, but I have not felt hungry for a long time.
There was a period when eating would trigger diarrhea, resulting in yellow watery stools, but now I often experience constipation for extended periods, sometimes up to a week.
After bowel movements, I feel numbness in the upper right part of my back.
The gastroenterologist referred me to other specialists, but they sent me back to gastroenterology.
I have lost 20 kg over the past six months.
Could you please provide me with some advice? Thank you.

Yang, 20~29 year old female. Ask Date: 2021/12/31

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello, your comprehensive examinations are sufficient to diagnose diseases of all abdominal organs.
However, functional issues such as abnormal peristalsis, irritable bowel syndrome; metabolic disorders (such as thyroid dysfunction, blood sugar abnormalities; or rarer conditions like porphyria), autonomic nervous system dysregulation, mental stress, or issues related to your dietary habits may also be present.
It is important to closely examine your lifestyle and mental stress levels.
If there is no improvement, you may consider consulting a gastroenterologist, an endocrinologist, or a psychiatrist.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2021/12/31

More Info

Abdominal pain can be a complex and multifaceted issue, particularly when it persists over an extended period, as in your case. Given the symptoms you've described—pain in the upper right abdomen, difficulty swallowing, feelings of fullness after eating small amounts, bloating, gas, and significant weight loss—it's crucial to consider a variety of potential underlying causes.

Possible Causes
1. Gastroesophageal Reflux Disease (GERD): Your mention of gastroesophageal reflux could explain some of your symptoms, such as difficulty swallowing and the sensation of fullness. GERD can lead to inflammation of the esophagus, which may cause pain and discomfort, particularly after eating.

2. Gallbladder Issues: The presence of gallbladder polyps and fatty liver could indicate gallbladder dysfunction. Gallstones or inflammation of the gallbladder (cholecystitis) can lead to upper abdominal pain, especially after meals, and may also cause referred pain to the back.

3. Functional Gastrointestinal Disorders: Conditions like functional dyspepsia or irritable bowel syndrome (IBS) could explain your symptoms, particularly the bloating, gas, and changes in bowel habits. Stress and anxiety can exacerbate these conditions, leading to a cycle of discomfort.

4. Esophageal Disorders: Conditions such as esophageal motility disorders could lead to swallowing difficulties and discomfort. The esophagus may not be functioning properly, leading to symptoms like chest pain or discomfort after eating.

5. Peptic Ulcer Disease: Although you have undergone multiple endoscopies, it’s worth considering that ulcers can sometimes be missed, especially if they are small or located in less accessible areas of the stomach or duodenum.

6. Malabsorption Syndromes: Conditions such as celiac disease or lactose intolerance could lead to gastrointestinal symptoms, including bloating and changes in bowel habits.

Recommendations
1. Follow-Up with a Gastroenterologist: Given the complexity of your symptoms and the weight loss you've experienced, it would be prudent to have a thorough follow-up with a gastroenterologist. They may recommend additional tests, such as a hydrogen breath test for malabsorption issues or motility studies for esophageal function.

2. Dietary Modifications: Keeping a food diary can help identify any potential food triggers that exacerbate your symptoms. A diet low in fat and high in fiber may help manage symptoms related to gallbladder issues and constipation.

3. Medication Review: Discuss your current medications with your healthcare provider. Certain medications can contribute to gastrointestinal symptoms, and adjustments may be necessary.

4. Consider Psychological Factors: Stress and anxiety can significantly impact gastrointestinal health. A referral to a mental health professional or a gastroenterologist with experience in psychosomatic disorders may be beneficial.

5. Nutritional Support: Given your significant weight loss, consider consulting with a nutritionist who can help develop a meal plan that ensures you receive adequate nutrition while managing your symptoms.

6. Regular Monitoring: Given your symptoms and weight loss, regular monitoring of your condition is essential. This may include routine blood tests to check for nutritional deficiencies or liver function tests, especially considering your fatty liver diagnosis.

Conclusion
Abdominal pain, especially when accompanied by other symptoms like difficulty swallowing and significant weight loss, requires a comprehensive approach to diagnosis and management. It’s essential to work closely with your healthcare providers to explore all potential causes and develop a tailored treatment plan. Your health is paramount, and addressing these symptoms holistically can lead to improved quality of life and better overall health outcomes.

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