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Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Hey doctor, So yesterday morning I woke up with really

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2040 Questions

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Posted on Sat, 5 Jan 2019 in Digestion and Bowels
Question: Hey doctor,

So yesterday morning I woke up with really bad upper centre sided stomach pain in the epigastric region. The day before that I’m not sure if I had overdone it but in the morning I had a probiotic, for lunch I had my daily gut supplement which is this one https://www.australianvitamins.com/product/nutrition-care-gut-relief
And then for dinner I had a vitiams tablet which had vitiam c, zinc and echinacea because I was feeling a little sick that day. But the day after I just woke up with really bad stomach pain mainly consisiting of cramps in the epigastric region along with nausea too. Could I have maybe overdone it with those supplements? I’ve had them before in the past with no issues but I’m unsure? The other thing was that I had just come back from Bali in Indonesia and I’m from Australia 2 days ago could I have possibly caught a bug over there that didn’t show up until after I came back? I had never been before and I’ve heard of a lot people getting sick there but my pain is mainly just upper tummy related.
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Follow up: Dr. Ramesh Kumar 0 minute later
Hey doctor,

So yesterday morning I woke up with really bad upper centre sided stomach pain in the epigastric region. The day before that I’m not sure if I had overdone it but in the morning I had a probiotic, for lunch I had my daily gut supplement which is this one https://www.australianvitamins.com/product/nutrition-care-gut-relief
And then for dinner I had a vitiams tablet which had vitiam c, zinc and echinacea because I was feeling a little sick that day. But the day after I just woke up with really bad stomach pain mainly consisiting of cramps in the epigastric region along with nausea too. Could I have maybe overdone it with those supplements? I’ve had them before in the past with no issues but I’m unsure? The other thing was that I had just come back from Bali in Indonesia and I’m from Australia 2 days ago could I have possibly caught a bug over there that didn’t show up until after I came back? I had never been before and I’ve heard of a lot people getting sick there but my pain is mainly just upper tummy related.
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Follow up: Dr. Ramesh Kumar 2 minutes later
I’ve also been passing a lot of gas too that smells bad but I haven’t had any unsual bowel movements yet just ones that kind of smell. I’ve kind of kept my meals simple the last day mainly bland foods like bananas and crackers because of the stomach pain hurting quite a bit.
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Follow up: Dr. Ramesh Kumar 0 minute later
I’ve also been passing a lot of gas too that smells bad but I haven’t had any unsual bowel movements yet just ones that kind of smell. I’ve kind of kept my meals simple the last day mainly bland foods like bananas and crackers because of the stomach pain hurting quite a bit.
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Follow up: Dr. Ramesh Kumar 1 minute later
What triggered as well the night before the stomach pain I went to the movies at night and had popcorn and a soft drink and I started getting stomach pain there and then the next morning it got even worse can popcorn trigger pain like that?
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Follow up: Dr. Ramesh Kumar 0 minute later
What triggered as well the night before the stomach pain I went to the movies at night and had popcorn and a soft drink and I started getting stomach pain there and then the next morning it got even worse can popcorn trigger pain like that?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Epigastric pain very likely acid peptic disorder or ulcers.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

As per your complaint, it seems that you are suffering from intestinal ulcers.These are called peptic ulcers some times they are in intestine while some times they may be in stomach.
Soft drink contains hypophosphoric acid which irritates the gut hence causing pain.Same is with popcorn usually they are coated with spices again they irritate the exposed mucosa of ulcers and may cause pain.

It's not the popcorn or soft drink rather the increased acidity of gut which is the real culprit.
Smell in stools is suggestive of fact that bad bacteria's are growing in gut and are fermenting the food.This fermentation and putrification releases gases which are toxic and are smelly.

It has nothing to do with supplements.
It's neither the bug.
It's a clear cut case of gastritis or acid peptic disorder or ulcers.
A test called endoscopy should be done in which a tube with camera would be inserted inside your gut via mouth to see the condition of gut and upper intestines.
Till then,

I would suggest you not to worry too much.
Take a proton pump inhibitor like Omeprazole 40 mg twice daily. This will provide you symptomatic relief from symptoms.
Antacid like Pepto bismol can be taken for few days.Both are over the counter.
Follow up with reports of endoscopy.
Hope I was helpful.
Follow ups are welcome!

