Chronic Stomach Pain: Long-Term Gastrointestinal Issues

Chronic stomach pain?

Hello Dr.
Yang, my stomach pain started about two to three years ago and has not improved since.
Two to three years ago, I was working part-time during the early morning hours, which led to: 1.
Irregular sleep patterns 2.
Eating only lunch and dinner (sometimes just dinner).
The pain became unbearable, prompting me to go to the hospital for an endoscopy.
The first one was about three years ago, and the doctor took a biopsy but said it was not a gastric ulcer.
I only took medication (but did not continue because I still felt pain and thought it was ineffective).
The second endoscopy was about a year ago.
In the time between the first and second procedures, I have always been an active person, playing badminton and basketball quite vigorously, almost every day.
I have wondered if I might have "gastric ptosis" because my symptoms seem similar, but I have also heard that gastric ptosis occurs after vigorous exercise following a meal, which makes me doubt that diagnosis.
The second endoscopy also showed nothing significant, and I was prescribed more medication and sent home, but I still experience pain.
Currently, my condition is such that I often feel pressure in my stomach whether I am standing or sitting, and I even have a very "sore" feeling (like the soreness you feel after holding your arms up for a long time).
I can no longer distinguish between the pain and soreness because it is often the same.
When I lie down, I feel somewhat more comfortable, but it still feels like something is pressing on my stomach.
Sleeping on my back is uncomfortable, but lying on my side is somewhat better.
It feels like my stomach has never had a proper rest, and I often feel fatigued and yawn frequently (even when I have had enough sleep!).
I wonder what your thoughts are, Dr.
Yang?

Qian Ming, 20~29 year old female. Ask Date: 2003/09/03

Dr. Yang Peizhen reply Gastroenterology and Hepatology

Hello! You have undergone two gastroscopies, and the results indicate that you only have gastritis.
Therefore, your symptoms are likely related to gastritis or dyspepsia.
The solution lies in maintaining a proper diet, which includes avoiding irritating foods, and minimizing the intake of tobacco, alcohol, coffee, and tea.
Additionally, some medications to relieve symptoms can lead to improvement.
Gastrointestinal discomfort can also cause systemic symptoms such as fatigue and dizziness.
Best wishes for your health from Dr.
Cheng Li-Chen, Dermatology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2003/09/03

More Info

Chronic stomach pain can be a complex issue, often stemming from a variety of underlying conditions. Based on your description, it seems that your symptoms have persisted for several years, and despite undergoing multiple endoscopies and treatments, you have not found relief. This situation can be frustrating and concerning, especially when it affects your quality of life.

Understanding Your Symptoms
1. Chronic Pain and Discomfort: The pressure and discomfort you feel in your stomach, especially when standing or sitting, could be indicative of several gastrointestinal issues. Conditions such as functional dyspepsia, gastritis, or even gastroesophageal reflux disease (GERD) could be contributing to your symptoms. The fact that you feel better when lying down suggests that gravity may be playing a role in your discomfort, which is common in cases of reflux or other motility disorders.

2. Diet and Lifestyle Factors: Your history of irregular eating patterns and intense physical activity could also be significant. Skipping meals or eating only once a day can lead to increased gastric acid production, which may irritate the stomach lining and exacerbate pain. Additionally, engaging in vigorous exercise immediately after eating can lead to discomfort, especially if your stomach is sensitive.

3. Psychological Factors: Chronic pain can often be exacerbated by stress and anxiety. While you may not feel overtly stressed, the body can react to underlying psychological factors in ways that manifest as physical symptoms. This is sometimes referred to as psychosomatic pain, where emotional distress contributes to physical discomfort.

Recommendations for Management
1. Dietary Adjustments: Consider adopting a more regular eating schedule with smaller, more frequent meals. This can help regulate stomach acid production and reduce irritation. Avoiding spicy, fatty, or acidic foods may also alleviate symptoms. Keeping a food diary to track what you eat and how it affects your symptoms can be beneficial.

2. Medication Review: Since you have been prescribed medications without significant relief, it may be worth discussing with your healthcare provider the possibility of trying different classes of medications. Proton pump inhibitors (PPIs) or H2 blockers can help reduce stomach acid, while prokinetic agents may assist with gastric motility.

3. Stress Management: Engaging in stress-reducing activities such as yoga, meditation, or mindfulness can help alleviate some of the psychological burdens that may be contributing to your symptoms. Even if you do not feel stressed, these practices can promote relaxation and improve overall well-being.

4. Further Investigations: If your symptoms persist despite these interventions, it may be necessary to explore further diagnostic options. Conditions such as gastroparesis (delayed gastric emptying) or even less common issues like functional gastrointestinal disorders may require specialized testing.

5. Consulting a Specialist: If you have not already, consider seeking a consultation with a gastroenterologist who specializes in functional gastrointestinal disorders. They may offer insights or treatment options that have not been previously considered.

Conclusion
Chronic stomach pain is a multifaceted issue that often requires a comprehensive approach to management. By addressing dietary habits, exploring medication options, managing stress, and possibly seeking further evaluation, you may find relief from your symptoms. It’s essential to maintain open communication with your healthcare provider and advocate for your health, ensuring that all potential causes are explored and treated appropriately. Remember, you are not alone in this journey, and with the right support and strategies, improvement is possible.

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