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Dr. Hasan
Dr. Hasan, Doctor
Category: Medical
Satisfied Customers: 9137
Experience:  MBBS, FCPS, with experience in all fields of medicine and surgery
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My 12 year old son has had constant nausea and upper abdo pain for over 3 months. All test

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My 12 year old son has had constant nausea and upper abdo pain for over 3 months. All tests come back normal. Says he is not anxious about school though it is a high pressured environment. Also has Aspergers but is very high functionning. Has missed a lot of school which is unusual for him. Gastritis diagnosed but waiting for endoscopy. Been on a lot of meds - all useless. Currently on Kolanticon, Domperidone and Lansoprazole.
Kolanticon did provide some relief for a while when he had a lot of pain after drinking some orange juice. Under consultant . Feel like we are getting nowhere. Slight improvement over summer holiday but no significant difference

Dr. Hasan :

HI, Thanks for your question. My name isXXXXX and I am here to help you today. I will be happy to help you with your follow-up questions also. I need few details.


 

Dr. Hasan :

What other tests have been done?

Customer:

stool test for H pylori - negative

Customer:

Ultra sound scan of abdo and kidneys - negative

Dr. Hasan :

ok

Customer:

Urine tests - negative

Dr. Hasan :

Where exactly is the pain in upper abdomen?

Dr. Hasan :

Right, left or mid line?

Customer:

Has now been referred for endoscopy

Dr. Hasan :

ok

Dr. Hasan :

Where exactly is the pain in upper abdomen?

Dr. Hasan :

Right, left or mid line?

Customer:

He describes it as going across

Dr. Hasan :

You mean it gets referred to the back?

Customer:

No, around the front

Dr. Hasan :

He gets the pain always after eating something?

Customer:

That is , all around the front, it does not move across

Dr. Hasan :

He gets the pain always after eating something?

Dr. Hasan :

I am sorry for all this info but i need it for best help.

Customer:

No, but eating can sometimes relieve it

Dr. Hasan :

ok i see.

Dr. Hasan :

Does he feel the pain when he gets up in the morning and it gets better after eating something?

Customer:

Yes he feels it in the morning and feels better half an hour after eating

Dr. Hasan :

Any pain on pressing the abdomen?

Customer:

yes

Dr. Hasan :

Blood tests done for pancreas?

Dr. Hasan :

Has he been checked for H Pylori infection?

Customer:

Blood tests have been done - not sure what they tested for however

Customer:

Yes H Pylori test came back negative

Dr. Hasan :

Thanks a lot for your input.

Dr. Hasan :

I am really sorry to hear about his illness and i can understand your level of stress for him.

Dr. Hasan :

Well as per symptoms this sounds like duodenal ulcer.

Dr. Hasan :

Duodenum is the part of intestine just after the stomach

Dr. Hasan :

Normally in ulcers pain aggravates after eating but in duodenal ulcers eating relieves the pain.

Customer:

Would this show up with an endoscopy?

Dr. Hasan :

Most of the times H pylori is associated with it. A negative test for H Pylori sometime is not sufficient and direct endoscopic examination and biopsy from the area is required.

Dr. Hasan :

Yes definitely.

Dr. Hasan :

It does show up on endoscopy.

Dr. Hasan :

In that case a course of combination antibiotics is required.

Dr. Hasan :

There are other causes like pancreas or gall bladder related diseases which should be checked for by a CT scan but the first step should be endoscopy.

Customer:

What about the constant nausea? He has just been put on 30 mg Lansoprazole which I hope will help. He is avoiding fatty and citrusy type foods - makes no difference

Dr. Hasan :

Constant nausea can be a feature of ulcer.

Dr. Hasan :

Yes he should avoid spicy foods also. Is he?

Customer:

Yes definitely. Isn't his current medication used in treatment of ulcers anyway?

Dr. Hasan :

Yes his current medications are for ulcer but sometime if they are not working, the next step is endoscopy and specially one should be checked for H pylori because duodenal ulcers are almost always associated with H pylori and antibiotics are required for its treatment.

Dr. Hasan :

Stress can play a role here too because ulcers gets aggravated by stress.

Customer:

What else should I ensure is checked when he has his endoscopy?

Dr. Hasan :

You should ask them to check for duodenal ulcers specially.

Customer:

He also says he is hungry all the time even just after finishing a meal. Is this consistent with duodenal ulcer?

Dr. Hasan :

and ask them for checking H Pylori if the gastro doc feels like.

