Gastrointestinal Discomfort: Seeking Answers for Unexplained Symptoms

Q: Gastrointestinal Discomfort: Seeking Answers for Unexplained Symptoms

Hello： I would like to know if you experience frequent bowel movements, have large stool volume, or if your stools are oily and float on the water's surface. <br>If so, it may be necessary to consider issues related to the small intestine or pancreas, and further examination of t

Gastrointestinal discomfort?

I am a 44-year-old male, and since July of last year, I have been experiencing the following symptoms: dull pain in the upper left abdomen (between the ribs and the navel, but pressing on it does not cause pain), bloating (gas is expelled both from the mouth and the rectum), and unformed stools (loose but not watery diarrhea).
My original weight was 53-54 kg, but during a health check in September, my weight dropped to 51.5 kg.
The health check included routine blood tests and a chest X-ray, which showed everything normal except for a low BMI (height 164 cm).
Subsequently, I underwent gastroscopy, abdominal ultrasound, colonoscopy, and thyroid tests (FT4, TSH), which revealed inflammation in the lesser curvature of the stomach and bile reflux, but everything else was normal.
Both the clinic and a regional hospital diagnosed me with gastrointestinal sensitivity and dyspepsia.
I have been continuously taking medication.
The medication sometimes alleviates the dull pain in the upper left abdomen and bloating, but at times it is ineffective, and there has been no improvement in the unformed stools.
My weight has continued to decline, recently dropping below 50 kg, and I feel significantly weaker.
Due to my lack of energy, I underwent a full-body MRI for tumor screening, which did not reveal any abnormalities.
I specifically asked the doctor to pay attention to the pancreas, and there were no findings.
Currently, only the small intestine and heart have not been examined.
It has been over eight months since I first felt unwell, and my appetite and food intake have not changed significantly.
I have been consistently seeing doctors and taking medication, but the effects seem unclear, and my weight continues to drop, which is causing me great concern.
I often feel lost, helpless, and anxious! I would like to ask: is this situation truly just gastrointestinal sensitivity and dyspepsia? Do I need to undergo further examination of the small intestine? I would appreciate some professional guidance from experts.
Thank you.

mike, 40~49 year old female. Ask Date: 2006/04/20

Dr. Yuan Hongdao reply Gastroenterology and Hepatology

Hello: I would like to know if you experience frequent bowel movements, have large stool volume, or if your stools are oily and float on the water's surface.
If so, it may be necessary to consider issues related to the small intestine or pancreas, and further examination of the small intestine may be required.
If these symptoms are not present, you might want to investigate endocrine factors (such as blood sugar and adrenal function), autoimmune diseases, or chronic infections.
If everything else checks out, it could also be related to emotional issues (such as anxiety or depression), and it may be worth consulting a psychiatrist.
Clinically, functional gastrointestinal disorders caused by stress are quite common, although significant weight loss is less frequently observed.
Sincerely, Dr.
Yuan Hongdao, Internal Medicine.

Reply Date: 2006/04/20

More Info

It sounds like you have been experiencing a complex set of gastrointestinal symptoms for quite some time, and I can understand how concerning this must be for you. Based on the information you've provided, it appears that you have undergone a thorough evaluation, including endoscopic examinations (gastroscopy and colonoscopy), imaging studies (ultrasound and MRI), and various blood tests. While these tests have ruled out many serious conditions, your ongoing symptoms and weight loss are indeed troubling.

Your symptoms of left upper abdominal discomfort, bloating, and irregular bowel movements (not fully formed stools) can be indicative of several gastrointestinal issues. The fact that your weight has decreased significantly (from 53-54 kg to below 50 kg) is particularly concerning, as unintentional weight loss can be a sign of underlying health problems.

Possible Explanations for Your Symptoms
1. Functional Gastrointestinal Disorders: Given that your tests have come back normal aside from some inflammation in the stomach and bile reflux, it is possible that you are experiencing a functional gastrointestinal disorder, such as Irritable Bowel Syndrome (IBS) or functional dyspepsia. These conditions can cause symptoms like bloating, abdominal pain, and irregular bowel habits without any identifiable structural abnormalities.

2. Dietary Factors: Sometimes, dietary habits can contribute significantly to gastrointestinal discomfort. Consider keeping a food diary to identify any potential triggers that may worsen your symptoms. Foods that are high in fat, caffeine, or certain carbohydrates (like lactose or gluten) can exacerbate symptoms in sensitive individuals.

3. Psychological Factors: Stress and anxiety can have a profound impact on gastrointestinal function. If you are feeling anxious or stressed about your health, this could potentially exacerbate your symptoms. It might be beneficial to explore stress management techniques or speak with a mental health professional.

4. Small Intestinal Issues: Since you mentioned that the small intestine has not been specifically evaluated, it may be worth discussing with your healthcare provider the possibility of further testing, such as a small bowel imaging study or a breath test for conditions like Small Intestinal Bacterial Overgrowth (SIBO) or malabsorption syndromes.

5. Pancreatic Function: Although your MRI did not reveal any abnormalities, pancreatic insufficiency can lead to malabsorption and weight loss. A stool test to evaluate fat malabsorption or pancreatic function could be considered.

Next Steps
1. Follow-Up with a Gastroenterologist: Given the persistence of your symptoms and weight loss, it would be prudent to have a follow-up appointment with a gastroenterologist. They may recommend further testing or a referral to a specialist in functional gastrointestinal disorders.

2. Nutritional Assessment: Consulting with a registered dietitian could help you identify any dietary issues and ensure you are getting adequate nutrition to prevent further weight loss.

3. Consider Psychological Support: If stress or anxiety is a factor, seeking support from a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help with gastrointestinal symptoms in some patients.

4. Monitor Symptoms: Keep a detailed record of your symptoms, including their frequency, duration, and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action.

In conclusion, while your symptoms may be attributed to functional gastrointestinal disorders, the significant weight loss and ongoing discomfort warrant further investigation. It is essential to continue advocating for your health and seeking answers until you find a resolution. Please do not hesitate to reach out to your healthcare provider for further evaluation and support.

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