
55 Years Old Female History Of 3 Drinks/day. IBS, PTSD,

I started taking pantoprazole 40mg 1 week ago for heartburn . Heart burn is gone. I get bloated and gassy. The pain concerns me now because it was there more often and moved to the back which is a new symptom. I have no other symptoms, no nausea, no yellow skin, no itching. Only symptoms are random mild pinch under right rib cage, and that pain in my right side/back last night which is gone now. The stools, I've had like this for a long time, assumed it was ibs. I had full physical 15 months ago, all blood tests where normal. Abdomen looks and feels normal. Energy is normal.

I started taking pantoprazole 40mg 1 week ago for heartburn . Heart burn is gone. I get bloated and gassy. The pain concerns me now because it was there more often and moved to the back which is a new symptom. I have no other symptoms, no nausea, no yellow skin, no itching. Only symptoms are random mild pinch under right rib cage, and that pain in my right side/back last night which is gone now. The stools, I've had like this for a long time, assumed it was ibs. I had full physical 15 months ago, all blood tests where normal. Abdomen looks and feels normal. Energy is normal.


Dyspepsia/Gastritis.
Detailed Answer:
Hi,
Thanks for choosing "Ask a Doctor" service for your query,
Have seen your query and photo of stools attached.
As per your query the site of pain is very specific for-
1)Gastritis-Very likely your case.
2)Gallbladder pathology-No your case as it gallbladder has already been removed.
Gastritis causes swelling and inflammation in the inner thin lining of stomach and pain is usually felt on right upper side, History of heart burn feeling gassy etc is also suggestive of same(plus other overlapping pathologies like IBS.
Just taking pantoprazole wont help.
Basically all these symptoms are covered under an umbrella term called dyspepsia.Dyspepsia, in layman's language is known as indigestion. It is a term that describes discomfort or pain in the upper abdomen. However, it's not a disease in itself. Dyspepsia is a group of symptoms which often include bloating, mild to moderate pain/discomfort and heartburn.
Most likely cause in your case is indigestion due to either overeating or taking over oily or fatty food. Anxiety or intake of alcohol or aerated beverages can also cause the symptoms.
Take a proton pump inhibitor like Esomeprazole 40 mg twice daily along with a prokinetic drug (eg.Domperidone). This will provide you symptomatic relief.(You may need to obtain prescription for this from your local physician).
Antacid like Pepto bismol can be taken for few days along with it.
Any over counter probiotic should be taken for few days to provide relief in symptoms of indigestion.
Apart from this, some dietary restrictions are to be followed-
- Avoid alcohol or smoking.
- No aerated beverages.
- Take light non spicy easily digestible food for few days.
- No Fast food like pizza or burger should be taken.
- Drink a cup of cold milk daily.
- Avoid fatty foods.
If not relieved in 2 WEEKS, an endoscopy may be planned to rule out any peptic ulcers or H.pylori infection(Very unlikely) after visiting your Physician.
Bloating and acid can be caused by any kind of food. In most of the cases, it's fatty foods which cause these symptoms. Any food whether it's fat or protein or complex carbohydrates.
Hope I've answered your query.
Feel free to ask any follow up questions.

Dyspepsia/Gastritis.
Detailed Answer:
Hi,
Thanks for choosing "Ask a Doctor" service for your query,
Have seen your query and photo of stools attached.
As per your query the site of pain is very specific for-
1)Gastritis-Very likely your case.
2)Gallbladder pathology-No your case as it gallbladder has already been removed.
Gastritis causes swelling and inflammation in the inner thin lining of stomach and pain is usually felt on right upper side, History of heart burn feeling gassy etc is also suggestive of same(plus other overlapping pathologies like IBS.
Just taking pantoprazole wont help.
Basically all these symptoms are covered under an umbrella term called dyspepsia.Dyspepsia, in layman's language is known as indigestion. It is a term that describes discomfort or pain in the upper abdomen. However, it's not a disease in itself. Dyspepsia is a group of symptoms which often include bloating, mild to moderate pain/discomfort and heartburn.
Most likely cause in your case is indigestion due to either overeating or taking over oily or fatty food. Anxiety or intake of alcohol or aerated beverages can also cause the symptoms.
Take a proton pump inhibitor like Esomeprazole 40 mg twice daily along with a prokinetic drug (eg.Domperidone). This will provide you symptomatic relief.(You may need to obtain prescription for this from your local physician).
Antacid like Pepto bismol can be taken for few days along with it.
Any over counter probiotic should be taken for few days to provide relief in symptoms of indigestion.
Apart from this, some dietary restrictions are to be followed-
- Avoid alcohol or smoking.
- No aerated beverages.
- Take light non spicy easily digestible food for few days.
- No Fast food like pizza or burger should be taken.
- Drink a cup of cold milk daily.
- Avoid fatty foods.
If not relieved in 2 WEEKS, an endoscopy may be planned to rule out any peptic ulcers or H.pylori infection(Very unlikely) after visiting your Physician.
Bloating and acid can be caused by any kind of food. In most of the cases, it's fatty foods which cause these symptoms. Any food whether it's fat or protein or complex carbohydrates.
Hope I've answered your query.
Feel free to ask any follow up questions.


