GI Issues/abdominal discomfort for 3+ months and loss of 30lbs with nothing showing on labs or testing

Medical Q&A [Moderated]
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Hello doctors,
For the past few months I’ve been dealing with some abdominal/GI issues that happened suddenly and so far my doctors have been unsuccessful in determining a cause or solution so I thought I’d try here as I’ve followed BBM for some time. Around the middle of March I had an evening where I started feeling nauseous after taking an ibuprofen on an empty stomach. After that I had a couple days of low appetite and eventually as my appetite returned I would get a very full feeling after eating moderate amounts. This continued for about 4 weeks up and down, having some days of feeling and eating mostly normally, until I visited my primary care doctor. After some labs, the only thing out of range was bilirubin which was only slightly elevated. She also ordered a CT scan which was unremarkable except a moderate amount of stool in my colon and a bit of fluid around my lungs.

I was referred to a GI doctor who started off by treating me for constipation by having me do colonoscopy prep. That was uncomfortable and yielded little results. We then did an ultrasound to check my gallbladder as well as general abdominal area which also came back normal. Since then, I have also had an x-ray of my abdomen, colonoscopy, EGD, and HIDA scan, all of which have come back unremarkable. His next course of action is antibiotics to treat SIBO which I have not been tested for and isn’t very sure that is even the issue.

It’s getting very frustrating. I’ve lost nearly 30lbs since March due to not wanting to eat and concerns about how I’ll feel after eating. It is typically an hour or so after eating when I begin to feel uncomfortable so I don’t really have a good grasp on how much I can eat or what foods. I’ve switched to a low FODMAP diet that hasn’t changed much so far. I’m at a loss and the Dr’s don’t seem to have many more ideas about what to check. My wife has been researching and we may pursue some testing for MALS or other vascular issues. I’m tired a lot, when standing I feel more comfortable if I’m slouched. My abdomen often feels like I’ve been flexing my abs for a long time and can’t relax them. It’s also uncomfortable to lay on my sides or stomach.

I know GI isn’t either or your specialties but if you have any insight I would love to hear your thoughts. If you have no other suggestions either I still appreciate your content and everything you guys offer the community.

Thank you

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Hey there –

Really sorry to hear about everything you’ve been going through here. If you’ve undergone contrasted CT and endoscopic evaluation, that does rule out a lot of issues, but not necessarily all of them. The thought of MALS is a good one, in addition to other abdominal vascular causes as a trigger for symptoms that worsen with/after eating. Other causes of pain in this context can relate to the pancreas and gallbladder, which have been evaluated by your imaging studies.

Unfortunately it’s quite difficult for us to weigh in on cases via the forum at this stage, especially after people have already undergone extensive testing with data, imaging, and other things that would need review.

Ultimately this is best served via a consultation – whether a medical consultation, which can be arranged via the website, and/or a consultation with our dietician. We can’t guarantee we’ll “crack the case”, of course, but are happy to listen and weigh in with any other thoughts.

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Hey Dr. Baraki,

Thanks for the reply. It’s nice to get some confirmation at least about what’s been done so far and what next steps might be beneficial. I assumed this would be a difficult medium to assess much but we’re starting to get desperate for something to show up somewhere or some obscure disorder to look into.

I saw someone ask about consults in a different post so we’re adding that as another option to consider if we feel another opinion may be beneficial.

Thanks again, I appreciate the feedback.

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