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Forum Name: Gastroenterology Topics

Question: Abdominal Pain


 MEM - Wed Dec 06, 2006 12:12 pm

Hello:

My daughter is 14 years old, and has been experiencing stomach and abdominal pain for the last nine months. Her symptoms include: vague stomach aches that defy description (she once said that it felt like someone had poisoned her and her stomach was slowly dissolving), sharp upper side pain (on both the left and right side, but mostly on the right during the last month), crampy stomach pain, weight loss, headaches, mid-back pain, random bouts of diarrhea, hair falling out, pale, acid reflux, belching and gas, stomach noises, excessive thirst, dizziness, and trouble sleeping. Her pain is worst after meals and at night, but can strike randomly on occasion. The very worst of the pain appears in “attacks” after meals that subside within 2-4 hours. Nothing seems to help. We have tried giving her Maalox or Tums, but they do pretty much nothing. We had her on Nexium for the acid reflux - to no avail. Her doctor prescribed a bulk-forming laxative that seemed to make her pain even worse. He has preformed blood tests for celiac and chrons diseases, both of which came back negative. She is on no medications at this time. What could be causing this?

Thanks for your time.
 Dr. Safaa Mahmoud - Wed Dec 06, 2006 1:29 pm

User avatar Hello,

The history you have given suggests that the pain is of a peptic origin. This include gastritis, esophagiis, H. pylori infections and GERD.

At this age, usually a trial of therapy with anti acids, histamine H2 blockers is indicated before further investigations are done to confirm the diagnosis. A 4-6 weeks trial is usually satisfactory, if poor response then more investigations are done to find out the causes like:
GI radiological series to diagnose reflux disease and others.
Endoscopy and biposies to chech for H. pylori and resistent ulcers, etc. that include
If the results are:
- Resistent ulcer then Proton pump inhibitors are prescribed
- H.Pylori specific oral therapy is given that include anti-acid, antibiotics, and flagyl.

Other causes in her age include:
- Colitis due to infectious or inflammatory disease like Crohn's disease and ulcerative colitis. Pain is mainly in the lower abdomen . Bloody diarhhea is common in such cases and eating less food help in decreasing symptoms. Colonoscopy is diagnostic in most of cases
They all can be associated with tenderness.

- IBS similar symptoms but not relaeated to meal. The diagnosis although made by exclusion of other causes , however abdominal pain and diarrhea or constipation lasting at least 12 weeks is the main criteria for the diagnosis of IBS.

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