Mr. Riad was visiting Dubai for business purposes when he developed stomach pain and loose motions. He initially attributed it to food that he may have eaten while traveling. But since pain persisted for the whole day, he visited our hospital to meet a gastroenterologist in Dubai, where I evaluated him. Mr. Riad was an otherwise healthy gentleman in his mid-forties and did not have any other illnesses. He had been having intermittent gastro problems such as stomach pain and cramps, bloated feeling and increased gasses since the past one year. Occasionally he used to have diarrhea that used to last a couple of days. There was no weight loss of fever. In between these episodes he used to absolutely fine.
He had always attributed his gastro problems to indigestion, acidity, and food allergy. He had visited several gastroenterologists in Dubai as well as his home country and he had undergone blood tests, breath tests for H. pylori, an ultrasound scan of the belly and an endoscopy for the stomach. All these investigations were normal and he was told that his gastro problem was related to irritable bowel syndrome. He used to take acidity and pain medications whenever he used to have this gastro problem.
When such a patient with stomach pain and other gastro problems without an obvious cause, visits a gastroenterologist, we look for several possible reasons:
- Pancreatic problems such as chronic pancreatitis: This condition can present with recurrent episodes of upper and central abdominal pain. The episodes can be mild or severe and each episode can last from a few hours to few days. There can be other gastro problems such as vomiting when pain is severe.
- Gallbladder dyskinesia: In this condition, the patient’s gallbladder does not function properly and the patient has pain in the upper and right side of the abdomen associated with nausea and vomiting usually after a fatty meal. It all looks like a straightforward gastro problem like stones in the gallbladder but repeated ultrasound scans show a normal gallbladder and diagnosis is missed. The condition can happen at any age. Diagnosis can be made by a special scan that looks at gallbladder emptying after a fatty meal.
- Microlithiasis: The symptoms of this disease are similar to gallstone disease such as pain in the upper and right side of the abdomen. These patients have very small stones less than 2 mm in size in the gallbladder. These are not always detected on an Ultrasound scan and diagnosis is thus difficult to make. The patient can present with serious gastro problems such as jaundice and pancreatitis. A special procedure called endoscopic ultrasound is needed to pick up these very small stones.
- IBD – Crohn’s Disease: This is a chronic inflammatory condition of the intestines in which segments of the intestine get narrowed and cause the blockage. In its early stages, it can cause repeated episodes of pain and the disease may not be detected by routine blood tests, ultrasound, and endoscopies.
- Cancers: Any cancer of the gastrointestinal system can cause pain. But most cancers have to significantly big in size before they can cause pain. Therefore in a patient who has abdominal pain and cancer is suspected, it is not difficult to detect one. Of course in such cases, one has to undergo endoscopy, colonoscopy and a CT scan of the abdomen because ultrasound cannot detect cancers of the gastrointestinal tract.
Mr. Riad was seen in our clinic for assessment of his gastro problems and initially we also thought that he may be having pain due to gas and acidity. But in his blood tests, we noticed that there was a particular test called eosinophil count that was elevated. When we asked Mr. Riad about this, he said that an earlier doctor had also told him about elevated eosinophils and that it was related either to some food allergy. Since food allergy is very rare to occur in adults, we investigated further. A CT scan of the belly showed thickened areas of the colon and mild fluid collection around the colon. At this stage, we even suspected cancer of the colon. We did a colonoscopy and took biopsies from the thickened area. We also removed some fluid from around the colon with a simple needle under ultrasound guidance. What came out was surprising to all of us. Both the samples showed a lot of eosinophils. It is very uncommon to have eosinophils in these samples. Eventually, after doing a few more special tests we made the diagnosis of a rare gastro condition called Eosinophilic Colitis. After treatment with steroids, the patient improved completely. It has been three years since Mr. Riad was diagnosed to have Eosinophilic Colitis. He uses specific medications when he gets symptoms and gets quick relief.
We believe that a gastroenterologist should evaluate every patient with abdominal pain and other gastro symptoms so that an exact cause can be found. A lot of patients are labeled as having acidity and gas problems and continue taking treatment that does not benefit them.