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Epigastric pain very likely acid peptic disorder or ulcers.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

As per your complaint, it seems that you are suffering from intestinal ulcers.These are called peptic ulcers some times they are in intestine while some times they may be in stomach.
Soft drink contains hypophosphoric acid which irritates the gut hence causing pain.Same is with popcorn usually they are coated with spices again they irritate the exposed mucosa of ulcers and may cause pain.

It's not the popcorn or soft drink rather the increased acidity of gut which is the real culprit.
Smell in stools is suggestive of fact that bad bacteria's are growing in gut and are fermenting the food.This fermentation and putrification releases gases which are toxic and are smelly.

It has nothing to do with supplements.
It's neither the bug.
It's a clear cut case of gastritis or acid peptic disorder or ulcers.
A test called endoscopy should be done in which a tube with camera would be inserted inside your gut via mouth to see the condition of gut and upper intestines.
Till then,

I would suggest you not to worry too much.
Take a proton pump inhibitor like Omeprazole 40 mg twice daily. This will provide you symptomatic relief from symptoms.
Antacid like Pepto bismol can be taken for few days.Both are over the counter.
Follow up with reports of endoscopy.
Hope I was helpful.
Follow ups are welcome!

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 16 minutes later
I had an upper endoscopy last year which came out clear last year do you think it’s possible I could have got an ulcer in that time? Would it be worth having another one done just to check again? I’ve had PPI in the past which didn’t really seem to work well for me just seemed to make things worse for me.
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Follow up: Dr. Ramesh Kumar 0 minute later
I had an upper endoscopy last year which came out clear last year do you think it’s possible I could have got an ulcer in that time? Would it be worth having another one done just to check again? I’ve had PPI in the past which didn’t really seem to work well for me just seemed to make things worse for me.
doctor
Answered by Dr. Ramesh Kumar 26 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello again XXXXXXX
Before going for endoscopy last year do you have the same symptoms(frequency and intensity).
What PPI have you tried and doses?
Have you taken them empty stomach?
Please reply.
Waiting

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up.

Detailed Answer:
Hello again XXXXXXX
Before going for endoscopy last year do you have the same symptoms(frequency and intensity).
What PPI have you tried and doses?
Have you taken them empty stomach?
Please reply.
Waiting

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 22 minutes later
I tried Nexium 40mg I was having originally one in the morning but then up the dose to one in the morning and one at night but it just made the stomach pain worse and I found it really hard to digest foods when I was on it so I don’t really want to go on it again. I had similar symptoms before but I used to have heartburn which I don’t really get anymore the main symptoms I have are definitely the stomach pain in the centre of the epigastric region.
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Follow up: Dr. Ramesh Kumar 0 minute later
I tried Nexium 40mg I was having originally one in the morning but then up the dose to one in the morning and one at night but it just made the stomach pain worse and I found it really hard to digest foods when I was on it so I don’t really want to go on it again. I had similar symptoms before but I used to have heartburn which I don’t really get anymore the main symptoms I have are definitely the stomach pain in the centre of the epigastric region.
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Follow up: Dr. Ramesh Kumar 1 minute later
I also had my endoscopy while I was still on Nexium I only came off it a couple days before , but now I’ve been off them for over a year now and I had my endoscopy in July 2017 and my colonoscopy in Ocotober 2017.
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Follow up: Dr. Ramesh Kumar 0 minute later
I also had my endoscopy while I was still on Nexium I only came off it a couple days before , but now I’ve been off them for over a year now and I had my endoscopy in July 2017 and my colonoscopy in Ocotober 2017.
doctor
Answered by Dr. Ramesh Kumar 9 minutes later
Brief Answer:
Follow up.

Detailed Answer:
Hello again XXXXXXX
Sorry for asking more questions but I have few more doubts-
1)Last time when you had medium was the nature location and characteristic of pain same as what you are having now. I Mean before you had your endoscopy the nature of pain was same?
2)Have you taken any enzyme supplements for food digestion till date containing amylase lipase and papain etc?
3)Have you take any probiotics till DATE?
4)Did your primary doctor gave you information on gastritis in which there is inflammation in stomach wall but many times endoscopy misses it?
5)Your bowel habits any constipation loose motion etc?
6)What did your primary Gastroenterologist said about your symptoms?
7)Any relieving factor observed by you     ?

Sorry for asking more queries but it's important in typical cases.
Waiting.



Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up.

