Male, 37, Experiences Intense Abdominal Pain for Two Decades: Seeking Insights
**Demographics:** 37-year-old male **Physical Stats:** Height 5 feet 10 inches, Weight 175 pounds **Ethnicity:** Caucasian **Main Issue:** Patient reports episodes of acute abdominal pain, lasting between one to two hours. The pain is particularly severe, described as debilitating, originating near the navel and radiating towards the back. Symptoms include bloating, gas, and an urge to defecate, yet relief is not achieved post bowel movement. These painful episodes typically arise in the evening around 7 to 8 PM. Applying heat brings some comfort, and the individual maintains a normal state in between episodes. **Previous Medical Investigations:** - Diagnosed with Gilbert’s syndrome. - Exhibits iron deficiency with low ferritin levels (~11 ng/mL) and diminished iron saturation around 12%. Additionally, serves as a regular blood donor, with the last donation occurring in June. Patient's diet is noted to be low in red meat and animal products. - Autoantibody testing revealed ANA at 1:320 (homogeneous), but the rest of the autoimmune panel (dsDNA/ENA/complement levels) was normal. - Slight elevation in tryptase levels, measured between 13-14 μg/L (the patient’s child has a similar condition). - A solitary lipase value indicated approximately 2.5 times the upper limit of normal, taken around 17 days after an attack. - Recent endoscopy and colonoscopy with biopsies returned normal results, ruling out celiac disease and inflammatory bowel disease; H. pylori test was negative. - Disaccharidase levels are within normal ranges. - Mild elevation in urine porphyrin fractions, although not assessed during an active episode. - Historical ultrasound and MRI imaging were normal. - A CT scan has been performed, with a capsule endoscopy and abdominal ultrasound yet to be completed. Any recommendations? Should I also consider consulting a rheumatologist in addition to my existing gastrointestinal care?
Answers (1)
9/6/2025, 12:40:38 AM
OpenHealth AI
It sounds like you've been dealing with significant abdominal pain for two decades, and it’s understandable to seek insights into such a challenging situation. Your symptoms, along with your medical history, suggest a complex interplay of factors that could be contributing to your discomfort.
Main Points:
- Persistent and Severe Abdominal Pain: This may be influenced by various factors, including dietary habits, iron deficiency, or underlying gastrointestinal issues.
- Normal Investigations: Recent tests, including endoscopy and colonoscopy, ruled out several potential conditions but did not provide a definitive answer.
- Consulting Specialists: Considering your ongoing abdominal pain and previous tests, consulting additional specialists might be beneficial.
Explanation:
Your episodes of acute abdominal pain, associated symptoms (bloating, gas, urge to defecate), and their timing suggest a possible functional gastrointestinal disorder, such as irritable bowel syndrome (IBS) or another functional dyspepsia. The fact that other serious conditions have been ruled out through testing is reassuring, yet the persistent nature of your pain warrants further attention.
Your dietary habits, low iron levels, and Gilbert's syndrome might play a role in your symptoms as well. Gilbert’s syndrome often doesn’t cause significant issues, but your ongoing iron deficiency can lead to fatigue and may impact your overall health.
Next Steps:
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Keep a Symptom Diary: Document your pain episodes, including timing, intensity, associated foods, and any other triggers or relieving factors. This can help identify patterns or potential dietary links.
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Dietary Adjustments: Consider evaluating your diet:
- Incorporate more iron-rich foods, such as legumes, nuts, seeds, and fortified cereals to help with your anemia, especially since red meat is limited in your diet.
- Increase fiber intake slowly to help with bowel regularity, paying close attention to how different foods affect your symptoms.
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Heat Therapy: Continue using heat pads during painful episodes, as you’ve noticed some relief. Gentle abdominal massages might also help alleviate discomfort.
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Consulting Specialists: Given the complexity of your case:
- Gastroenterologist: Since you have not yet completed capsule endoscopy and abdominal ultrasound, it’s crucial to follow through with these tests for further evaluation.
- Rheumatologist: Considering a referral to a rheumatologist could be valuable, especially since you have a positive ANA and mild elevation in tryptase levels, which may warrant a closer look into potential autoimmune conditions.
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Stress Management: Look into stress-reduction techniques such as mindfulness, yoga, or relaxation exercises, as stress can exacerbate gastrointestinal symptoms.
Please continue to engage with your healthcare team and keep them informed about your ongoing symptoms and any new ones that arise. It’s important to ensure that all aspects of your health are addressed comprehensively.
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