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What are the causes for chronic upper abdominal pain ?

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Practicing since : 1997
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I am looking for some help and advice as I am in sheer desperation.

I am a 29-year-old male living in England. For the past two years I have been experiencing excruciating abdominal pain on a sporadic basis, starting when I was approximately 26. Sometimes the pain is unbearable and forces me to attend hospital, other times I am able to function but it is a constant, dull ache. The pain occurs just below my breastbone in a central area. Over the past 6 weeks, the pain has been occurring on a more regular basis, particularly after eating and eating fatty foods inparticular. I also feel nauseous 80% of the time and occasionally heave, sometimes producing bile. I have also gone from 12 st to 10 st 6 lbs in four months (I am 5 ft 10). I do eat, although I seldom have an appetite lately and eat only because I feel I should rather than out of hunger.

A couple of years ago, I began to get severe abdominal pains. It began one morning when I awoke with abdominal pain. I thought it was because I had needed to urinate during my sleep, but upon urinating, the pain did not subside. I occasionally had diarrhea when the pain occurred. It was a very painful ache that would make me want to stay in bed. Sometimes it would last days before it subsided. Things have not been right ever since. The pain disappeared for a while before, just over a year ago, I began getting the pains again on a regular basis. They suspected possible Crohn’s disease, but I had an ultra sound, pancreas test, colonoscopy and nothing was found and they discharged me. For the past year I have been in reasonably good health – until six weeks or so ago.

I had the severe abdominal pain again. I visited the doctor and hospital several times and was prescribed all sorts of drugs such as Omeprazole, Buscopan, Mebeverine, and Domperidone. Over the past three weeks, I have attended hospital on three occasions with the severe abdominal pain. Yesterday was my most recent attack. A week prior, I had attended hospital with the excruciating pain. My GP suspected that I may have gallstones (my mum has had it and had her gallbladder removed a few years ago), so he booked me in for an ultrasound. My last three blood tests showed that my white blood cell counts were slightly low, which he said suggests my body has been fighting some kind of infection. My bilirubin levels were 24, which were slightly elevated he said but not major. I had felt quite ill at work again all week, I was unable to go in one day due to throwing up small amounts of bile in the morning and feeling constantly nauseous with the abdominal pain about 5 on a scale of 1-10. Yesterday at work, I felt the pain just below my breastbone all day and felt extremely nauseous.

Yesterday afternoon I had my ultrasound and was praying they would find gallstones so I could possibly finally find out what is wrong with me. However, there were no signs of gallstones and I was sent away and told to refer back to my GP. Later that day I had a sausage in batter and chips for my evening meal. Within no more than ten minutes, I was in excruciating pain below my breastbone, in exactly the same place that I had felt the pain all week, but just in a more extreme way, so much so that I could hardly stand or sit down. I felt extremely sick and the pain reduced me to tears (which has happened many times, in fact sometimes the pain wakes me up during my sleep). Within ten minutes, I was having violent diarrhoea that was extremely strange as it was full of fat floating in it. Upon flushing the toilet, the water was then left with lots of bright, almost florescent yellow left in it, that looked like either fat or bile. This has happened to me at least 5 or 6 times over the past week where I have had diarrhoea that is full of what I am certain is fat.

In agony, my dad took me to the hospital, where I was left waiting for about 5 hours before I was finally seen by a nurse. During this time, the pain had subsided a lot from the intense pain I had been suffering. The doctor examined me and looked at my ultrasound from earlier in the day, which she said looked normal. She took a blood test about 5 hours after I had entered the hospital and the blood test results came back normal, showing that my bilirubin levels this time were actually 14. My amylase levels were also normal, which she felt ruled out any problems with the pancreas.

Today, I feel slightly better, although can still feel the pain on a low level. Pretty much every day I wake up with abdominal pain when I open my eyes and I think, “Here we go again…”. Every day is a struggle to get through, and at 29 my life should not be like this.

I am going on holiday with a friend to Las Vegas two weeks today and I am now very worried about how I am going to cope on the 10-hour flight from London and during the six nights that I am staying in Vegas.

I have done a lot of research tonight and acute and chronic pancreatitis keep coming up and the symptoms seem exactly what I have been experiencing. I have read that pancreatitis can exist even when the amylase levels are at a normal level?

I really need some advice and help. Please can you tell me what you think this could be? I know that something is wrong and it really feels to me like there is something wrong with one of my XXXXXXX organs. I am also very worried about my weight loss, 1.5 stones in 4 months is a lot without trying to lose weight.

I’ve been told all sorts – acid reflux, gastritis, IBS. None of these seem right to me, the pain and the way I am feeling seem far more intense than any of these would give me. I’ve had acid reflux before and it certainly isn’t that.

I look forward to your response,

Posted Mon, 16 Apr 2012 in Abdominal Pain
Answered by Dr. Vaibhav Banait 20 hours later

Thanks for your query.

Chronic upper abdomenal pain and fatty diarrhea are expected in following conditions

1. Chronic pancreatitis : where USG and amylase may be normal, Ct abdomen is the better options to pick it up.

2. Extensive small bowel disease like crohns or celiac disease or lymphoma. Ct abdomen , Endoscopy, enteroclysis would pick it up.

3. Hypergastrinemia, where Endoscopy will show ulcers, serum gastrin will be high, and extensive investigations will be required to pick up a small tumor.

As you mentioned, common causes like GERD ', ulcers disease seem to be ruled out.

Hope I have answered your query. If you have any follow up queries I will be available to answer them.


Dr Vaibhav XXXXXXX
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