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Gastroenterology (Expert Forum)
Chronic Nausea and back pain
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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Chronic Nausea and back pain
by maurao, Feb 11, 2004 12:00AM
For the past 12 years I have had a progressively worsening stomach problem where eating makes me nauseous and gives me pain in the upper back and under the ribs on the left side; often followed by heartburn. It started with just a few foods but now I hardly eats anything. I have been eliminating one food after the other and went on a strict vegatarian diet with no fats whatever about a 2 years ago. I have lost 25lb. since then but my weight has remained the same for months now. I've also tried eating small meals frequently but that also had no effect.
I've been to a number of doctors and GI guys and all tests come back negative except for the pancreatic enzyme which is elevated. The specialist says that that doesn't mean anything. I've had a colonoscopy, endoscopy, ultrasounds, a nuclear study of the gall bladder, ulcer tests, etc. A few years back the hearburn medicines were tried and made me feel worse. I also took antibiotics for the ulcer bacteria.
Now the back pain is almost always there. Sometimes mild and sometimes much worse. When I feel sick and nauseous from eating the wrong food it doesn't go away until several hours later when I eat again -- as long as I eat the "right" food.
I'm also hungry all of the time whether I feel sick or not.
Some of the foods I can eat (that is, they only make me a little bit sick) are: Poppy seed bagels,lemons, plain salads with fat and milk free dressing, most vegatables (steamed, boiled or roasted with nothing added), sweet potato, white potato (sometimes) and sugar. The list of what I can't eat is basically everything else. I can't eat any fat of any type, soy, meat (beef, poultry or fish), eggs, nuts, fruits grains, dairy, garlic, tomato sauce, breads, pastas (most).
To make matters worse my HMO won't let me go to any places where there are specialized programs and groups of GI doctors.
I need some direction and help on what this is and how to treat it. It is getting so hard.
I've been to a number of doctors and GI guys and all tests come back negative except for the pancreatic enzyme which is elevated. The specialist says that that doesn't mean anything. I've had a colonoscopy, endoscopy, ultrasounds, a nuclear study of the gall bladder, ulcer tests, etc. A few years back the hearburn medicines were tried and made me feel worse. I also took antibiotics for the ulcer bacteria.
Now the back pain is almost always there. Sometimes mild and sometimes much worse. When I feel sick and nauseous from eating the wrong food it doesn't go away until several hours later when I eat again -- as long as I eat the "right" food.
I'm also hungry all of the time whether I feel sick or not.
Some of the foods I can eat (that is, they only make me a little bit sick) are: Poppy seed bagels,lemons, plain salads with fat and milk free dressing, most vegatables (steamed, boiled or roasted with nothing added), sweet potato, white potato (sometimes) and sugar. The list of what I can't eat is basically everything else. I can't eat any fat of any type, soy, meat (beef, poultry or fish), eggs, nuts, fruits grains, dairy, garlic, tomato sauce, breads, pastas (most).
To make matters worse my HMO won't let me go to any places where there are specialized programs and groups of GI doctors.
I need some direction and help on what this is and how to treat it. It is getting so hard.
Doctor's Answer
by Kevin Pho, MD, Feb 14, 2004 12:00AM
, Feb 14, 2004 12:00AM
With the elevated pancreatic enzymes, certainly chronic pancreatitis should be considered. In this disease, the pain is typically epigastric, often radiates to the back, is occasionally associated with nausea and vomiting, and may be relieved by sitting upright or leaning forward. The pain is often worse 15 to 30 minutes after eating.
If there are no calcifications seen on the X-rays, you may want to consider an ERCP or endoscopy ultrasound to further nail down the diagnosis.
If this is the case, you may want to consider pancreatic enzymes replacent - which can alleviate the pain in some cases. Another consideration would be endoscopic therapy aimed at decompressing an obstructed pancreatic duct which can be associated with pain relief in some patients.
You may want to discuss these options with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
If there are no calcifications seen on the X-rays, you may want to consider an ERCP or endoscopy ultrasound to further nail down the diagnosis.
If this is the case, you may want to consider pancreatic enzymes replacent - which can alleviate the pain in some cases. Another consideration would be endoscopic therapy aimed at decompressing an obstructed pancreatic duct which can be associated with pain relief in some patients.
You may want to discuss these options with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
I have the same thing and have had it for a over 3 years.
It hurts after I eat and longer. The muscles in my upper chest and back now spasm in pain frequently.
STATS: white 43 female, 25lbs overweight, good health, exerciser
MY TESTS....
1. MRI
2. Ultra sound (one tiny stone in gallbladder) so...
2. Gallbladder removed----didn't relieve the pain
4. Ultrasounded after gallbladder removal—looking for stones in the bile ducts. Found Nothing!
3. Been on EVERY acid relux medication there is. Nothing has worked.
(Even double doses). I still get acid.
4. Endoscope (2x)
5. 24-Ph moniter (showed postive for Acid Reflux)
6. Blood tests for pancreas and liver problems. All fine-no problems
7. Heart has been throughly checked out as well as a stress test. Passed flying colors.
8. UW GI doctor does not want to do an operation, since my symptoms are very A typical. Being I had a perfect Endoscope and that relux meds aren't working.
9. Chest X-rays
Next month I go in for a Manometry test for esophageal spasms.
Although, I have tried many medications for esophageal spasms, nothing so far has brought relief.
I strongly believe it's Acid Reflux...but medication does not work for me. Since I have acid frequently coming up despite being on the medication.
I have noticed that fats and foods that aggrevate acid reflux make it worse.
But I still have not had RELIEF.
If you get any anwsers I would appreciate it if you would drop me a line at: (***@****)
Good luck!