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Can I Still Have Gastritis Even After An Endoscopy Which

Posted on Sun, 1 Sep 2019

Question: Can I still have gastritis even after an endoscopy which was normal? I have pain under my right ribs right below the right chest, more like in the upper abdomen. I also have lot of belching/burping, feeling of gas in my chest.

This has been going on for almost 3-4 months.

Answered by Dr. Bhagyesh V. Patel (2 hours later)

Brief Answer:
can have gastritis with normal endoscopy.

Detailed Answer:
Hello and welcome to Ask A Doctor services.
I have read your query and here is my advise.

* There are 10-15 % of cases where endoscopy findings are normal and
patient is having symptoms of gastritis ( where stomach findings are not
suggestive , but clinically symptoms are exactly that of gastritis ).

Actually , there are constellation of symptoms and clinical findings which suggest particular case with gastritis and the endoscopy is supportive for the establishment of the same and rule out other issues.

Gastritis and stomach upset related issues do stay long for period of times when there is improper balance of necessary diet modifications, stress level and other life style management with medicines.

Thanks.
Regards.

Dr Bhagyesh

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (57 minutes later)

So since last friday, I have been having the issues of gassy feeling in the chest and about 100-150 deep/big burps. Also, pain in the upper abdomen ( I am not sure if its abdominal pain or muscoskeletal as it does not feel like some organ pain, but then I am not sure).

What can i do to get relief from my symptoms.

Is this some bile duct issue, if so should I do any evaluations like HIDA or EUS? ( I read couple of things on google, that EUS is the best to rule out anything with the bile ducts).

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
focus on basic management with life style changes and medicines.

Detailed Answer:
Hi
Welcome for follow up.

* Here are some best suggestions for primary relief

- Frequent small meals.
- Avoidance of dairy fat, aerated drinks, beverages, cheese, spices, non veg.
- Addition of Yogurt with bland diet.
- Control of stress ( the main recovering factor for you ).
- Supportive medications as proton pump inhibitor, digestive enzymes and
bulk forming laxative in case of constipation.

* This is not bile duct issue and you do not require EUS at present, be sure
that all symptoms narrated on google do not apply to every individual
and it is good to get information through that but getting stressed out via
that will flare up your symptoms rather than helping.

Wish you good day.
Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Bhagyesh V. Patel (38 minutes later)

Brief Answer:
follow up .

Detailed Answer:
Hi
I have seen the attached image showing the painful areas.

* The blue area indicate upper part of stomach and classical site of gastritis
pain origin.
The black areas are the regions where the accumulated gas disturbs
nerves and provide referred pain.

* Gas pain also gets exacerbated when pressure over ribs in many cases and
as there is no redness or other inflammatory changes over any particular
rib or muscle, chances of muscular pain is very less.

* Dietary restrictions vary depending upon the percentage and time of
recovery, but usually it takes around 2-3 weeks on an average if all things
are obeyed precisely with life style modifications and stress control, any
single point of medicine or diet change is not going to change the
condition.

It is the assembly of total dedicated efforts in multiple directions, which will make you better and better day by day.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (7 minutes later)

Due to the constant burping my taste has changed like I have acidy taste in my mouth and feel like gas stuck in my chest. I do have GERD but its been really mild but since this event I feel its gone by a level or 2.

How long should I stay on the restricted diet, any medication I should be taking?

I have done a MRI of abdomen and it came back as normal. I also forced my doctor to give me LFT,Lipase and Amylase due to the fear of something to do with bile ducts.

Follow up: Dr. Bhagyesh V. Patel (1 minute later)

I have attached the image of where the pain is, the blue circle is where it originates and then I feel the gassy feeling in the black areas.

When I push on the rib cage thats when I feel the pressure. (I am not sure if its muscoskeletal or not).

Follow up: Dr. Bhagyesh V. Patel (10 hours later)

Also, does water cause acidity?

Every morning after getting up when I drink a glass of water all the acid that has been dormant gets activated and I start burping and this goes on for some time and then it stops after I have something to eat.