Detailed Answer:
Hello again XXXXXXX
Sorry for asking more questions but I have few more doubts-
1)Last time when you had medium was the nature location and characteristic of pain same as what you are having now. I Mean before you had your endoscopy the nature of pain was same?
2)Have you taken any enzyme supplements for food digestion till date containing amylase lipase and papain etc?
3)Have you take any probiotics till DATE?
4)Did your primary doctor gave you information on gastritis in which there is inflammation in stomach wall but many times endoscopy misses it?
5)Your bowel habits any constipation loose motion etc?
6)What did your primary Gastroenterologist said about your symptoms?
7)Any relieving factor observed by you     ?

Sorry for asking more queries but it's important in typical cases.
Waiting.



Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar 13 minutes later
1)Last time when you had medium was the nature location and characteristic of pain same as what you are having now. I Mean before you had your endoscopy the nature of pain was same?

A: The pain that I’ve had the last couple of days is more severe than what it usually is which is why I think something has triggered it off possibly something I ate or a bug from travelling to Bali? In terms of the location and type of pain it’s exactly the same as what I usually get just more way painful than normal.

2)Have you taken any enzyme supplements for food digestion till date containing amylase lipase and papain etc?

A: I haven’t had any enzyme supplements like that no only the gut relief that I linked earlier.

3)Have you take any probiotics till DATE?

A: I find probiotics for me in general seem to make things a lot worse. I find as soon as I start one symptoms seem to get worse for me and usually my acne flares up as well. Yakult is the only one that kind of dulled the stomach pain down a little but at the same time made the acne on my face worse. I recently tried this travel probiotic for when I travelled to Bali which I seemed to tolerate okay and it had “Saccharomyces Cerevisiae (Boulardii).5 billion CFU (Colony Forming Units)(Organisms).” in it.

4)Did your primary doctor gave you information on gastritis in which there is inflammation in stomach wall but many times endoscopy misses it?

A: They didn’t really mention that endoscopy can miss it but I do know a little about gastritis which was why I was taking that natural supplement to try ease it.

5)Your bowel habits any constipation loose motion etc?

A: Most of the time they are formed but I do see a lot of vegetables in my stool and undigested fragments and I do go quite often at least once a day but sometimes 2-3 times a day.

6)What did your primary Gastroenterologist said about your symptoms?

A: Her diagnosis was that because both the gastroscopy and colonoscopy where clear that I had IBS and there wasn’t really any treatment she gave me mainly that I just have to manage it.

7)Any relieving factor observed by you?

A: For some weird reason bananas seem to be the most soothing thing for me they are one of the only things that calm down my stomach pain a little.
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Follow up: Dr. Ramesh Kumar 0 minute later
1)Last time when you had medium was the nature location and characteristic of pain same as what you are having now. I Mean before you had your endoscopy the nature of pain was same?

A: The pain that I’ve had the last couple of days is more severe than what it usually is which is why I think something has triggered it off possibly something I ate or a bug from travelling to Bali? In terms of the location and type of pain it’s exactly the same as what I usually get just more way painful than normal.

2)Have you taken any enzyme supplements for food digestion till date containing amylase lipase and papain etc?

A: I haven’t had any enzyme supplements like that no only the gut relief that I linked earlier.

3)Have you take any probiotics till DATE?

A: I find probiotics for me in general seem to make things a lot worse. I find as soon as I start one symptoms seem to get worse for me and usually my acne flares up as well. Yakult is the only one that kind of dulled the stomach pain down a little but at the same time made the acne on my face worse. I recently tried this travel probiotic for when I travelled to Bali which I seemed to tolerate okay and it had “Saccharomyces Cerevisiae (Boulardii).5 billion CFU (Colony Forming Units)(Organisms).” in it.

4)Did your primary doctor gave you information on gastritis in which there is inflammation in stomach wall but many times endoscopy misses it?

A: They didn’t really mention that endoscopy can miss it but I do know a little about gastritis which was why I was taking that natural supplement to try ease it.

5)Your bowel habits any constipation loose motion etc?

A: Most of the time they are formed but I do see a lot of vegetables in my stool and undigested fragments and I do go quite often at least once a day but sometimes 2-3 times a day.

6)What did your primary Gastroenterologist said about your symptoms?

A: Her diagnosis was that because both the gastroscopy and colonoscopy where clear that I had IBS and there wasn’t really any treatment she gave me mainly that I just have to manage it.

