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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56523
Experience:  GP in the United States
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I have been suffering from deep, central abdominal pain

Resolved Question:

Hi, I have been suffering from deep, central abdominal pain for 12 years. It ebbs and flows, and is sometimes associated with headache and lethargy. If I palpate the area it feels denser than the surrounding viscera and the pain escalates and becomes stabbing, almost cramp-like.
When it started I was investigated with blood tests, an endoscopy and MRI scan, with no result. I persisted for an answer or at least managment options but was told by the consultant that I had been investigated much further than usual and to take ordinary NSAIDs for pain relief (not very effective). I have lived with this for too long now and would like a solution. Could the pain be functional/neuropathic? Where do I go from here?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.
Thanks for this question
have you noticed any triggers?
Customer: replied 2 years ago.
The pain is always there, but seems worse if I'm constipated. I rarely get gastroenteritis, but over the last 12 years I have found that the pain becomes severe during these times.
Expert:  Dr. Phil, MD replied 2 years ago.
what bowel tests and what imaging tests have you had?
Customer: replied 2 years ago.
Upper GI endoscopy (some antral inflammation) and MRI (no abnormalities). The former was treated with a PPI to no avail. There were also some 'Campylobacter-like' bacteria detected on the grab biopsy, treated with ciprofloxacin. This was back in 2003. Nothing has been done since then.
Expert:  Dr. Phil, MD replied 2 years ago.
do you alternate diarrhea and constipation?
Customer: replied 2 years ago.
No, not really. Just in case you're steering towards IBS, I have an over-the-counter IBS relief compound containing clenbuterol, but it does not seem to help.
Expert:  Dr. Phil, MD replied 2 years ago.
I am thinking, SIBO, sphincter of Oddi dysfunction, pancreatic divisum or IBS
Customer: replied 2 years ago.
1. I am not familiar with the middle two differentails, but would they have shown up on bloods? If I remember the rightly the panel included pancreatitis.
2. What is your suggested course of action?
Expert:  Dr. Phil, MD replied 2 years ago.
1)no they would not. You would need an MRCP. MRI of the pancreas and something called an ERCP. This is where they go into the small intesting and check the sphincter too see if it is abnormal.2)I would get on the FODMAP diet.https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdfIt will help if there is any chance of IBSAlso you need to establish with a good GI doctor. Preferably at a university hospital and inquire about an ERCP and MRCP
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Expert:  Dr. Phil, MD replied 2 years ago.
I appreciate the excellent rating.

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