My son has servere stomach pains and we are 99% sure it's ibs, where do I start ?

Okay, I've read your complaint. I'm a retired medical professional from the U.S. and will try to provide you with information that will hopefully get you pointed in the right direction.

Regarding where to start, I'd like to inquire your son's age and whether the pain experienced by your son is actually originating precisely from his stomach. I ask because IBS, or Irritable Bowel Syndrome as the name implies, more commonly affects the bowel function of patients, being clarified as constipation-predominant, Diarrhea pre-dominant or Mixed-predominant. Abdominal pain is generalized due to cramping of the large intestine and colon and the underlying cause is water imbalance at the level of the colon that results in variations of bowel dysfunction. While pain can be said to arise in the stomach itself, it is necessary to realize that the transverse colon runs horizontally across the upper abdomen and at a point, beneath the stomach itself. The left region of the pancreas also lies at a point in front of the stomach and just above the transverse colon, so there are many potential origins of the pain to be considered depending upon your son's constellation of symptoms.

IBS is very often accompanied by significant stress and/or anxiety. IBS is also known as a functional disease. In other words, there is no actual pathology involved with IBS but rather the disturbance is related to nervous system irregularities specifically associated with the gastrointestinal tract. While the pain is real, it is considered somatic in form, or otherwise not associated with an organic pathology of any kind.

So while I understand your comment relating to your impressions regarding diagnosis, I'd like to know a bit more regarding his symptoms if that's alright. Firstly, please describe in detail what precise symptoms are associated with the morning "flare-ups?" Exactly what is involved in that process and does it strictly occur in the morning or at unexpected times during the day and evening as well? Please tell me what follows the flare-ups and whether it is associated with bowel movement dysfunction and specifically what type. How long does the stomach pain last and is there anything that relieves it?

Also tell me explicitly the precise nature of the stomach pain. Is the pain sharp or dull? Is it intermittent shooting pain or constant? Is the pain located in the upper left abdominal area adjacent to the ribs or lower? Does the pain gradually spread or is it isolated to a very specific spot? Has the location of the pain changed to any degree over time or does it remain at a specific location? Is your son experiencing any acid reflux? Does the pain change once he has eaten? Does drinking water make matters worse? Is there evidence of belching and/or flatulence?

If you'd care to provide me with answers to the above questions, it would be very helpful in providing a more detailed response. There are specific treatments for IBS if that is the diagnosis provided by your physician, but depending upon age they may not be appropriate and their side-effect profiles are somewhat undesirable. There are other options that include medications that focus upon smooth muscle relaxation, such as chlordiazepoxide / clidinium, mebeverine, pinaverium, dicyclomine, hyoscyamine, but the proper choice not only depends upon his medical history and other medications being taken but more importantly the best choice for treatment depending upon cause that would be chosen by your physician or specialist.

Consideration must also be given to whether an upper GI endoscopy by a gastroenterologist would be appropriate depending upon the more precise origin of the pain, whether pain worsens over time, becomes more frequent or is inconsistent with IBS. Nothing surpasses direct examination if circumstances best warrant it. If symptoms remain consistent then the simplest and least invasive approach is typically the best. In other words, symptomatic relief would be the initial goal with follow-up examination to determine progress.

Lastly, while the internet is an excellent resource for persons experiencing symptoms who have already been evaluated by the medical community and are seeking reassurance, it is an extremely poor resource for medical advice. So I'll leave you here with the thought that the true place to start is directly with the physician providing care to your son. If no cause can be isolated at that level then your physician would most likely make referral to a gastroenterologist for more in-depth examination. Having said that, it must first be determined whether the GI tract is the origin of the pain.

My comments here should not be construed as formal medical advice, consult or treatment but rather information that you may electively choose to consider or pass along as you work to seek the best avenue in obtaining successful medical treatment for your son.

Best regards