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Digestive Disorders

Vomiting uncontrolled

06/23/2008

Question:

My 25-year-old daughter first had a large gastric ulcer (caused by NSAID use) a year ago, was put on proton pump inhibitors, but continued to be in major pain, especially when eating, even though she healed (as proven by an endoscopy). She also had esophageal candidiasis (as proven by the endoscopy) that diagnosed the ulcer. She suffered from gastroparesis for many months (8 or more) and had a duodenal ulcer 3 months ago, about the same time the gastroparesis improved. She`s been tested over and over for h-pylori and all tests and biopsies are negative.

She vomits most of what she eats except for liquids. The duodenal ulcer is healed (proven by endoscopy), but she was hospitalized with incredible throat pain (blisters in her throat, too), asthma, (and eventually a sinus infection) and of course, the vomiting problem. They did lots of GI tests and discovered a duodenal diverticulum. They ignored the throat pain except for giving her heavy pain meds until she was comfortable on vicodin alone.

She runs a low fever (99-99.8) most of the time, and her fingernails often turn purple. She`s lost 20 pounds (looks fantastic since she used to be overweight) unintentionally. Her voice is definitely compromised by this year`s problems. All inflammation markers are slightly elevated, and her calcium and iron are low. (She`s a vegetarian, should that effect things). The latest attempt is liquid carafate before eating. It has reduced the vomiting by 40%.

Can you offer any reason for her inability to keep food down, for the esophageal pain (though the endoscopy showed a healthy looking esophagus) and for the lingering fever? She had two doses of an NSAID before the duodenal ulcer presented. She is a singer by profession and cannot book engagements due to her voice not holding out. The GI doctor is out of ideas. The ENT prescribed Evoxac as well as the carafate and Prilosec. She likes not having to chew gum to have saliva. Any suggestions or clues? (allergist discovered no allergies but confirmed chronic sinus infections). The GI cocktail that is supposed to relieve all ulcer symptoms sends her into incredible pain within 5 minutes of swallowing the stuff (lidocain and something else).

Answer:

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