[33F] With chronic upset stomach and gastrointestinal symptoms

Patient Description

A 33-year-old female has been experiencing an upset stomach for the past 3-4 days. The discomfort is described as a dull ball of stomach acid lingering at the top of the stomach and sometimes moving up to the back of the throat. Episodes occur once or twice a week, lasting 3-5 days. The patient has not found any relief. Additional symptoms include constipation for 2-3 days, vomiting once a couple of hours ago, and a feeling of fullness in the chest without a burning sensation. There is slight unintentional weight loss and some difficulty swallowing, including choking on phlegm during sleep. No sour or bitter taste in the mouth, bloating, or excessive gas reported. The patient smokes ¼-½ pack of cigarettes per day and has not recently changed diet or traveled. Medical history includes possible stomach cancer, chronic fatigue, chronic depression, PTSD, social phobia, general anxiety, syncope, seizures, and recent use of a heart monitor, all diagnosed around May 2020. Menstrual periods have changed from every 4 weeks to every 6 weeks. The patient has an allergy to penicillin but is not currently taking any medications. Family history includes heart disease, stroke, autoimmune diseases, diabetes, cancer, and psychiatric illnesses.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

Gastroesophageal Reflux Disease (GERD)

Rationale: The sensation of stomach acid moving up to the back of your throat, chest fullness, and difficulty swallowing are common symptoms of GERD. GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).
Typical Treatments/Testing: Treatment often includes lifestyle changes, over-the-counter antacids, and prescription medications to reduce acid production. Your doctor may recommend an endoscopy to examine your esophagus and stomach.

Peptic Ulcer Disease

Rationale: The dull, lingering pain in your stomach could be indicative of a peptic ulcer, which is a sore on the lining of your stomach or the first part of your small intestine.
Typical Treatments/Testing: Treatment usually involves medications to reduce stomach acid and antibiotics if an infection is present. An endoscopy may be performed to confirm the diagnosis.

Functional Dyspepsia

Rationale: This condition is characterized by chronic indigestion with no clear cause. Symptoms include a feeling of fullness, bloating, and nausea.
Typical Treatments/Testing: Treatment may include dietary changes, medications to reduce stomach acid, and prokinetics to help your stomach empty more quickly.

Constipation

Rationale: Your constipation could be contributing to your stomach discomfort and nausea.
Typical Treatments/Testing: Increasing fiber intake, staying hydrated, and using over-the-counter laxatives can help. If constipation persists, your doctor may recommend further testing.

Anxiety and Stress

Rationale: Chronic anxiety and stress can exacerbate gastrointestinal symptoms, including stomach discomfort and nausea.
Typical Treatments/Testing: Managing stress through therapy, medication, and lifestyle changes can help alleviate symptoms.

What you can do

For GERD or Peptic Ulcer Disease:

Lifestyle Changes: Avoid foods and drinks that trigger symptoms, such as spicy foods, alcohol, and caffeine. Eat smaller, more frequent meals and avoid lying down immediately after eating.
Medications: Over-the-counter antacids can provide quick relief. Proton pump inhibitors (PPIs) or H2 blockers can reduce acid production.
Consult a Doctor: Schedule an appointment to discuss your symptoms and potential treatments. Your doctor may recommend an endoscopy to confirm the diagnosis.

For Constipation:

Dietary Changes: Increase your fiber intake by eating more fruits, vegetables, and whole grains. Drink plenty of water throughout the day.
Physical Activity: Regular exercise can help stimulate bowel movements.
Over-the-Counter Remedies: Consider using a mild laxative or stool softener if dietary changes are not effective.

For Anxiety and Stress:

Therapy: Cognitive-behavioral therapy (CBT) can help manage anxiety and stress.
Medications: Your doctor may prescribe medications to help manage anxiety.
Relaxation Techniques: Practice mindfulness, meditation, or yoga to reduce stress levels.

General Tips:

Symptom Journal: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
Avoid Smoking: Smoking can exacerbate gastrointestinal symptoms. Consider seeking help to quit smoking.

What you should look out for

Given the severity and persistence of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Severe or worsening pain: If your stomach pain becomes severe or unbearable.
Blood in vomit or stool: This could indicate a more serious condition that requires immediate attention.
Unintentional weight loss: Continued weight loss without trying can be a sign of a serious underlying condition.
Difficulty swallowing: If swallowing becomes increasingly difficult or painful.
Fainting or severe dizziness: Especially if associated with your syncope or seizures.

Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and appropriate treatment.