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What causes chronic fatigue, night sweats, lower abdominal pain and nausea?

Answered by
Dr. Ramesh Kumar


Practicing since :1986

Answered : 2381 Questions

Posted on Wed, 14 Jun 2017 in Digestion and Bowels
Question: I have been diagnosed with Mild Crohns Inactive.
I am currently taking 2 x 500 mg Salofalk a day. I have been diagnosed with Crohns Mild In Active.
However I still suffer fatigue, some days worst than others. I also suffer night mild sweats, I still suffer some pain down the right hand side of lower abdomen, and some mornings I experience nausea - fleeting. I have been diagnosed with Caeitis. From my last colonoscopy I had inflammation in the lower bowel. Caceium area. However I cannot get over fatigue. Is this normal ?
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Could possibly by Myasthenia gravis or chronic fatigue syndrome.

Detailed Answer:
Thank you for choosing HealthcareMagic for your query.
I am a Gastroenterologist and would be answering your concerns.

Have gone through your details and i appreciate your concerns.

As per your query there are two possibilities-
1)As you are suffering from GERD as well as inflammation in intestines the overall digestion and absorption process is hindered.Proper digestion of food is the only way by which our body gets all essential nutrients.As there is severe inflammation in your intestines proper absorption of nutrients is not taking place.Hence causing fatigue and lack of energy but i dont feel that this can cause such extreme levels of fatigue as you are experiencing right now.

2)It could be chronic fatigue syndrome-There is a possibility that you are having some auto immune disease which is effecting various systems.It started from your intestines and now could be possibly affecting your eyes too.
Severe fatigue can also be associated with an autoimmune disease called myasthenia gravis.The symptoms of MG often consist of muscle fatigability with the myasthenic complaining of worsening of symptoms later in the day after their muscles have been fatigued or after being repetitively exercised.
Eyes are very frequently involved in myasthenia gravis(as in your case).It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction.Hence signals from nerve cannot be properly conducted to muscles in various parts of the body.

I would suggest you to go for the test named-

Anti–acetylcholine receptor antibody test -The anti–acetylcholine receptor antibody test is reliable for diagnosing autoimmune myasthenia gravis and is highly specific (as high as 100%) to diagnose this disease.
As per your query no inflammatory bowel disease does not result in such extreme levels of fatigue.

Initially go for the test suggested by me if its turns up to be normal you would be investigated further on lines of chronic fatigue syndrome.

Hope i answered your query well.
Follow ups are welcome.

Above answer was peer-reviewed by : Dr. Remy Koshy
Follow up: Dr. Ramesh Kumar 16 hours later

Thank you.

I believe GERD is further inflamed from using high anti inflammatory drugs to control the Crohns.

I have had allergic reactions to Mercaptopurine ( immunological suppressants) so my only hope is the Salofalk . Salofalk doesn't affect my liver or kidneys as does Mercaptopurine.

I was taken off all medications for 3 months due to my liver inflamed. Liver/kidney's came back to normal, GERD settled down.

I had spoken to a Gastro Surgeon about repairing my Hiatus Hernia ( a result of medication Mercaptopurine and Pentasa 4 mg a day) . The Gastro Surgeon said he wouldn't operate unless all pain was gone because if he operated on my Hiatus Hernia it could mean I could end up with pain for life. So I had to get things settled - no pain - and he would repair the Hiatus Hernia.

I am wondering with GERD if the Hiatus Hernia was repaired would that mean GERD would disappear ? Or because my body reacts to anti inflammatory
would GERD reappear again even if I had the Hiatus Hernia repaired ? ie If I continued to take Salofalk after the repair.

The reason I am asking this is if the Salofalk can contain the Crohns without heavier medication which affects my Liver etc would I not be best to come off medication for 3 months while I am experiencing some form of remission with Chrons and let GERD settled down ( it is acting up at the moment) and then operate to repair the Hiatus Hernia and resolve the GERD situation which would enable me to remain on a medication that doesn't affect my other body organs as they are in good health at present. ? Or is it once you have GERD there is no fixing it either in any way ?

It seems that if one settles down ( bowel) then the stomach ( GERD) acts up.
It is like being on a merry go round.

Also still to be resolved is the droopy eyes and eye brow which they are undertaking blood tests for. Myasthenia Gravis blood test has come in negative so they are looking for other auto immune issues. Yes I do suffer fatigue some days worst than others. I have been in business for 20 years and been a very high performer ( hard working etc) but I know now I couldn't even think of doing what I use to do ( high stress long hours). Stress seems to affect GERD, which is frustrating for me because I use to be able to handle lots of intense stressful situations in my work. I can't seem to do that anymore. So I am in the process of restructuring my lifestyle. I also suffer Tinnitus so between GERD, Crohns, Tinnitus and whatever they find these droopy eyes ( severe ) is then I think it is high time I make some life style changes because stress seems to affect all of these.

So my question is :
If I was to be able to settle down GERD ( no pain) and I had the Hiatus Hernia Repaired, do you think GERD would return if I continued to take Salofalk into the future ? Or do you think because I have a 'allergic' reaction in some way to Anti Inflammatory medicine concerning my stomach GERD would return in time anyway ? I am trying to the following - save my liver and kidneys as they are in excellent condition while also maintaining some control over Chrons from a maintenance perspective and fix the stomach issue of GERD . What is to arise from my severe dry eyes and droopy eyelids and eyebrow remains to be seen. They seem to think it is some form of auto immune but which one is yet to be determined .

Answered by Dr. Ramesh Kumar 10 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hello again dear,
As per the standard trials-Gastritis and reflux disorders are found among people who take Mesalamine, especially in patients who are female, and above 40 years of age. Therefore it should always be given along with a proton pump inhibitor.

These drugs are all metabolized by liver and are hepatotoxic. Hepatotoxicity causes inflammation in cells of liver causing the enzymes stored inside liver cells to leak out hence raising LFT.

See frankly speaking Hiatus hernia is among one of the causes which can cause GERD. In your case you are on a medication Salofalk which unfortunately irritates the mucosa lining of stomach.Any thing which irritates a gastric mucosa would increase secretion of acid from parietal cells and will cause gastritis which would result in aggravating symptoms of GERD.

Ideal way is to give Solafalk with a proton pump inhibitor like Rabeprazole in combination of a prokinetic medicine like Domperidone. Proton pump inhibitor will prevent formation of excessive acid while prokinetic will control acid reflux.

So surgery and taking medicines as adviced would definitely help you dear.

Unfortunately medicines we use for treating crohn's are strong one and are hepatotoxic. Therefore regular monitoring of liver functions and renal functions is usually done by most of patients.
A better strategy would be to use this medicine with liver rejenuvators like sylimarin(Milk of thistle).
Use of potent anti oxidants are also adviced.
What is to arise from my severe dry eyes and droopy eyelids and eyebrow remains to be seen. They seem to think it is some form of auto immune but which one is yet to be determined- As explained earlier Anti–acetylcholine receptor antibody test should be done initially to rule out possibility of Myasthenia gravis. Any further comment could be given only after having reports of this investigation.

Hope i answered your query well.
I wish you a great luck and early recovery.
Follow ups are welcome.

Above answer was peer-reviewed by : Dr. Nagamani Ng

The User accepted the expert's answer

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