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Forum Name: Gastroenterology Topics

Question: stomach pain on upper left side


 murphy101 - Tue Jan 31, 2006 12:16 pm

Hello, I am a 26 year old Caucasian female. Last Friday, 1/27/06, I began having sudden cramping in my upper abdomen (right underneath by breastbone and between my rib cage). The pains were sharp and would last about 15 seconds each. This went on for about 45 minutes. During this time I also felt warm (however I did not haev a tempterature) and I had the chills. In addition, I felt nauseous, but I did not vomit. Because I recently moved to a new city, I was in the process of getting a new PCP. As a result, I went to the emergency room to get checked out. By the time I got there (about an 1 and 15 minutes after the pain started) the cramping subsided and while it was still sporadically present, the pain was weak. And sometimes the pain would be constant, however weak. The doctor performed blood and urine tests on me and while he said my white blood cell count was up by 1,500 there was no reason to beleive that I had an infection, so as to rule out appendicitis or gallbladder disease. He told me that it was probably due to my stomach having excess acid and he prescribed me 20 mg. of Pepsid to take two times daily.
Since being released from the ER, I have continued to have these weak stomach pains. They continue to be in the upper stomach area (ditrectly under the rib cage) and favor the left side. The pain does not go down the left side of my body however, it is very specific to the upper left hand side. I recently had a day when I did not feel any pain for the entire day, however the same pain returned the following day. I want to also note that when I say pain, it is not sharp or severe, in fact it is very slight. I have modified my diet and I have not had any citric or caffiene products since going into the ER. And I have a pretty simple diet, consitign of soups, lean chicken, sandwiches, crakers, jello, etc.
One note that I thought i should make is that in the past two months i haev had major transitions take place in my life that has been very stressful. But recently I haev not been feeling stressed out. I have been sleeping normally, have normal appetite, and I feel happy with the direction my life is going in. I am not sure if stress is a factor but I wanted ot mention it.
Can you tell me if the ER doctor probably diagnosed me right adn I should just continue to take the antacids, or should I seek further testing to rule out a more serious issue. Do you haev any ideas as to what could be causing the pain in that specific area?
Thank you for taking the time to read this adn provide me your opinion.
I have never been diagnosed iwth any other health issues, I have never had surgery, adn I am on no medication at this time. I recently stopped taking the birth control pill (stopped in November 2005).
Many people in my family have IBS, however no other GI issues that I know of.
Have a geat day!
 Dr. Tamer Fouad - Wed Feb 01, 2006 9:17 am

User avatar Hello,

Dyspepsia is upper abdominal pain or discomfort that is episodic or persistent and often associated with belching, bloating, heartburn, nausea or vomiting.[1] The condition is reported to occur in approximately 25 percent of the population each year.[2]

Because there are many causes for dyspepsia, initial efforts focus on the most common identifiable causes which include peptic ulcers and gastroesophageal reflux disease (GERD). Gastric or esophageal cancers are serious causes but account for fewer than 2 percent of cases.[3] Other causes include irritable bowel syndrome, biliary tract disease or medication induced. In about 50 to 60 percent of patients, a specific etiology is not identified (ie, "functional" or nonulcer dyspepsia) which is the most common cause of dyspepsia.[3]

After a thorough clinical evaluation and detailed history, conditions such as GERD, irritable bowel syndrome, biliary pain and medication-induced dyspepsia can most likely be confirmed or excluded.[4] The remaining patients probably have ulcer-like, dysmotility-like or functional (nonulcer) dyspepsia.[5] When these patients were investigated in one study most patients are found to have functional or nonulcer dyspepsia.[5]

The next step is to decide whether the patient is at high risk for serious disease and should be scheduled for immediate endoscopy or whether the patient can safely receive medication. Those at high risk include, patients above the age of 50 years, those with dysphagia, anorexia with weight loss or persistent vomiting; in addition to those with a palpable mass or those with evidence of GIT hemorrhage (melena or anemia). All patients at high risk should undergo immediate endoscopy.

Once it is determined that the condition is safe the patient may be given a trial of empiric antisecretory drug therapy. Noninvasive serologic testing for H. pylori infection followed by antibacterial treatment if the test is positive may be an option in some patients.[6] In all patients, management includes avoidance of ulcerogenic agents (including alcohol), patient reassurance, stress reduction and smoking cessation. All empiric drug trials should be stopped after 6 to 8 weeks, and endoscopy should be performed if symptoms return or continue.[3]

I think your doctor made the right decision. The condition seems to be improving but it does take time. If any new symptoms should arise you should contact a doctor immediately.

References:
==========
1. Heading RC. Definitions of dyspepsia. Scand J Gastroenterol (Suppl) 1991;182:1-6.
2. Ofman JJ, Etchason J, Fullerton S, Kahn KL, Soll AH. Management strategies for Helicobacter pylori­seropositive patients with dyspepsia: clinical and economic consequences. Ann Intern Med 1997;126:280-91.
3. Talley NJ, Silverstein MD, Agreus L, Nyren O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. Gastroenterology 1998; 114:582-95.
4. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 1998;114:579-81.
5. Talley NJ. The role of Helicobacter pylori in nonulcer dyspepsia. A debate--against. Gastroenterol Clin North Am 1993;22:153-67.
6. Soll AH. Medical treatment of peptic ulcer disease. Practice guidelines. JAMA 1996;275:622-9 [Published erratum in JAMA 1996;275:1314].
 Nanse - Sun Feb 05, 2006 10:25 am

Doctor,

You don't mention Pancreatic disorder. I have had similar symptoms which were thought to be gastric in nature. Now after months of not feeling well it is considered to be mild pancreatitis and looks as if I have had many episodes.

Just a thought!

Nanse
 Dr. Tamer Fouad - Mon Feb 06, 2006 1:14 am

User avatar Yes I agree.

Other rare causes of dyspepsia include, gastroparesis, pancreatitis, carbohydrate malabsorption (lactose, sorbitol, fructose, mannitol), infiltrative diseases of the stomach (Crohn's disease, sarcoidosis), metabolic disturbances (hypercalcemia, hyperkalemia), hepatoma, ischemic bowel disease, systemic disorders (diabetes mellitus, thyroid and parathyroid disorders, connective tissue disease), intestinal parasites (Giardia, Strongyloides) and abdominal cancer, especially pancreatic cancer.

Best regards.

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