Question: I have had pretty serious gastrointestinal problems for much of my adult life. I had peptic ulcer disease in my mid 20s. At 39, my GI problems started again with a vengeance, this time requiring hospitalization and frequent ER trips.

During the course of the episode that began at 39, I also developed a lot of joint pain. After 18 months and losing about 40 pounds, things finally began to improve. As my GI symptoms got under control (contemporaneously with xifaxen, possibly because of it), I was eventually left with mostly just joint pain. Eventually, that all cleared too, except for the pain in my right hip.

My hip never got better. After giving it time, PT, and Celebrex, I went to an ortho. On my first visit, I was diagnosed with Ficat class IV avascular necrosis and learned I needed a total hip replacement and soon.

My hip recovery has been great. However, my GI symptoms are back 3 months after hip surgery. I do not have Crohns. Is there possibly something common between these problems? I've not had much for corticosteroids in my life, and I don't have any other risk factors for AVN that we can tell. I also am cold all the time but sweat profusely (mostly lower half of my body) when I sleep.

This has taken enough of my and my family's quality of life. I am desperate to turn this around.

Hi Dr. Klerida,

Thanks for taking the time to respond. Here are the answers to your questions:

- The GI problems that would send me to the ER are non-stop abdominal pain and constant vomiting. I'd wake up rocked with unrelenting vomiting and abdominal pain. My vomit frequently had undigested food in it. (I have a gastric emptying study this Friday.)
- I've never had any trauma to my hip. Also, I'm an executive in my organization, so my job is not physically demanding.
- Leading up to surgery and during recovery for my hip, I took Celebrex, Xaralto, Roxicet, Omeprazole daily. Occasionally I'd also take Promethazine and Ambien. I'm not taking anything now except Donnatal as needed. The phenobarbitol in the Donnatal helps relieve some anxiety when I'm getting sick, but I don't experience much other benefit that I've noticed.
- Regarding infectious diseases of the GI tract, I've been extensively evaluated and would think that my series of university doctors have checked for that. However, I don't know for sure. I had a very high calprotectin test result while admitted to the hospital in January/February of 2013. One of the doctors said I have an inflammatory bowel disease, but the test results have not been repeated in follow-up calprotectin tests... yet.
- I don't have any other substantial health problems that I know of. However, I'm willing to push my in-person doctors for any tests you think might yield useful results. My suspicion is there is a common root cause of both my avascular necrosis and my GI problems, possibly something endocrine. My mood has been a wreck since the GI problems started picking back up again. I'm not sure if it's related to the root cause or a side effect of my currently poor diet and anxiety about the problem returning.
Again, thanks for responding to my question. I hope the additional information is useful.On reviewing some of the risk factors for AVN, I see that gout is on the list. I've had several gout flares in my life, beginning sometime in my mid 30s. My most recent gout flare was slightly less than 1 year before my first ER visit related to non-stop vomiting and nausea. I'm not sure if this information is useful, but I thought I'd share in case it is.
Best,
XXXXX

Hi Dr.Klerida,

My last upper endoscopy showed an irregular z-line and hiatal hernia, but no new ulcers or anything like that.
My colonoscopy last year showed hemorrhoids and some potentially forming diverticulosus, but nothing really to account for my troubles.
Type 1 Diabetes does run in my family, but I am not diabetic.

That leaves the test of pancreas function and serological tests. Are there any specific tests you'd recommend? Will my in-person physician know what I'm asking for?

Best, XXXXXXX