Chronic Bloating, Unproductive Burping, and Unexplained Fever: Seeking Answers

Bloating, inability to burp, and unexplained fever issues?

Hello doctor, I would like to ask about my issues with frequent bloating and an inability to burp, which has made me feel nauseous for over five years.
Every morning, I wake up feeling very nauseous, and I almost always experience bloating after drinking water.
I have undergone three gastroscopies and colonoscopies, and the results indicated gastroesophageal reflux disease (GERD) with some inflammation.
Different gastroenterologists from various hospitals have said that this should not cause such severe bloating.
However, an abdominal ultrasound showed that my abdomen is filled with gas.
Over the past few years, I have also experienced unexplained fevers (ear temperature between 37.5 and 38 degrees Celsius) that have lasted for over ten consecutive days, during which I felt dizzy, had a fever, headaches, general weakness, and occasional sore throat.
The fever episodes typically coincide with my ovulation period, and I also suffer from severe premenstrual syndrome (PMS).
I have tried traditional Chinese medicine, which was effective for a while but later lost its effect.
However, even when my menstrual period arrives, my body temperature does not decrease, so I consulted a gynecologist, who said everything was normal.
I have also seen specialists in rehabilitation and neurosurgery due to my scoliosis, as well as nephrologists and cardiologists, all of whom conducted blood tests and stated that these issues would not cause bloating or fever.
I have also consulted with a psychiatrist, who mentioned autonomic nervous system dysregulation, but the medication did not improve my condition.
I have tried Pilates and brisk walking at the gym, but I still felt uncomfortable.
The only time I felt completely healthy was when I traveled abroad without any issues.
Could you please advise me on which type of doctor I should see? Thank you!

Ms. Chen, 30~39 year old female. Ask Date: 2024/04/01

Dr. Li Jian reply Internal Medicine

If traveling abroad can improve the issue, it may be caused by psychological factors.
It would be advisable to consider consulting a psychosomatic medicine specialist.
Thank you for your inquiry.

Reply Date: 2024/04/01

More Info

Chronic bloating, unproductive burping, and unexplained fever can be quite distressing symptoms, especially when they persist for an extended period, as you have described. Your situation is complex and multifaceted, involving gastrointestinal, systemic, and possibly psychosomatic components. Let's break down your symptoms and explore potential avenues for diagnosis and treatment.

Understanding Your Symptoms
1. Chronic Bloating and Unproductive Burping: These symptoms often indicate gastrointestinal issues. You mentioned having undergone multiple endoscopies and ultrasounds, which have shown gastroesophageal reflux disease (GERD) and some inflammation. GERD can lead to bloating due to the backflow of stomach contents, which can cause discomfort and a sensation of fullness. Additionally, if you are experiencing bloating after drinking water, it may suggest a sensitivity or intolerance to certain substances, or it could be related to the way your body processes fluids.

2. Unexplained Fever: The recurrent fever you experience, particularly around your ovulation period, raises questions about possible underlying conditions. A fever that persists without a clear infectious cause can sometimes be linked to autoimmune disorders, hormonal imbalances, or chronic inflammatory conditions. Given that your fever has been recorded between 37.5°C and 38°C, it is considered a low-grade fever, which can sometimes be associated with chronic conditions.

3. Associated Symptoms: The accompanying symptoms of dizziness, headaches, and fatigue can be indicative of several issues, including chronic fatigue syndrome, hormonal fluctuations, or even anxiety and stress-related disorders. The fact that you feel better when traveling could suggest that environmental factors, lifestyle changes, or stress relief play a significant role in your overall well-being.

Potential Causes and Next Steps
Given the complexity of your symptoms and the various specialists you have consulted, it may be beneficial to consider a more integrative approach:
1. Gastroenterologist: Since you have already seen several gastroenterologists, it may be worth seeking a second opinion from a specialist who focuses on functional gastrointestinal disorders. Conditions like irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO) can sometimes be overlooked in standard evaluations.

2. Endocrinologist: Given the cyclical nature of your fever and its correlation with your menstrual cycle, consulting an endocrinologist could help assess any hormonal imbalances or thyroid issues that might be contributing to your symptoms.

3. Rheumatologist: If there is a suspicion of an autoimmune condition, a rheumatologist can perform tests to rule out conditions like lupus or other inflammatory diseases that can cause systemic symptoms, including fever and fatigue.

4. Psychosomatic Specialist: Since you have seen a psychiatrist and have been diagnosed with autonomic nervous system dysregulation, it may be beneficial to explore therapies that address the mind-body connection, such as cognitive behavioral therapy (CBT) or mindfulness-based stress reduction.

5. Dietitian: Consulting a registered dietitian who specializes in gastrointestinal health can help identify any food intolerances or dietary patterns that may be exacerbating your bloating and discomfort.

Conclusion
Your symptoms are multifactorial and may require a multidisciplinary approach for effective management. It is crucial to maintain open communication with your healthcare providers and advocate for further testing if necessary. Keeping a detailed symptom diary, including food intake, activity levels, and symptom fluctuations, can also provide valuable insights for your healthcare team.

In summary, while your symptoms are challenging, a thorough and collaborative approach involving various specialists may lead to a clearer understanding of your condition and ultimately improve your quality of life. Don't hesitate to seek further evaluations and insist on comprehensive testing to uncover any underlying issues that may have been missed.

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