pain in mid abdomen for over two weeks, with a brief hiatus

by D Michael
(Las Vegas, NV USA)

My sister (type I diabetic) has had a dull to sharp pain in an area near/at bottom of rib cage, duodenal area?, accompanied by various degrees of nausea, for over two weeks. Recent pics and ultrasound, negative. Appointment with Gastroenterologist in March. Possible infection? metronidazole 500 mg prescribed, pantoprazole sod dr 20 mg prescribed for pain, ondansetron hcl 4 mg for nausea. None seem to be offering any relief???


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Dear D Michael,

It sounds like your sister might be suffering from a complication of diabetes called Gastroparesis. That is likely the cause of her "pain in mid abdomen for over two weeks" associated with nausea.

Gastroparesis is a condition where the muscle of the stomach that suppose to contract to release food into the duodenum and down the small intestine becomes weak due to the effect of diabetes on the nerves that work the stomach muscles.

Food then tends to remain for a longer time in the stomach, causing a feeling of bloating. Because the food is spending longer than it should in the stomach, bacteria grows and multiply in the stomach, causing irritation and pain, and sometimes foul smelling odour when the person with this condition belches. Is that the case with her?

The food eventually is released and could lead to sudden rise or drop of her blood sugar levels and poor control of her diabetes.

This condition is more commonly seen in those with type 1 diabetes.

It is good that she is already scheduled to see a gastroenterologist in a few week's time (March).

She has been started on some good medications. I would think that she might benefit from a review of her medicines, if possible.

She is perhaps better off with continuing with her pantoprazole, increased to 40 mg daily as well as the use of :

• Metoclopromide, 10 mg Three Times Daily about half an hour before meals. This helps to activate the stomach muscles to contract and get food moving. This medication can be taken by children, but best reserved for adults. I take it that your sister is older than 18. She would also need to check with her doctor that she is not allergic to it.
  
• Domperidone. Again at a dose of 10mg tablets Three Times Daily - is the recommended adult dose. This medication is also a good combination with metoclopromide for gastroeparesis.

She could take these two medications with the pantoprazole as advised above and see if they help.

What about discussing this possibility with your family doctor ... there is no harm in trying them, if agreeable to your sister and her Family doctor.

While gastroparesis cannot be cured, having small regular meals spread over a number of times a day and keeping a food diary to see what seems to trigger it would help.

Hopefully, when she sees a gastroenterologist in March, she would have a full evaluation and perhaps an endoscopy to look inside the stomach to exclude other likely causes of such symptoms like a significant hiatus hernia or stomach ulcer.

Hope this helps.

Please do not hesitate to contact us, again, should you require any further information.

I hope your sister gets well fast.

Dr Omatseye Edema MD MRCGP CCFP MSc DRCOG
Family Physician, Emergency Medicine Practitioner and WebMD
Abdopain.com.

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