7)Any relieving factor observed by you?

A: For some weird reason bananas seem to be the most soothing thing for me they are one of the only things that calm down my stomach pain a little.
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Follow up: Dr. Ramesh Kumar 1 minute later
Another symptom that I also get is pain in the upper right side of my back after overeating as well it’s ache type of pain that persists at the same time as my stomach pain but only really if I eat too much food.
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Follow up: Dr. Ramesh Kumar 0 minute later
Another symptom that I also get is pain in the upper right side of my back after overeating as well it’s ache type of pain that persists at the same time as my stomach pain but only really if I eat too much food.
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Follow up: Dr. Ramesh Kumar 4 minutes later
To add they also did a biopsy when they did my gastroscopy last year to test for gluten intolerance and a few other things but that ended up coming up with nothing. Now that I think about it as well the stomach pain really did stem from after having that gastroscopy last year and has only ever gotten worse with the PPI’s before I had that test and went on the PPI’s heartburn was my only symptom but now it’s jsut the stomach pain.
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Follow up: Dr. Ramesh Kumar 0 minute later
To add they also did a biopsy when they did my gastroscopy last year to test for gluten intolerance and a few other things but that ended up coming up with nothing. Now that I think about it as well the stomach pain really did stem from after having that gastroscopy last year and has only ever gotten worse with the PPI’s before I had that test and went on the PPI’s heartburn was my only symptom but now it’s jsut the stomach pain.
doctor
Answered by Dr. Ramesh Kumar 20 hours later
Brief Answer:
follow up

Detailed Answer:
Hello again my dear patient,
As most of the tests done in gastroenterology are almost normal in your case and pain is confined to epigastric area.Secondly proton pump inhibitors/probiotics etc are not very helpful.I would suggest you to move toward other causes of epigastric pain the most common one is cardiac.
I would suggest you to get a Echo and stress test done to see if its not related to heart.Many times epigastric pain is also related to heart and is often missed by many doctor.
Follow up with reports!
As both endoscopy and colonoscopy are clear we have to make spectrum of investigation broad.
This may be a presentation of angina(heart pain) as it starts usually after heavy meals(post prandial angina) and is not relieved by antacids etc.
I would suggest you to go for above mentioned test and follow up with reports.
As far as infection in bali is concerned get a stool culture test done if there is a bacteria it would be reflected in that.
Pain mimicking heart burn is also seen in cardiac problem.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
follow up

Detailed Answer:
Hello again my dear patient,
As most of the tests done in gastroenterology are almost normal in your case and pain is confined to epigastric area.Secondly proton pump inhibitors/probiotics etc are not very helpful.I would suggest you to move toward other causes of epigastric pain the most common one is cardiac.
I would suggest you to get a Echo and stress test done to see if its not related to heart.Many times epigastric pain is also related to heart and is often missed by many doctor.
Follow up with reports!
As both endoscopy and colonoscopy are clear we have to make spectrum of investigation broad.
This may be a presentation of angina(heart pain) as it starts usually after heavy meals(post prandial angina) and is not relieved by antacids etc.
I would suggest you to go for above mentioned test and follow up with reports.
As far as infection in bali is concerned get a stool culture test done if there is a bacteria it would be reflected in that.
Pain mimicking heart burn is also seen in cardiac problem.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ramesh Kumar 46 hours later
Hey doc, I had a follow up with my gp and did an ecg which I have attached. Apparently it’s abnormal and something to do with my pacemaker, I have been referred to a cardiologist for further testing as well but what do you make of that? I do also find I get shortness of breath a lot when I walk or run fast which could be more so related to this.
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Follow up: Dr. Ramesh Kumar 0 minute later
Hey doc, I had a follow up with my gp and did an ecg which I have attached. Apparently it’s abnormal and something to do with my pacemaker, I have been referred to a cardiologist for further testing as well but what do you make of that? I do also find I get shortness of breath a lot when I walk or run fast which could be more so related to this.
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Follow up: Dr. Ramesh Kumar 38 minutes later
Just to add this morning I passed a stool that was full of mucus, and there was a lot of pain in my lower bowels when I passed the stool could this be a sign of a infection?
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Follow up: Dr. Ramesh Kumar 0 minute later
Just to add this morning I passed a stool that was full of mucus, and there was a lot of pain in my lower bowels when I passed the stool could this be a sign of a infection?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hello XXXXXXX
Thank you for follow up,
Firstly I would like to comfort you by saying that your ecg reflects ventricular pre excitaion syndrome in which the lower chamber of heart is excited quiet early hence lower chamber does not get sufficient time to fill up.Though for your relief it's rarely serious and only one type called wolf Parkinson white(WPW) syndrome is dangerous which you don't have in your EKG.
However the serious point is bradycardia ie the slow heart rate.The normal heart rate should vary some what between 60 to100 beat/ min.In your case it's low.A holter test would be done in which a small machine would be attached to your waist to keep a record of your heart rate for 24 hours.This would reflect the minimum heart rate.If it dips below 30 then cardiologist may implant a Pace maker.
As there is shortness of breath also a complete cardiac triology should be done
Stress test
2d echo
The above two would reflect any blockage in artery supplying blood to heart.
Holter 24 hour for heart rate and rythm.
Yes mucoid stool can be a sign of infection.
Please take a course of ciprofloxacin and metronidazole for 5 days(Prescription needed).
For any further query regarding Heart or Gastro do follow up.
I would be happy to provide you with professional advice..

