Chronic Stomach Pain and Right Side Back Pain: Seeking Effective Solutions

Stomach pain and right flank pain?

Hello Dr.
Liu,
I have been suffering from stomach pain for a long time and have been diagnosed with gastritis.
Two years ago, during a health check-up, I tested positive for Helicobacter pylori.
I have undergone three gastroscopies (at different times), which only showed gastritis, and the doctor mentioned that it hasn't progressed to a gastric ulcer yet.
However, my condition has not improved, and I often experience headaches and nausea.
I would like to know if there are better methods or medications available for treatment.
Additionally, I started experiencing lower back pain about six months ago, which has been persistent in the right posterior area.
I have consulted both traditional Chinese medicine and a chiropractor, but I have not received any answers.
Even after correcting my sitting posture, there has been no improvement.
I subsequently visited an internal medicine specialist and underwent an abdominal ultrasound, which revealed no abnormalities (only a small cyst on my liver).
Recently, the traditional Chinese medicine practitioner, due to my stomach issues, suggested that if internal medicine problems are ruled out, I should see an orthopedic specialist for further evaluation.
I visited orthopedics yesterday, and after an X-ray, the doctor indicated that there were no abnormalities and suggested it might be myofascial pain syndrome.
However, since the pain has not diminished (it has become difficult to distinguish between the frequency and nature of my stomach pain and back pain), I would like to ask for your advice on how I should seek further assistance (which specialty would be most appropriate to consult?).
Thank you very much!

Xiao Lin, 30~39 year old female. Ask Date: 2007/05/24

Dr. Liu Nanshan reply Gastroenterology and Hepatology

Abdominal pain with no identifiable cause is often functional in nature and related to gastrointestinal motility, such as spasms.
This condition is more likely to occur in individuals who are prone to anxiety, high work demands, or other significant stressors, or it may be associated with certain foods or medications.
Functional gastrointestinal disorders may not respond well to pharmacological treatment, and it is essential to eliminate triggering factors, such as stress.
This is currently the most likely cause of your symptoms.
Additionally, it is important to rule out issues with the pancreas or the transverse colon, which are located behind the stomach.
For lower back pain, it is necessary to exclude problems related to the lumbar spine or the urinary tract; myofascial pain syndrome is a common cause, often due to prolonged sitting or poor posture.
It is recommended that you first consult a gastroenterologist to rule out any issues with the pancreas or transverse colon.

Reply Date: 2007/05/24

More Info

Chronic stomach pain, especially when associated with back pain, can be quite distressing and may indicate several underlying issues. Based on your description, it appears that you have been dealing with gastritis and have a history of Helicobacter pylori infection, which can contribute to chronic gastric inflammation. Additionally, the right-sided back pain you are experiencing could be related to musculoskeletal issues or referred pain from your gastrointestinal system.

Understanding Your Symptoms
1. Gastritis and Helicobacter Pylori: Chronic gastritis can lead to symptoms such as abdominal pain, nausea, and even headaches. The presence of Helicobacter pylori is significant because it is a common cause of gastritis and can lead to peptic ulcers if left untreated. It is essential to ensure that this infection is adequately managed, typically with a combination of antibiotics and proton pump inhibitors (PPIs).

2. Back Pain: The right-sided back pain could be multifactorial. It might be related to muscle strain, poor posture, or even referred pain from your stomach issues. Since you have already consulted with various specialists, including internal medicine and orthopedics, it may be beneficial to consider physical therapy to address any musculoskeletal components.

Recommendations for Management
1. Medical Treatment:
- Proton Pump Inhibitors (PPIs): If you are not currently on a PPI, consider discussing this with your doctor. PPIs can significantly reduce stomach acid production, allowing the gastric lining to heal.

- Antibiotic Therapy: If you have not been treated for Helicobacter pylori recently, a regimen of antibiotics (usually a combination of two) along with a PPI is recommended.

- Antacids and H2 Blockers: Over-the-counter antacids can provide symptomatic relief, while H2 blockers can help reduce acid production.

2. Dietary Modifications:
- Avoid spicy, fatty, or acidic foods that can exacerbate gastritis.

- Eat smaller, more frequent meals to reduce the burden on your stomach.

- Stay hydrated and consider incorporating soothing foods like bananas, rice, applesauce, and toast (the BRAT diet) during flare-ups.

3. Lifestyle Changes:
- Posture: Ensure that you maintain good posture, especially if you sit for long periods. Ergonomic adjustments to your workspace may help alleviate some back pain.

- Physical Activity: Engage in gentle exercises, such as walking or stretching, which can help improve both gastric motility and musculoskeletal health.

- Stress Management: Chronic pain can be exacerbated by stress. Techniques such as mindfulness, yoga, or meditation may help reduce stress levels and improve your overall well-being.

4. Follow-Up Care:
- Given your ongoing symptoms, it may be beneficial to have regular follow-ups with a gastroenterologist. They can monitor your condition and adjust your treatment plan as necessary.

- If your symptoms persist despite treatment, further investigations such as an endoscopy may be warranted to rule out other conditions like ulcers or malignancies.

5. Consider Multidisciplinary Approach:
- Since your symptoms involve both gastrointestinal and musculoskeletal components, a multidisciplinary approach involving a gastroenterologist, physical therapist, and possibly a pain management specialist may provide a comprehensive treatment plan.

Conclusion
Chronic stomach pain and associated back pain can significantly impact your quality of life. It is crucial to address both the gastric issues and the musculoskeletal pain through a combination of medical treatment, dietary changes, lifestyle modifications, and possibly physical therapy. Regular follow-ups with your healthcare providers will ensure that you receive the most effective care tailored to your specific needs. If you continue to experience symptoms, do not hesitate to seek further evaluation and support.

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