Ask a doctor on the topic of General medicine

Constant nausea without any findings!

December 16, 2017 | 50,00 EUR | answered by Dr. med. Frauke Gehring

Good day,

Today I am reaching out to you with a very distressing issue.

For the past 4 months, I have been experiencing constant nausea, the details of which are as follows:

- Occurs regardless of the situation (no matter where I am)
- It all started after I had a barbecue with my family, immediately afterwards
- Nausea, no vomiting, categorized as mild, moderate, severe
- Unaffected by meals

Tests that have already been conducted:

- Double blood test
- Urine sample
- Endoscopy
- Double stool sample
- Abdomen CT upper abdomen

The endoscopy showed no abnormalities, but indicated a possible past HP gastritis. HP was ruled out through a stool test, and biopsies of the gastric mucosa did not confirm a Helicopacter infection.

Blood, urine, and abdomen CT were normal. The CT showed an enlarged spleen, which is attributed to a past mononucleosis infection. No intolerances were found, especially no celiac disease.

My primary care physician referred me to the hospital because I have lost a significant amount of weight. Although they could have admitted me, they explained that the results are recent and they would need to repeat the tests. Even the chief physician deemed admission currently unnecessary.

There are 2 potential diagnoses:
1. Functional disorder of the stomach
2. Psychosomatic illness

As a result, I was referred to a psychologist. In an emergency consultation (2 x 50 minutes), they diagnosed:

- Somatoform complex
- Anxiety disorder
- Suspected atypical anorexia

I have been through a lot in recent years, a very painful breakup that I am still not over, the death of my father, and other events that have changed my life. However, I simply do not believe that there is a psychological cause!

Medication-wise, I have taken Pantoprazole, MCP, Domperidone, Citalopram.

Currently, I am taking:

Pantoprazole as needed, Doxepin 2 x 10mg, 1 x 25mg

My question:

- Are there any further meaningful tests that could be done? Particularly a skull CT to rule out the possibility that the nausea is originating from there?

Dr. med. Frauke Gehring

Good day,

First of all, in the absence of gastritis, pantoprazole would be counterproductive as the medication inhibits acid and therefore digestion. It would cause more harm than benefit and also lead to nausea. It is only useful as needed for heartburn, and it only works when given on an empty stomach.

A sensible examination would be a colonoscopy, but only if there were irregularities in the stool (alternating diarrhea-constipation, bloating, etc.). A skull CT would be a pointless high radiation exposure, as there is nothing to expect that would cause nausea. Tumors there only cause countless other symptoms.

Doxepin is a strongly sedating medication. If escitalopram has not helped, maybe Cymbalta or venlafaxine would be more sensible.

A dysfunction of the stomach would be better treated with Motilium, MCP, or domperidone, but it is very unlikely.

Given your stress levels, a psychosomatic cause is very likely. In any case, I would recommend seeking psychotherapeutic support to cope with unresolved traumas. It can only be beneficial!

It might be worthwhile to look for a food intolerance (fructose, lactose, but also sorbitol).

I wish you all the best!

Sincerely, Dr. Gehring