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Patient profile: 24 y/o male with no previous medical history; formerly a light smoker and current social drinker
I have been having the following symptoms for about a year now associated with alcohol intake, eating spicy food (or even seasoned with small amounts of pepper or garlic), and NSAIDs:
- Gurgling/slight burning pain in the epigastric region lasting for up to 2 weeks after ingestion of alcohol/spicy foods/NSAIDs
- Occasional reflux (no heartburn, however)
- Symptoms are worst when hungry
Additional info & history:
- Pain usually starts with some delay after ingesting the above, sometimes as much as 1 or 2 days later
- Having a hard drink on empty stomach causes severe, debilitating pain the next day
- Had an endoscopy done about 6 months ago which showed nothing. A biopsy obtained during the endoscopy showed no H. pylori infection. No ulcer was found in either stomach or upper duodenum, and there was no visible inflammation of the stomach wall
- Have tried the following with very limited success: omeprazole OTC (20mg) by itself, sucralfate by itself, and currently on a combination of sucralfate and esomeprazole (40mg); these therapies have reduced the gurgling slightly, but have far from gotten rid of it
- I have tried avoiding the triggers (alcohol, seasoned food, NSAIDs) a few times and the symptoms have gone away; however, as soon as I ingested even a tiny amount of the irritating substance, the sympotoms came back with full force
- I have not experienced any black or tarry stools, nor any changes in my stool movements.
Although I am consulting with health providers on this, no one has made a definitive diagnosis. My own belief is that it's either GERD or functional dyspepsia. The most troubling part is that no cause can be found even when the symptoms are present, not even an inflamed stomach lining despite the irritants being clear.
Although the symptoms are tolerable, my primary concern is that the continuation of this disorder may lead to a more serious disease down the road. If having to choose complete abstinence from the above-mentioned irritants or the presence of symptoms without diet modification, I'd rather go with the latter. The only factor that may convince me otherwise would be the development of a more serious disease. This means that a definitive diagnosis would be helpful (as in, GERD increases cancer risk, functional dyspepsia does not).
Any help or suggestion with how to proceed would be helpful. Should I go for another endoscopy? Should I consider getting a colonoscopy?
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