Is this a sign of Gerd or Gastritis or something else?

Again this has been going on for some time now, nothing is giving me relief.

Answered by Dr. Bhagyesh V. Patel (57 minutes later)

Brief Answer:
follow up .

Detailed Answer:
Hi XXXXXXX

* Usually water will not provoke severe gastritis, unless it is consumed in
large quantity on empty stomach, where there is reciprocal secretion of
extra acids to dilute the water amount.

* It is recommended to consume about 50 - 100 ml of drinking water only
on empty stomach.

* And very important that you do not keep your stomach empty for prolong
period of time, which would be very detrimental factor for your outcome.

As previously said, frequent small meals or snacks are pioneer of basic disturbance correction in your case.

Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (2 hours later)

Thank you for the reply.

One last question, why does it pain in the blue area it’s more like 1-2 out 10 the pain, when I feel bloated or gassy?

Answered by Dr. Bhagyesh V. Patel (7 hours later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Welcome back.

* The cause of pain at scale of 1-2 indicate various possibilities as minor
mucosa irritation of stomach via acid, nerve related through chemical release
as acetyl choline, reflux of gas compressing upper end of gastro esophageal
junction etc.

Thanks.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (22 hours later)

I have been taking omeprazole 20mg and even when i eat something basic or light like dahi/yogurt or curd rice, I burp a lot and it pains. The pain is always relieved by burping or flatulence though.

Follow up: Dr. Bhagyesh V. Patel (2 hours later)

Also, I wanted to ask this question, but it kept on slipping away from my head. Why is my lower end of stomach being irritated? What causes it and apart from diet is there anything else I can do ?

Also, the region also has bile ducts and I am really stressed on that fact, can you please let me know if I can do some test to check and rule out for good any bile duct issue? I know you have stressed on this but I am getting really stressed on the irritation/pain in the region.

Answered by Dr. Bhagyesh V. Patel (32 minutes later)

Brief Answer:
HIDA scan can be obtained for hypo function gall bladder.

Detailed Answer:
Hi XXXXXXX
Welcome for follow up.

* As the pain is relieved by burping it indicates gas induced pressure
obviously.

Already satisfactory work up for the same has been done by your consultant,
but still if anything else is to be needed would be HIDA scan for hypo function of gall bladder and leading secondary to indigestion issue.

* Can discuss the same with your gastro specialist during your next visit.

Thanks.
Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Bhagyesh V. Patel (21 minutes later)

DO you think EUS is needed or not at all and its just my stress thats playing with my head?

Follow up: Dr. Bhagyesh V. Patel (5 minutes later)

Also, when is EUS usually done? Is EUS needed since my MRCP and blood works are normal? This is just for my information.

Follow up: Dr. Bhagyesh V. Patel (0 minute later)

Also, is hypo function of gallbladder anything like serious or dangerous?

Follow up: Dr. Bhagyesh V. Patel (5 minutes later)

Is my pain indication of biliary pain?

Answered by Dr. Bhagyesh V. Patel (25 minutes later)

Brief Answer:
pain is not biliary. HIDA scan will be mind satisfactory.

Detailed Answer:
Hello
Welcome for follow up.
Kindly find sequence of answers as per your query.

* Your pain is not typically indicating biliary pain.

* When MRCP is normal, I do not agree with further work up requirement till
all the aspects of medical management with life style modifications are in
best harmony for recovery purpose.

* Hypo function of gall bladder is not dangerous and it merely impairs
enzyme function of digestion in most of the cases.
There are lot number of cases operated for gall bladder removal for hypo
function of gall bladder and the complain remains same after surgery for
years together.

I believe in quality management of the patient rather than quantitative investigative work up which is not required at certain stage.

HIDA scan or other work up would just make you feel better that you have additionally seen something, the management will remain same.

But it may be possible that after that report being turning out to be normal, you may think of some other work up and the list will go on like that.

Thanks.

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj