A general internist presented a medical case:
18 Years old Male/ Suffering from recurrent stomach Pain
RECURRENT STOMACH PAIN AND BLOATING / Excessive stomach gases which is causing loss of appetite and weight loss.
Close details
Patient demographics
Gender
male
Age
18
Ethnicity
Occupation
Student
Chief complaint or problem to solve
After treated from H.Pylori,The patient has recurrent stomach pain,with constant bloating and bleaching.. he is feeling nauseous all of the time and loss of appetite and lost 4 Kilo grams in one month.I ordered A CT scan on the abdomen with oral contrast, which showed no abnormality or evidence of tumors.What can be causing the loss of appetite and stomach gases all the time?
Case history
A 18 years old male,Suffering from stomach pain,Gerd and Acid reflux, Did an endoscopy last year which showed insignificant inflammation and H.pylori infection and weak lower esophageal sphincter.treated from H.pylori successfully.After one year recurrent of stomach pain.but no evidence of H.Pylori as I did Stool antigen test,and stool culture, which was clear.apart from intermittent passage of e.histolytica cysts.The patient has slightly elevated Calprotectine and slightly elivated Triglycerides,Serum Cholestrol and Lipase.But normal blood picture and NORMAL Thyroid function, and Liver,Kidney functions.The Patient is anxious and from the way he speaks i think he could be having obsessive compulsive disorder,could this be cause gastrointestinal gases? The patient is complaining that symptoms are interfering with daily life activities.Bad breath all the time.
Purpose of case discussion
Diagnostic dilemma: "What are the next steps for evaluation?"
Supplemental Materials

Dr. Ratna Dhingra
Pediatrics
2 doctors agree

In brief: Gall bladder?

Would get a complete check up with labs.
Could be gall bladder disease

In brief: Gall bladder?

Would get a complete check up with labs.
Could be gall bladder disease
Dr. Ratna Dhingra
Dr. Ratna Dhingra
Thank
Dr. Ravinder Nagpaul
Internal Medicine
2 doctors agree

In brief: Possible

need to get more hx related to stress and depression,adjustment disorder, peer pressure, any issues with relationship etc.
Provide all other organic causes are ruled out

In brief: Possible

need to get more hx related to stress and depression,adjustment disorder, peer pressure, any issues with relationship etc.
Provide all other organic causes are ruled out
Dr. Ravinder Nagpaul
Dr. Ravinder Nagpaul
Thank
1 comment
Dr. Zafar Khan
if stomach bloating is long standing, comes on after drinking milk or milk product- it may be lactose intollerence. Try to use lactose free milk available in most supermarkets and see if helps. Your medical doctor can test you for lactose intollerence as well. It is a fairly common condition.

In brief: Other pathogens

Have you checked for Campylobacter? The presence of bad breath does speak for H Pylori but other pathogens can create the same constellation of symptoms.
Can have false negative testing and can have resistance as well for helicobacter.

In brief: Other pathogens

Have you checked for Campylobacter? The presence of bad breath does speak for H Pylori but other pathogens can create the same constellation of symptoms.
Can have false negative testing and can have resistance as well for helicobacter.
Dr. Lois Freisleben-Cook
Dr. Lois Freisleben-Cook
Thank
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