Persistent Upper Abdominal Discomfort: Causes and Solutions

Q: Persistent Upper Abdominal Discomfort: Causes and Solutions

Hello： Vonoprazan is a new type of acid-suppressing medication that belongs to a longer-acting category, addressing the limitation of current proton pump inhibitors that have a duration of action of less than 24 hours. <br>If symptoms persist after use, it is evident that gastric

Persistent bloating in the upper abdomen throughout the day?

Hello, I have been experiencing a feeling of fullness and bloating in my upper abdomen all day since February 1st of this year.
It feels somewhat better at night when I sleep, but sometimes I still feel uncomfortable, which affects my sleep.
Occasionally, I have pain in my upper left abdomen.
I have seen several doctors and have been prescribed antacids, but they have not been effective.
I then went to a large hospital where a colonoscopy was normal, an abdominal CT scan was normal, and I was diagnosed with mild gastric antritis with slight bleeding in the gastric wall.
The doctor prescribed vonoprazan for 14 days.
However, I found it strange that after the colonoscopy, my stomach felt better for three days, but then the bloating returned.
Before the CT scan of my stomach, I was under a lot of stress, and once I learned that I only had mild gastric antritis, my stomach felt somewhat better.
After taking the medication for three days, I felt completely fine.
But on the tenth day, I woke up with pain in my upper abdomen, and after that, my stomach started experiencing the same issues as before, which is the bloating.
I have been switching medications since then, but nothing seems to help.
I am very worried because my weight has been dropping; in February, I weighed 56 kg, and now in April, I weigh 51 kg, a loss of 5 kg.
Recently, I have also started feeling nauseous at times.
When it's mealtime, my stomach growls, but I have no appetite and don't feel hungry, although I can finish my meals without feeling nauseous.
Currently, I am taking Ganaton 50 mg and Mucosta 100 mg.
Can you please tell me what is wrong with me? The doctor said my gastric antritis is mild, but why hasn't it improved? I still feel very bloated, and sometimes I have pain in my lower back, which severely affects my daily life and work.
I would greatly appreciate your valuable advice! Thank you, Doctor! Xiaoxiong

Lai Xiao Xiong, 40~49 year old female. Ask Date: 2022/04/04

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Vonoprazan is a new type of acid-suppressing medication that belongs to a longer-acting category, addressing the limitation of current proton pump inhibitors that have a duration of action of less than 24 hours.
If symptoms persist after use, it is evident that gastric acid may not be the primary cause.
It is important to consider whether there is rapid peristalsis, other endocrine issues (such as hyperthyroidism), or if there are underlying lifestyle and dietary habits that are abnormal, excessive anxiety, or the use of analgesics.
A CT scan can help rule out pancreatic lesions.
You may return for a follow-up consultation with your physician to discuss the treatment that is suitable for you.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2022/04/04

More Info

Persistent upper abdominal discomfort can be a complex issue with various underlying causes. Based on your description, it seems you have been experiencing significant discomfort since February, which has affected your quality of life and led to weight loss. You have undergone several diagnostic tests, including a CT scan and endoscopy, which revealed mild gastric antrum inflammation and slight bleeding. Despite treatment with medications like vonoprazan, Ganaton, and Mucosta, your symptoms persist.

There are several potential reasons for your ongoing discomfort:
1. Gastritis: The mild inflammation in your gastric antrum could be contributing to your symptoms. Gastritis can be caused by various factors, including stress, certain medications (especially NSAIDs), alcohol consumption, and dietary habits. Even mild gastritis can lead to significant discomfort, bloating, and changes in appetite.

2. Functional Dyspepsia: This condition is characterized by chronic upper abdominal discomfort without any identifiable organic cause. Symptoms can include bloating, early satiety, and nausea. Stress and anxiety can exacerbate these symptoms, leading to a cycle of discomfort and worry.

3. Gastroesophageal Reflux Disease (GERD): If you have not been evaluated for GERD, it might be worth considering. GERD can cause symptoms similar to what you describe, including a feeling of fullness, discomfort, and even nausea.

4. Dietary Factors: Sometimes, certain foods can trigger symptoms of bloating and discomfort. Keeping a food diary to track what you eat and any subsequent symptoms may help identify potential triggers.

5. Psychosomatic Factors: Given that you mentioned experiencing stress and anxiety, it’s possible that these emotional factors could be contributing to your physical symptoms. Stress can lead to increased gastric acid production and changes in gut motility, which may exacerbate your discomfort.

6. Weight Loss and Appetite Changes: The significant weight loss you’ve experienced (from 56 kg to 51 kg) is concerning and could be a result of your ongoing gastrointestinal issues. It’s essential to address this with your healthcare provider, as unintended weight loss can lead to further health complications.

Given the persistence of your symptoms and the impact on your daily life, I recommend the following steps:
- Follow-Up with a Gastroenterologist: If you haven’t already, consider seeking a second opinion from a gastroenterologist who specializes in functional gastrointestinal disorders. They may suggest additional testing or alternative treatments.

- Consider Psychological Support: If stress and anxiety are contributing to your symptoms, speaking with a mental health professional may provide relief. Cognitive-behavioral therapy (CBT) has been shown to help with functional gastrointestinal disorders.

- Dietary Modifications: Work with a dietitian to explore potential dietary triggers and develop a meal plan that minimizes discomfort. They can help you identify foods that are easier to digest and recommend strategies for managing bloating.

- Medication Review: Discuss your current medications with your doctor to ensure they are appropriate for your symptoms. Sometimes, adjusting the dosage or switching to a different medication can lead to better outcomes.

- Lifestyle Changes: Incorporate stress-reducing activities into your daily routine, such as yoga, meditation, or gentle exercise. These can help improve your overall well-being and potentially alleviate some gastrointestinal symptoms.

In conclusion, persistent upper abdominal discomfort can stem from various causes, and it’s crucial to approach the issue holistically. By addressing both the physical and emotional aspects of your health, you may find a path toward relief and improved quality of life. Please ensure to keep an open line of communication with your healthcare providers and advocate for your health needs.

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