I forgot to mention I've had diverticulitis twice (and this wasn't it, I know what that felt like) during first colonoscopy, they removed what they thought was a polyp but it was a small well differentiated neuroendocrine tumor in the rectum. I've had follow up colonoscopy and sygmoiscopy a few years ago and all was clear.
I was concerned about liver or pancreas. The location of the "pain" (like twinge, pinch) is very localized, where the gallbladder would be. I was worried it may be a retained stone blocking a duct to the liver? spyncter of oddi?
Also, wondered if it could be adhesions because I've had surgery in the area, full hysthertomy where they removed a 5 lbs fibroid and later, a laparoscopy surgery to remove gallbladder. I get strange cramping, twisting. XXXXXXX horse like spasm in between some ribs on right side (very localized) , where I stretch it out it goes away, very uncomfortable when that happens.
Should I worry about the new discomfort I get in the right side of the back on and off?
How about the stools? I worried that it was Steatorrhea. From the picture I sent you, would you say that's what steatorrhea looks like?
Stools today are normal again, If I had liver or pancreas disease, would the stools return to normal like this? I failed to mention I was also taking probiotics for the last week, maybe causing gas?
Thank you for your help and understanding. Given my history, I get anxious about abdominal discomfort.

I forgot to mention I've had diverticulitis twice (and this wasn't it, I know what that felt like) during first colonoscopy, they removed what they thought was a polyp but it was a small well differentiated neuroendocrine tumor in the rectum. I've had follow up colonoscopy and sygmoiscopy a few years ago and all was clear.
I was concerned about liver or pancreas. The location of the "pain" (like twinge, pinch) is very localized, where the gallbladder would be. I was worried it may be a retained stone blocking a duct to the liver? spyncter of oddi?
Also, wondered if it could be adhesions because I've had surgery in the area, full hysthertomy where they removed a 5 lbs fibroid and later, a laparoscopy surgery to remove gallbladder. I get strange cramping, twisting. XXXXXXX horse like spasm in between some ribs on right side (very localized) , where I stretch it out it goes away, very uncomfortable when that happens.
Should I worry about the new discomfort I get in the right side of the back on and off?
How about the stools? I worried that it was Steatorrhea. From the picture I sent you, would you say that's what steatorrhea looks like?
Stools today are normal again, If I had liver or pancreas disease, would the stools return to normal like this? I failed to mention I was also taking probiotics for the last week, maybe causing gas?
Thank you for your help and understanding. Given my history, I get anxious about abdominal discomfort.


Follow up answer.
Detailed Answer:
Hello again,
1)I was concerned about liver or pancreas. The location of the "pain" (like twinge, pinch) is very localized, where the gallbladder would be. I was worried it may be a retained stone blocking a duct to the liver? spyncter of oddi?-Usually this would present shortly after removal of gall bladder and is very uncommon...By that i mean that they are all hypothetical or rare of rare cases and no one can make a comment on them...Easiest way to rule out this along with liver or pancreatic pathology is go for a Ct scan of abdomen.....One test would make every thing clear.
Should I worry about the new discomfort I get in the right side of the back on and off?
Would suggest you to go for a CT. If its normal take Esomeprazole with prokinetic drug and a probiotic if things don't go well in 2 weeks then any further assumption would be made.
How about the stools? I worried that it was Steatorrhea. From the picture I sent you, would you say that's what steatorrhea looks like? -As per the history you are a diagnosed case of IBS.
Such stools are normal in IBS. Secondly you don't have a gallbladder.
Gallbladder stores the bile secreted by liver and uses it from time to time when intestine has to digest fat.As your gallbladder is not there stools having fat is normal for you.
You could take some external enzyme supplements like lipase etc for better digestion of fat.
Stools today are normal again, If I had liver or pancreas disease, would the stools return to normal like this-No usually the things worsens up with time. This is a case of dyspepsia with overlapping ailments and uncontrolled diet.
Probiotic's won't cause gas rather would replete gut flora which would help in proper digestion and fermentation of food. Gas means that gut flora has large number of bad bacteria's and fungi.....Proper Probiotic course of Econorm /VSL#3 Twice daily should be taken.
Anxiety alone would be sole cause of every problem from IBS to dyspepsia....I would recommend you to take proper anxiolytic agent(after consultation) to curb down your anxiety.
Hope i was helpful and easy to understand,
Follow ups are welcome,
Thank you!

Follow up answer.
Detailed Answer:
Hello again,
1)I was concerned about liver or pancreas. The location of the "pain" (like twinge, pinch) is very localized, where the gallbladder would be. I was worried it may be a retained stone blocking a duct to the liver? spyncter of oddi?-Usually this would present shortly after removal of gall bladder and is very uncommon...By that i mean that they are all hypothetical or rare of rare cases and no one can make a comment on them...Easiest way to rule out this along with liver or pancreatic pathology is go for a Ct scan of abdomen.....One test would make every thing clear.
Should I worry about the new discomfort I get in the right side of the back on and off?
Would suggest you to go for a CT. If its normal take Esomeprazole with prokinetic drug and a probiotic if things don't go well in 2 weeks then any further assumption would be made.
How about the stools? I worried that it was Steatorrhea. From the picture I sent you, would you say that's what steatorrhea looks like? -As per the history you are a diagnosed case of IBS.
Such stools are normal in IBS. Secondly you don't have a gallbladder.
Gallbladder stores the bile secreted by liver and uses it from time to time when intestine has to digest fat.As your gallbladder is not there stools having fat is normal for you.
You could take some external enzyme supplements like lipase etc for better digestion of fat.
Stools today are normal again, If I had liver or pancreas disease, would the stools return to normal like this-No usually the things worsens up with time. This is a case of dyspepsia with overlapping ailments and uncontrolled diet.
Probiotic's won't cause gas rather would replete gut flora which would help in proper digestion and fermentation of food. Gas means that gut flora has large number of bad bacteria's and fungi.....Proper Probiotic course of Econorm /VSL#3 Twice daily should be taken.
Anxiety alone would be sole cause of every problem from IBS to dyspepsia....I would recommend you to take proper anxiolytic agent(after consultation) to curb down your anxiety.
Hope i was helpful and easy to understand,
Follow ups are welcome,
Thank you!

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