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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Pain Below Sternum, Vomiting, Diarrhea. Done Ultrasound And CT Scan

A friend of mine has had severe pain just under the sternum, vomiting (including yellow bile ), diarrhea . He experienced just symptoms about a year ago, but it s back and worse. Doctors have taken Ultrasounds, CT Scans, but seem to have ruled out Gall Bladder problems. He s feeling pretty desparate right now, and has had several appointments with doctors, but no answer yet. He has an appointment with a kidney doctor and an internist. HELP!!
Mon, 22 Oct 2012
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Pulmonologist,  's  Response
Hi
Thanks for your query
As gall bladder issues are excluded as per your version then its most important now to exclude now gastric pathologies. Two important entities are consistent with symptomatology. One is gastric or dudenal ulcer and another is gatro-esophageal reflux disorder (GERD). To exclude gastric or dudenional ulcer the investigation of choice is upper G I endoscopy with rapid urease test to exclude H. pylori infection. To diagnose GERD its important to measure 24 hr ph monitoring at the lower end of esophagus. To start with pantoprazole tablet 40 mg twice daily before food and modify your treatment after availability of the test results. Another important entity is pancreatitis which should have been detected in USG or CT abdomen, though it will be better to go for serum amylase and lipase assay. Heart diseases should also have to be excluded. Therefore an ECG should be done atleast to exclude them. I think by all thses you will get the answer.
Thank you.
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General Surgeon,  Dr. Grzegorz Stanko's  Response
Hello!

Thank you for the query.

Such symptoms may be caused by peptic ulcer. Especially if such symptoms appear about 2 hours after meal. It is very common that peptic ulcer gives negative ultrasound and CT results as well as blood work is usually normal. That is why upper GI endoscopy with Helicobacter Pylori test should be performed. Before that fool blood work and abdominal ultrasound should be done again, as a lot could have changed during this year.
If your friend will find all this tests negative including endoscopy, stool tests should be performed as such symptoms may be also caused by some intestines infection. That is why he should ask his doctor about Rifaximine therapy.

Hope this will help.
Regards.
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Pain Below Sternum, Vomiting, Diarrhea. Done Ultrasound And CT Scan

Hi Thanks for your query As gall bladder issues are excluded as per your version then its most important now to exclude now gastric pathologies. Two important entities are consistent with symptomatology. One is gastric or dudenal ulcer and another is gatro-esophageal reflux disorder (GERD). To exclude gastric or dudenional ulcer the investigation of choice is upper G I endoscopy with rapid urease test to exclude H. pylori infection. To diagnose GERD its important to measure 24 hr ph monitoring at the lower end of esophagus. To start with pantoprazole tablet 40 mg twice daily before food and modify your treatment after availability of the test results. Another important entity is pancreatitis which should have been detected in USG or CT abdomen, though it will be better to go for serum amylase and lipase assay. Heart diseases should also have to be excluded. Therefore an ECG should be done atleast to exclude them. I think by all thses you will get the answer. Thank you.