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Gastric Outlet Obstruction.

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Hi I need some help I feel like I'm going crazy here. I'm a 25 year old female, 5'7'' 135 lbs and maintaining that weight. My only medication is oral contraceptive. My problems started February of 2013. After an acute illness, which I chalked up to the 24 hour bug, I began having upper left quadrant abdominal pain. Af first it just seemed to be attributed to when I ate or when my stomach was too empty. After a month of dealing with it I went to my PCP who took an immunoglobulin test to h pylori, it came back positive. Other labs drawn were a CBC, CMP, mad TSH which were normal. We did a two week course triple therapy and I felt better for a few month though I still noticed occasional (maybe 2/3 times a day) pain attacks lasting just a few moments. Then the pain accelerated again to the point that I went back in and we did a quadruple therapy round. Once again it helped for a little bit but within 2 months I was miserable again. I set up an appointment to see a GI specialist and during the month wait my symptoms continued to escalate. The end of December 2013 in had an EGD which showed some sites of gastritis, no ulcers, and a compression on the 3rd portion of my duodenum. I have had a CT angio of the abdomen which showed aortic angle of 27 degrees and a compression to 6mm in the duodenum. I didn't fit all categories for SMA syndrome but we tried to treat it as such and I was told to try and gain weight with oral intake. In the mean time I had a gastric emptying scan which came back normal, a HIDA scan which came back at 91% ejection fraction and normal. Last week after failing to gain any weight in two months I had an upper GI study with small bowel follow through. The only noted abnormalities were that my stomach is in a "vertical" position and some slight dilation of the duodenum as the contrast passed into the jejunum. I received a call today informing me that I do NOT have sma syndrome and there is nothing surgically that could be done. I'm being sent back to my GI in two weeks but my symptoms are now progressing so quickly I'm afraid of how bad off I will be in two weeks. For the last two weeks all I can eat is tiny amounts of bland food and for the most part I stick to liquids. The nausea is increasing, I've vomited twice in the last week after trying to eat a 1/2 slice of toast and the pain is now constant but still worsens with food intake. Throughout the whole process my bowel movements have remanded regular and without any signs of blood. I'm asking for possible diagnosis and suggestions to help ease the discomfort; I'm so fed up with this.

Category: Gastroenterologist, Medical

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Category: Hepatologist
 25 Doctors Online

Hello,

Thank you for choosing DoctorSpring.

I understand your concern and will try my best to help you out here. These symptoms of 1 year duration would have been really frustrating to you. First of all the positive news is that the OGD and other investigations did not show any growth or swellings which is actually a good sign.

You are having symptoms similar to GOO or Gastric Outlet obstruction. There could be many causes for this. Peptic ulcer being the most common. Other causes that has to be considered are a gallstone obstruction, annular pancreas, pancreatitis, crohn's disease etc.

1. I would like to know how your symptoms respond to anti ulcer medication like Prilosec ? (Does it get any better?)
2. Was a CECT / Ultrasound of the abdomen done ? (if so was it normal ?)
3. Was a Biopsy done / planned ?
4. Is there any food items / general measures or medications that gives you relief ?

You can reply as a followup
Thank you


Patient replied :

I've taken Zantac and Prilosec and my symptoms were unchanged. I have not had an ultrasound . Biopsies were done with the egd and the results were "unremarkable". I have not noticed any particular foods that make it worse though if I stick to liquids and soft foods I seem to do better. Solid foods increase both the pain and nausea. I have noticed that last week when I was taking DayQuil for a cold the pain seemed better but I have not found any other medications that make a significant difference.


Thank you for the reply.

If the symptoms persists you will need an ultrasound abdomen, S.Amylase, S.Lipase tests. I would advise you to get an urea breath test to see whether H.pylori has been completely eradicated. If it is not you may require another course of treatment.

All your tests have been come as normal except for the positive H.pylori.

You are not having any alarm signs/symptoms like weight loss, blood vomiting or black stools.
So if after successful eradication of H.pylori and ruling out other causes mentioned above if symptoms still persists, then we can call this functional abdominal pain.

Hope this helps
Feel free to ask followups
Thank you


Dr. Ratnakar Kini
Category: Hepatologist
Experience: 
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
Dr. Ratnakar Kini and 4 other Medical Specialists are ready to help you

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