Thanks and may God bless you!
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up.

Detailed Answer:
Hello XXXXXXX
Thank you for follow up,
Firstly I would like to comfort you by saying that your ecg reflects ventricular pre excitaion syndrome in which the lower chamber of heart is excited quiet early hence lower chamber does not get sufficient time to fill up.Though for your relief it's rarely serious and only one type called wolf Parkinson white(WPW) syndrome is dangerous which you don't have in your EKG.
However the serious point is bradycardia ie the slow heart rate.The normal heart rate should vary some what between 60 to100 beat/ min.In your case it's low.A holter test would be done in which a small machine would be attached to your waist to keep a record of your heart rate for 24 hours.This would reflect the minimum heart rate.If it dips below 30 then cardiologist may implant a Pace maker.
As there is shortness of breath also a complete cardiac triology should be done
Stress test
2d echo
The above two would reflect any blockage in artery supplying blood to heart.
Holter 24 hour for heart rate and rythm.
Yes mucoid stool can be a sign of infection.
Please take a course of ciprofloxacin and metronidazole for 5 days(Prescription needed).
For any further query regarding Heart or Gastro do follow up.
I would be happy to provide you with professional advice..

Thanks and may God bless you!
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 36 hours later
Hey doc just a follow up regarding the stomach problems I’m still have this server pain in my upper tummy along with bad lower bowel pains every time I have to go. Do you think this is related to the infection is there any tests I can do? I read up about infections manifesting after returning home from holidays especially from places like Indonesia where I went could I have possibly got a parasite or more likely an infection like you meniotned?
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Follow up: Dr. Ramesh Kumar 0 minute later
Hey doc just a follow up regarding the stomach problems I’m still have this server pain in my upper tummy along with bad lower bowel pains every time I have to go. Do you think this is related to the infection is there any tests I can do? I read up about infections manifesting after returning home from holidays especially from places like Indonesia where I went could I have possibly got a parasite or more likely an infection like you meniotned?
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Follow up: Dr. Ramesh Kumar 4 minutes later
I’d much rather be on the safer side and do some tests before taking antibiotics since I have a a bad track record of them making my symptoms worse I use to be on minocycline for acne which seemed to really flare my gut symptoms up. I’ve heard with stool tests the traditional ones aren’t that accurate and the comprehensive one is better?
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Follow up: Dr. Ramesh Kumar 0 minute later
I’d much rather be on the safer side and do some tests before taking antibiotics since I have a a bad track record of them making my symptoms worse I use to be on minocycline for acne which seemed to really flare my gut symptoms up. I’ve heard with stool tests the traditional ones aren’t that accurate and the comprehensive one is better?
doctor
Answered by Dr. Ramesh Kumar 27 minutes later
Brief Answer:
Follow up

Detailed Answer:
Hello my dear,
Go for stool test and culture.
fecal calprotectin(to rule out inflammation in intestine)

As of now take antispasmodic dicyclomine 10 mg twice to relieve pain.
Follow up with reports.

Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Follow up

Detailed Answer:
Hello my dear,
Go for stool test and culture.
fecal calprotectin(to rule out inflammation in intestine)

As of now take antispasmodic dicyclomine 10 mg twice to relieve pain.
Follow up with reports.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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