Dr. Hasan :

Yes one can feel so with duodenal ulcers. There are many unusual symptoms with most of the diseases and we have to focus on main symptoms.

Dr. Hasan :

Does he get any diarrhea or constipation?

Customer:

No, he says his bowel actions are daily and normal

Dr. Hasan :

Ok

Dr. Hasan :

Suppose if his endoscopy is ok then functional dyspepsia can be the cause.

Dr. Hasan :

I guess they have some suspicion of it and that might be the reason for starting him with Kolanticon.

Dr. Hasan :

but again treatment remains the same, specially H pylori again has to be treated.

Customer:

What is functional dyspepsia?

Dr. Hasan :

Good thing is this that he is on right tract and getting investigated in a good way.

Dr. Hasan :

Functional dyspepsia is basically a problem in which there are symptoms of ulcers but no ulcer is found. The treatment is same.

Dr. Hasan :

We call it non ulcer dyspepsia also.

Dr. Hasan :

But we can label it after his endoscopy is negative.

Customer:

I suppose that is my concern that everything is coming back negative. In the case that it does come back negative, will a CT scan be the next step or will there be enough to suggest non ulcer dyspepsia?

Dr. Hasan :

Yes CT scan will be the next step so that other causes can be ruled out.

Dr. Hasan :

But if CT is negative too then yes we can call it non ulcer dyspepsia.

Dr. Hasan :

Don't worry he will be fine.

Customer:

What is the prognosis like for both conditions or is it too variable to say?

Dr. Hasan :

No the prognosis is excellent.

Dr. Hasan :

You just need to get the right diagnosis and things can go in right direction then.

Customer:

If stress is a factor I suppose it is likely to flare up with exams

Dr. Hasan :

Well yes you are right.

Dr. Hasan :

But try to council him as much as you can.

Dr. Hasan :

Your support can make a difference.

Customer:

Many thanks. I have been feeling like I am going a bit mad especially as some people including teachers, are suggesting it might be purely psychological. It has made me question whether he is making it up for attention, though to be fair, the GPs and consultant have not suggested this.

Dr. Hasan :

You are most welcome. Yes it can be psychological but how can we call someone's pain to be psychological until unless we have ruled out everything.

Dr. Hasan :

I suggest you to just relax and just support him.

Dr. Hasan :

This will make him feel better.

Customer:

Thank you. I will do my best.

Dr. Hasan :

That's good.

Dr. Hasan :

I wish him all the best, please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.

Dr. Hasan and 2 other Medical Specialists are ready to help you
Customer: replied 5 years ago.


Don't know if this link still open or if extra charge. Son is increasingly symptomatic - up until 3 am last night with discomfort/pain. A week last Friday spoke to GP who added cyclizine to the Lansoprazole, Kolanticon and Domperidone. Have dropped cyclizine as it made no difference. Saw gastroenterologist last week who will do endoscopy on 2-10-13. He is testing also for coeliac disease. Problem is I don't know how to help son manage symptoms for another week and a half. He is off school - can't envisage him going back on current meds as they are barely helping.

Hi, thanks for updating me about his problem. I am sorry that he is still having all these issues. Have you discussed with your doctor about prescribing him some anxiolytic. It will help him in getting relief from pain and will have sedative effect also. What about CT scan. Regards.
Customer: replied 5 years ago.


Many thanks for this. I will discuss with GP.

Customer: replied 5 years ago.


Would an anxiolytic be taken in conjunction with his other medication.? He has been on two PPIs (omeprazole and lansoprazole) and neither of them appear to have any effect.. Is that unusual? What would CT scan be to look for?

 

He is now alternating between a day or so of constipation and then when he manages to open his bowels ( he said that it was difficult to do) his stools were greenish and loose. Is this significant?

 

He seems to feel ravenously hungry - in the evening he just never seems to have had enough. Also have noticed that at night he gets very thirsty

 

Many thanks

Hi, Sorry for the delay. Yes anxiolytics can be taken with his current medicines. No effect from medicines is making us think about other causes like functional dyspepsia. CT scan would look for causes like pancreas problems, liver problems (as per symptoms they are least likely but yet CT scan is required. Yes the stool changes can be significant. Greenish colour can be due to some gall bladder problem but more likely it can be due to loose stool or lastly it can be an infection. The hungry feeling can be due to stomach issues. My best wishes again to you and your family. You don't have to pay again but if you feel satisfied with my answer, you can rate it, it's your choice. Regards