Chronic Epigastric Pain with Gastrointestinal Symptoms in a Young Woman

Case at a Glance

A 23-year-old female presents with a 2-year history of severe, constant epigastric pain described as raw and burning, accompanied by gastrointestinal symptoms including loose stools, mucus in stool, and persistent tongue coating.

Patient's Story

The patient reports severe upper abdominal pain localized to the epigastric region, directly under the ribs in the midline. She describes the pain as feeling like 'a raw open wound' with constant bubbling and popping sensations. The pain intensity varies but is continuously present and does not correlate with food intake. The symptoms began approximately 2 years ago, occurring 3 months after breast implant surgery. Additional symptoms include excessive gastrointestinal sounds, mucus in stools, persistent tongue coating, and general body discomfort. She has daily bowel movements that are soft and poorly formed.

Initial Assessment

Physical examination revealed a 165cm, 55kg female appearing distressed due to chronic pain. Vital signs stable. The patient has implemented significant dietary modifications, eliminating sugar and alcohol for 2 years while maintaining a healthy, balanced diet. No other significant medical history except acne. No current medications.

The Diagnostic Journey

Multiple primary care consultations have been conducted without definitive diagnosis. Extensive workup included: multiple blood tests, stool examinations, screening for diabetes and autoimmune conditions, and treatment trials for gastric acid disorders and suspected fungal overgrowth. Functional medicine consultation was pursued. Breast implant removal was performed due to concerns about possible correlation with symptoms, which resolved associated fevers and vaginal infections but did not improve the primary gastric complaints. Endoscopic evaluation has been repeatedly declined by primary care providers despite patient requests.

Final Diagnosis

Chronic functional dyspepsia with possible small intestinal bacterial overgrowth (SIBO) - pending further gastroenterological evaluation and endoscopic confirmation.

Treatment Plan

1. Urgent gastroenterology referral for comprehensive evaluation and endoscopy 2. Consider upper GI series and hydrogen breath testing for SIBO 3. Symptomatic pain management with proton pump inhibitors and antispasmodics 4. Probiotic therapy trial 5. Dietary consultation for elimination diet protocol 6. Psychological support for chronic pain management

Outcome and Follow-up

Patient continues to experience significant functional impairment due to persistent symptoms. Treatment response to antifungal therapy has been minimal. The temporal relationship between breast implant placement and symptom onset, along with partial symptom resolution following implant removal, suggests possible immune-mediated or systemic inflammatory etiology requiring further investigation. Ongoing advocacy for specialized gastroenterological care is essential for proper diagnosis and management.