Help with a stomach problem?

April 11, 2009 6:20 AM

I need help with a stomach problem I'm having.

Okay, first, I know you're not a doctor, and if you are you're not my doctor. I do have an appointment with a gastroenterologist but, lucky me, I can't get in for more than a month. Plus, this has been going on for a while but due to several factors, including finances, I haven't been able to deal with it. But I can now, so hooray.

In a nutshell, I have a burning pain at the top of my stomach. I just assumed that it was heartburn, until I had a conversation with a friend and figured out that heartburn goes more into the chest. This pain never does. It's not a constant pain; it comes in waves. It seems to be worse if I don't eat for a long while. It does not seem to be inflamed by spicy food -- I eat a fair amount of Indian/Thai/Chinese and the pain doesn't get worse after any of it. The pain does not get worse if I lie down.

I dealt with it for a long time by taking Pepcid Complete once a day. I talked to my doctor who suggested I take OTC Prilosec while waiting to see a gi doctor. That was six months ago.

I stopped taking the Prilosec maybe a month ago because I was wigged out by the warnings not to take it more than two weeks at a time. The stomach pain came back unabated, except now when I take the Pepcid it only lasts a couple of hours instead of all day.

Some other possibly relevant factors: I am a female in my early thirties. I don't drink anything but water and very occasionally (less than twice a month) a glass of tea. No alcohol. I am overweight but get regular exercise. I take a birth control pill and glucophage. I am not diabetic but I have something called polycystic ovaries and take the glucophage as a preventative measure. The stomach pain predated my use of both of the medications. My, ah, poo habits don't seem to be affected. I have vomited after eating twice since this started, which I'd never done before in my life.

Also, I do have a family history of gallbladder problems but my symptoms don't seem to match up with gall stones. I have never experienced anything like I'm told a gallbladder attack is like.

All the background info aside, I am looking for two things: one, an idea of what this could possibly be, and two, some things I can do to mitigate my pain until I can get in to see the doctor. I don't want to take something that could make the problem worse, you know? My primary care did contact the gi doctor to see if they could see me earlier but it didn't work.

I appreciate any assistance. Yes, I know I should have dealt with this earlier, but I didn't, so please, no lectures about it. Thank you so much.

posted by anonymous to Health & Fitness (15 answers total)

If prilosec or Pepcid helped, it likely is related to stomach acid. Worse lying down would suggest reflux into your esophagus, so given that you don't have that, it may not really be refluxing up all that high. Nevertheless, if it hurts more on an empty stomach and acid-reducers help, then anything that lowers stomach acid would be the way to fix it!

If Pepcid worked, stick with that -- no reason to switch to Prilosec if Pepcid was working. But either drug, if it works for you, would be fine. In terms of not taking Prilosec for more than 2 weeks, that's because of how the studies were performed and thus what the company was allowed to put on the label. However, Prilosec (and other proton-pump inhibitors) are used by some people for many years and it's fine to do. My advice: Do what works for you. And do get to see a GI doctor at some point, as ongoing problems definitely need to be investigated.
posted by davidnc at 6:33 AM on April 11, 2009

Not a doctor etc but second acid reflux, use of proton-pump inhibitors etc

Losing weight will help in the long term
posted by fearfulsymmetry at 6:40 AM on April 11, 2009

Not a doctor either, but someone with a long history of stomach issues and PCOS. Two things that might help: restricting carbohydrates, and switching from generic glucophage to brand-name Glumetza. The pain you're describing could be a symptom of nonalcoholic fatty liver disease, which is common and often goes undetected among those of us with PCOS and/or insulin resistance. The good news is that by upping your protein/fat intake and limiting your carb intake to green veggies and some fruits (no grains, no sweets, no starchy fruits like bananas) this can be reversed.

As for the glucophage - I tried the regular, the extended release, several brands and couldn't tolerate any of the stuff. I didn't get pain so much as my body just wanted to reject it by any means necessary, but it wouldn't surprise me if what you're experiencing is another form of the well-known gastric distress associated with glucophage. When my endo switched me to brand-name Glumetza, I was skeptical - but I've been on it for two years now with no stomach issues.

Best of luck to you!
posted by chez shoes at 6:55 AM on April 11, 2009

Have you looked up "Hiatal Hernia"? It's basically when a part of your stomach extends into the esophagus, and the stomach acid burns that top area where the two join. Since you're feeling pain at the top of your stomach, it might be related to that?
posted by jsmith77 at 7:28 AM on April 11, 2009 [1 favorite]

I had very similar symptoms, and we've called it reflux. I am now on Protonix for this. It has done wonders.
posted by Countess Elena at 7:35 AM on April 11, 2009

IANAD but I recently develped GERD (aka Acid Reflux). I rarely get "heartburn" it is often lower down like you described.

Even if you don't see a direct link between spicy foods or acidy foods and your pain, I'd suggest cutting them out completely for a week and see if that helps.
posted by radioamy at 7:38 AM on April 11, 2009

In my 20s and 30s I had similar trouble (gnawing pain like extreme hunger; occasional vomiting) and it was eventually diagnosed as gastritis. Doctors weren't much help except to tell me to take Prilosec. It got better when I got better at reducing stress. I also cut back on simple carbohydrates, chocolate, and citrus; was careful with "scratchy" types of fiber like beans; and chewed more thoroughly. I didn't feel a clear connection between spicy food and stomach pain.

