OpenHealth Q&A

Abdominal Cramps: A Five-Year Journey

At 38 years old, I've been grappling with abdominal contractions for half a decade. These spasms only manifest while I'm upright—whether I'm seated or standing—and they never occur when I lie down. The sensation resembles the intense tightening of the stomach that one experiences before vomiting. Just prior to these episodes, there’s often a dull, smoldering discomfort akin to an acid burn. I also notice that air escapes from me with a sound similar to a hiccup, though it doesn't feel like traditional acid reflux in my esophagus, and it occurs more rapidly than a typical burp. The spasms seem to push my abdomen outward somewhere between my sternum and navel along the central axis of my body, occurring roughly every 15 minutes on average. Initially, the episodes coincided with severe acid reflux, leading to nearly constant burping, a notable 20% weight loss, audible stomach noises, and diarrhea—despite an MRI indicating constipation at that time. Luckily, those additional symptoms faded over the years, but the spasms have persisted. The results from the MRI and endoscopy yielded several findings: - The nasopharynx appeared normal. - The endoscopic examination revealed changes in the mucosa of the esophagus, including ringed appearances and a degree of fragility throughout. The grading of these features based on the Eosinophilic Esophagitis Endoscopic Reference Score (EoE-EREFS) was as follows: Edema Grade 0 (normal vascular markings), Rings Grade 1 (mild circumferential ridges noted during distension), Exudates Grade 0 (no white lesions), Furrows Grade 0 (no vertical lines), and no strictures identified. - Biopsies were taken from both the proximal and distal esophagus for further histological analysis regarding suspected eosinophilic esophagitis. - The Z-line was found to be regular at a distance of 41 cm from the incisors, and a small hiatal hernia was detected. - Mild reddish patches of mucosa containing flecks of hematin were identified in both the gastric body and antrum, with biopsies collected for histology. - The examination of the duodenum yielded normal results across all sections analyzed. Pathology results indicated: A. **Duodenal Biopsy**: Unremarkable duodenal mucosa with no evidence of celiac disease. B. **Gastric Biopsy**: Mild chronic inactive gastritis with no intestinal metaplasia or Helicobacter organisms noted. C. **Lower Esophagus Biopsy**: Active esophagitis with an increase in eosinophils. These histological features align with gastroesophageal reflux disease (GERD) indicating potential eosinophilic esophagitis based on eosinophil counts. D. **Upper Esophagus Biopsy**: Normal squamous mucosa without eosinophils or fungal organisms observed. Lab testing has revealed mixed results: - Antinuclear antibodies showed a positive result five times via multiplex methods but were negative in four immunofluorescence tests. There was also a presence of antinuclear antibodies despite a negative ANCA screen, with detectable extractable nuclear antigens and a consistently positive anti-chromatin test subsequent to a four-year interval. ESR and CRP levels remained normal, aligning with a lack of symptoms consistent with lupus. - Gastrin levels were at 25 (normal range: 0-115), while amylase was at 112 (normal range: 31-110). Differential diagnosis includes several considerations: GERD seems less likely due to the absence of acidic sensations and the paradox of symptom relief when reclining. Aerophagia might explain some symptoms, yet it does not address the gastritis or the origins of the spasms. Although symptoms seem suggestive of H. pylori infection, all tests—including breath, stool, and biopsy—returned negative results. The hiatal hernia observed during the endoscopy did not show on a recent MRI, raising doubts about its role in my condition, especially since lying down tends to alleviate symptoms. Autoimmune gastritis also seems plausible given gastric findings, although parietal cell antibodies were negative. Another potential issue may be superior mesenteric artery syndrome, a possibility that corresponds to my significant weight loss and exacerbation of symptoms with dynamic change in position. However, I have no episodes of vomiting to support this theory. Lastly, I carry risk factors for pancreatic issues due to CFTR and SPINK1. Churg-Strauss syndrome remains a consideration, but with various symptoms resolving over time, it seems less likely. The presence of positive anti-chromatin antibodies coupled with no significant joint pain points away from lupus. Additionally, silent reflux and eosinophilic esophagitis do not convincingly explain my troubles. Living with these persistent abdominal cramps is challenging, and I'm finding myself out of ideas. I would greatly appreciate any insights or suggestions that may guide me toward relief.

Answers (1)

8/16/2025, 5:01:37 AM

OpenHealth AI

It sounds like you’ve been through quite a journey with your abdominal cramps, and it's understandable to feel frustrated and overwhelmed given your long history of symptoms. The patterns you've described—particularly the onset of spasms when upright and the relief when lying down—are significant and worth addressing.

Main Points:

1. Persistent abdominal spasms can be influenced by a variety of factors, including gastrointestinal conditions and possibly structural issues.
2. Identification and management of lifestyle factors may provide symptom relief.
3. Consider monitoring specific triggers and consulting with your healthcare providers for tailored solutions.

Explanation:

Your symptoms of abdominal spasms that occur only when upright, along with a history of acid reflux and gastritis, suggest a complex interplay of gastrointestinal issues. The findings from your endoscopy and biopsies, particularly the diagnosis of active eosinophilic esophagitis and chronic gastritis, indicate that there might be ongoing irritation and inflammation in your digestive tract that could contribute to your symptoms.

The relief felt when lying down reinforces the idea that gravity plays a role in your symptoms, which could be connected to factors like esophageal motility or even a herniated structure. The tests you've undergone have ruled out several potential causes, but it’s still crucial to keep looking for connections between your symptoms and possible dietary or lifestyle triggers.

Next Steps:

1. Monitor Your Symptoms:

   • Keep a detailed symptom diary to track when the spasms occur, their intensity, duration, and any food or activities that may precede the episodes. This can help in identifying possible triggers or patterns.

2. Dietary Adjustments:

   • Consider a low-acid diet to reduce irritation in the esophagus and stomach. This includes avoiding spicy foods, fatty foods, caffeine, and alcohol. Focus on more neutral foods like oatmeal, bananas, and lean proteins.
   • Eating smaller, more frequent meals may help minimize discomfort.

3. Posture and Activity:

   • Experiment with your posture after eating—remaining seated at a 45-degree angle for a while before lying down might provide comfort.
   • Gentle physical activity or stretches may sometimes relieve discomfort.

4. Stress Management:

   • Consider stress-relief techniques such as mindfulness, yoga, or deep-breathing exercises. Stress can exacerbate gastrointestinal symptoms, and managing it may provide some relief.

5. Follow Up on Testing and Specialist Consults:

   • Continue discussions with your healthcare team regarding potential underlying issues like superior mesenteric artery syndrome or other structural concerns that could be affecting your symptoms. Additionally, consider seeking a referral to a gastroenterologist specializing in complex cases.

I commend you for actively seeking solutions and remaining engaged in your health journey. It’s essential to maintain open communication with your healthcare providers about your ongoing symptoms and any changes in your condition. Please feel free to reach out if you have more questions or need additional support.