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November 2000

Q. After eating a hamburger and getting sick I have not felt the same since. For the past 3 years I've had nausea that comes and goes throughout the day. This nausea is quite debilitating. I also get stomach pains. I've had numerous tests done and all seem normal according to my doctor. They did tell me that I have a B12 deficiency (I had to take shots once a month for this) and also an enlarged liver with fatty deposits (I don't drink and never have). The doctors are unsure why. I am taking Motilium 10 mg. 3 x a day which seems to help the nausea somewhat. The specialist says it isn't gastroparesis as I did have a gastric emptying study done. Is it possible that the tests are not conclusive? With gastroparesis being inconsistent is it possible the testing missed it? How accurate is it? I've also had a pancreatic attack. Once again I was told that my gallbladder is okay and they have no idea why I have the stomach pains or nausea. Any ideas on what this could be or where I could be looking for some relief? Any help is appreciated.

A. There are many causes of nausea. Although it seems extremely coincidental that your symptoms began after a bad experience 3 years ago, (? food poisoning then). Food poisoning really should not cause chronic nausea, although it is not uncommon to get lactose intolerance following such an illness. Lactose intolerance usually presents as abdominal cramps, gas and diarrhea after consuming dairy products. Your symptoms do not resemble this disorder.

Due to your diagnosis of Vitamin B12 deficiency, one has to consider atrophic gastritis (inflammation of the stomach) or a malabsorption disorder of the intestine, both of which may cause nausea, although there is usually diarrhea with malabsorption. The fatty liver is probably an incidental finding. It is very unlikely that you have gastroparesis (impairment of stomach motility) with a normal gastric emptying study. If not done already, I would recommend a Schillings test which can help distinguish between stomach vs. intestinal disorder. Also, if an upper and lower endoscopy, and small bowel series have not been performed yet, I would advise this be considered. Treatment with an acid blocker such as Zantac or Aciphex may be very helpful. Domperidone (Motilium) may also be very helpful as may be Reglan.

I suggest you follow up with your gastroenterologist and consider psychological evaluation, as anxiety and various other disorders may cause nausea as well. Less likely is a central nervous system disorder that may cause nausea. If the GI work up is normal, one could consider checking a CT scan of the brain. Also, you mentioned you "had to take B12 shots"; generally, once you have B12 deficiency, you have to stay on life long monthly B12 injections. You may want to get another B12 blood test level done.

Good luck.

Ref: Am J Gastroenterol 1997 Jun;92(6):976-80 CITATION IDS: PMID: 9177513 UI: 97320662

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