Chronic Stomach Pain: Seeking Answers Beyond Endoscopy and Ultrasound

Chronic stomach pain?

Hello Doctor, I have been experiencing a long-term issue for about six to seven years.
Due to my busy work schedule, I often ate irregularly or sometimes not at all.
Subsequently, I began to have symptoms similar to acid reflux.
The symptoms are not characterized by stomach pain, but rather a burning pain in the esophagus that can radiate to my back, especially after consuming oily foods or caffeine.
The pain can be severe enough to make me roll around in discomfort (it occurs approximately once every two to three months, so it is not frequent).
During this time, I consulted a doctor who prescribed medication that was initially very effective.
However, recently, the pain has returned, and taking the medication no longer alleviates it.
Therefore, I underwent an endoscopy a month ago, which revealed acute gastritis and a small ulcer in the duodenum.
However, since I have been experiencing this pain for six to seven years, the doctor mentioned that it is unlikely to be the true cause of my symptoms.
The doctor then arranged for an abdominal ultrasound, which also came back normal.
Next week, I will return to the doctor to check if the acute gastritis and the small duodenal ulcer have healed.
I would like to ask you, Doctor Yuan, if there are other possibilities or deeper examinations that I could discuss with my doctor regarding their necessity.
It is quite distressing that neither the endoscopy nor the ultrasound has revealed the source of my long-standing pain.
Thank you.

YI, 30~39 year old female. Ask Date: 2005/04/22

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello, the initial symptom of burning in the chest is caused by gastric acid reflux into the esophagus.
At this time, using proton pump inhibitors typically results in significant improvement.
The size of the ulcer does not necessarily correlate with the symptoms of upper abdominal pain.
If the abdominal ultrasound is normal and the patient does not have fever, weight loss, or anemia, it is recommended to start treatment with ulcer medications.
Patients are advised to relax, avoid alcohol, coffee, smoking, and self-medication, and to refrain from consuming overly sweet or greasy foods, along with engaging in moderate exercise.
Most cases of recurrent, unexplained, chronic upper abdominal pain in young individuals are functional dyspepsia, and further testing is generally not required.
If there are symptoms such as fever, weight loss, anemia, or persistent and worsening symptoms, consider conducting a CT scan, upper gastrointestinal series, electrocardiogram, and blood tests to evaluate liver function, pancreatitis, and pancreatic cancer markers, among others.
Sincerely, Dr.
Yuan Hongdao, Internal Medicine.

Reply Date: 2005/04/22

More Info

Chronic stomach pain can be a complex issue, especially when initial investigations such as endoscopy and ultrasound do not reveal clear causes. Based on your description, it seems you've been dealing with symptoms related to gastroesophageal reflux disease (GERD) and possibly peptic ulcers for several years. The fact that you experience pain primarily after consuming fatty foods and caffeine suggests a potential link to your diet and lifestyle, which can exacerbate acid reflux and gastric discomfort.

Your endoscopy results indicating acute gastritis and a small duodenal ulcer provide some insight, but as your physician mentioned, the acute nature of these findings may not fully explain the chronicity of your symptoms. It's important to understand that while acute gastritis can cause discomfort, chronic symptoms often require a more comprehensive evaluation.

Potential Next Steps and Considerations
1. Dietary Modifications: Since you've noted that certain foods trigger your symptoms, it may be beneficial to keep a food diary to identify specific triggers. Avoiding spicy, fatty, or caffeinated foods can help manage symptoms. Eating smaller, more frequent meals rather than large meals can also reduce gastric pressure and reflux.

2. Lifestyle Changes: Stress management techniques such as mindfulness, yoga, or regular exercise can help alleviate symptoms. Stress can exacerbate gastrointestinal issues, leading to increased acid production and sensitivity.

3. Further Testing: If your symptoms persist despite medication and dietary changes, consider discussing the following tests with your physician:
- 24-hour pH Monitoring: This test measures the acidity in your esophagus over a 24-hour period and can help determine if acid reflux is a significant issue.

- Esophageal Manometry: This test evaluates the function of the esophagus and can identify motility disorders that may contribute to your symptoms.

- Helicobacter pylori Testing: Although you may not have been tested for H. pylori, this bacterium is a common cause of gastritis and peptic ulcers. If not previously tested, it may be worth discussing with your doctor.

4. Medication Review: Since you mentioned that your current medications are becoming less effective, it may be time to review your treatment plan. Proton pump inhibitors (PPIs) like Nexium or Lansoprazole are commonly prescribed, but if they are not providing relief, your doctor may consider adjusting the dosage or switching to a different class of medications.

5. Psychological Factors: Chronic pain can often be exacerbated by psychological factors. If you suspect that stress or anxiety may be contributing to your symptoms, consider discussing this with your healthcare provider. They may recommend counseling or therapy as part of a comprehensive treatment plan.

6. Follow-Up: Regular follow-up with your gastroenterologist is crucial. Ensure that you communicate any changes in your symptoms or new concerns during your visits. This ongoing dialogue can help your doctor tailor your treatment plan more effectively.

Conclusion
Chronic stomach pain can be multifactorial, and while endoscopy and ultrasound are valuable tools, they may not always provide a complete picture. By considering dietary and lifestyle modifications, exploring further testing options, and maintaining open communication with your healthcare provider, you can work towards finding a more effective management strategy for your symptoms. Remember, it’s essential to advocate for your health and seek a comprehensive approach to address your ongoing discomfort.

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