Unfortunately, while I reduced their frequency, the flare-ups didn't really stop until I had my ovaries removed due to repeated cysts and endometriosis. Now I get a mild version of gastritis only if I drink too much coffee or get very stressed. Eating dried bananas seems to help (not the crispy ones; just basic, chewy dried bananas).
posted by PatoPata at 8:29 AM on April 11, 2009

I had GERD for a while, though it eventually went away for unknown reasons. The best remedy I found (aside from taking ppi's) was to elevate the head of my bed by 6 inches. Keeping the acid from bubbling up to my esophagus while sleeping seemed to do great things. You might see if that improves things... and for the price of two bricks, it's worth a try.
posted by pjenks at 8:38 AM on April 11, 2009

I've been dealing with this for a while. Try different PPI's. The first one you try might not work, but there are several, and they work through slightly different means. A lot of them are generic, so not too expensive.

I didn't want to believe these things make a difference, but they do: elevate your bed; do not eat after 6:00 p.m.; cut out coffee, greasy foods, spicy foods, peppermint, chocolate - these 5 things are all killers. I found the pain is caused by what and when I eat, but it can occur at any time, not directly related to eating.

The side effects of the PPI's are significant (bone/hip fractures), but the risk of esophageal cancer is worse. Plus, if you're only on them for another month, it's not a big deal. The warning is mainly there so you don't medicate pain away if the cause is serious.

Definitely get a scope. It does sound like hiatal hernia, but there are a lot of things it could be.
posted by clarkstonian at 9:06 AM on April 11, 2009

This sounds exactly like what I experienced with duodenal ulcers - ultimately diagnosed with a barium swallow. (In other words, I'm not your doctor!) I came back negative on the blood test for h.pylori which surprised everyone.

The solution for me was to eat mini-meals (as opposed to 3 larger meals) so as to keep my stomach from becoming overly acidic, take PPIs for a brief period - combined with bismuth salicylate (pepto-bismol or generic) and to avoid highly acidic foods . It went away quite quickly once I was on the right combination/quantities of meds and dietary changes. I now eat 'normally' and have no problems.
posted by VioletU at 10:52 AM on April 11, 2009

"I stopped taking the Prilosec maybe a month ago because I was wigged out by the warnings not to take it more than two weeks at a time. ... I am looking for .. some things I can do to mitigate my pain until I can get in to see the doctor"

You don't say what wigged you out about the warnings but I suspect it is related to the AskMeFi Prilosec needs a 4 month break?. The consensus in that thread was that gastric troubles lasting longer than two weeks really should be seen as a symptom in need of diagnosis so the recommendation is to get you to a physician which you are already doing. Cough suppressants carry a similar warning for the same reason; if you are coughing for more than two weeks, see a doctor.

Nothing in the literature suggests that using Prilosec for longer than two weeks is contraindicated. IANAD, IDEPOOT (I don't even play one on television).
posted by fydfyd at 12:24 PM on April 11, 2009

I had the same thing and was diagnosed with hiatal hernia. Later, an endoscopy showed it was actually several stomach ulcers. If prilosec helped and you can't speak to your GP or a specialist, speak to a pharmacist. Sometimes the warnings of "do not take for more than 2 weeks without speaking to a doctor" are there to make sure people go to a doctor when they need to, not because the medicine is necessarily dangerous to take long-term. Speak to your pharmacist about that.
posted by K.P. at 1:35 PM on April 11, 2009

fydfyd is correct, the two week thing is because you should be seeing a doctor after that time, not because you can't take ppi's longer than that. They are generally well tolerated and often prescribed for years at a time. Side effects are rare and generally include nausea or constipation, neither of which you seem to have issues with. If your problem is caused by acid then taking something to stop the burn is important to stop development of GERD (note acid reflux and GERD aren't the same thing). So if prilosec is helping stop the pain then start taking them again while you wait to see the doc.

There are a few different things which could be causing your problem, even acid reflux isn't a straight forward diagnosis exactly and has several causes. Also what works for one person may not work for another (spicy food and caffeine has no effect on my reflux for example) and overall treatment depends on what the cause is. Seeing a doctor is the correct thing to do even if taking prilosec helps in the meantime, so it looks like you're on track there.

I'm not a doctor, I am a digestive physiologist/biochemist, am up on the latest literature in this area, and have had acid reflux for many years (including a round of GERD last year).
posted by shelleycat at 3:59 PM on April 11, 2009

I can't offer much except sympathy and commiseration. You, PatoPata and VioletU - you guys could've been describing me over the past few years! After more than a year of doctor's visits and tests (including two endoscopies, ultrasound, numerous blood tests, and a gallbladder scan) I'm left with just a diagnosis of "duodinitis" and not much anyone can do about it. I've tested negative for h.pylori several times. My doctor has given me several prescriptions for Nexium, but it never seemed to make much difference. It's gradually died down, but I still get flare-ups whenever I'm stressed. (The flare-ups with a known cause I can deal with; it's the weeks and weeks of low-level chronic pain that really sucked.) As with PatoPata, I never saw a clear connection with spicy or acidic food.
posted by web-goddess at 12:43 AM on April 14, 2009

Oh - in my case, the pain was extremely localised to the area of the duodenum. (Basically just below my left ribs, just to the left of center.) It was noticeably worse if I laid on my left side in bed. Might be something to check and mention to your doctor. I know in my case, it helped them rule out a lot of other areas (like kidneys).
posted by web-goddess at 12:47 AM on April 14, 2009