Nicki asks:
I have growling and gurgling in my upper and lower abdomen that does not correlate with a specific action or food. I was diagnosed with celiac disease in 2008, but it turned out to be a misdiagnosis. I eat healthy and take care of myself, but I am never completely free of this problem.

Anil Rustgi, MD responds:
Stomach noises like gurgling and growling are typically signs of normal digestion. They can occur before, during or after meals. When the body is hungry, the stomach and intestines begin to contract and release acids and digestive fluids into the digestive system, which causes the noises. The thought, sight or smell of food is enough to trigger the digestive system to act. Sometimes excessive stomach noises can be a sign of irritable bowel syndrome (IBS), but IBS is usually accompanied by other symptoms like bloating, cramping or diarrhea.

To schedule an appointment with Dr. David Ingis, MD, a Penn gastroenterologist who can determine the cause of your symptoms, please call 800-789-PENN (7366) or you can also request an appointment online.

Kelli asks:
My mom is concerned about the following symptoms: lower back and stomach pain, gas, constipation, mucus and blood in her stool. She has diverticulitis, but the pain and symptoms are not going away with medication.

Anil Rustgi, MD responds:
Diverticulitis occurs when diverticula – small, bulging pouches in the digestive tract that are common in adults over age 40 – become infected or inflamed. Mild diverticulitis can be treated with diet changes, rest and antibiotics. More severe cases may require surgery to either remove the diseased part of the colon or to drain the abscess formed by the infection.

Since the pain has sustained over time, I recommend seeing a gastroenterologist. To schedule an appointment with David Ingis, MD, a Penn gastroenterologist who can advise you, please call 800-789-PENN (7366) or request an appointment online.

Cherie asks:
I have been having pain on my right side for about a month that is especially painful at night. In the morning I vomit bile and have diarrhea. I have gone to my primary physician and had blood work done, which comes back normal. I had a laparoscopy done, but now they are sending me to get an MRI. I was given a prescription for Nexium®, but I've had no improvement. The doctors seem baffled. Do you have any ideas?

Anil Rustgi, MD responds:
Right-sided abdominal pain, vomiting and diarrhea can independently indicate a variety of conditions, such as gallstones or gastroesophageal reflux disease (GERD), among others. To schedule an appointment with Dr. David Ingis, MD, a Penn gastroenterologist who can evaluate your symptoms, please call 800-789-PENN (7366) or request an appointment online.

Beth asks:
I have been having irregular bowel movements for the past few weeks along with some sporadic abdominal cramps and frequent, smelly gas. When I do have a bowel movement, it is soft, sticky and hard to eliminate. I haven't changed my diet and I am not taking any medication.

I was diagnosed with GERD four years ago but stopped taking Nexium® five months ago. I am trying to manage it by watching what I eat and using antacids. I've also gained about 10-12 pounds in the past three months. Help!

Anil Rustgi, MD responds:
Trouble with irregular bowel movements can usually be easily remedied by increasing the amount of fiber you consume in your diet, drinking more fluids, and increasing your activity level. Because of your history, I suggest you discuss your case with a Penn gastroenterologist. Please call 800-789-PENN (7366) or request an appointment online.

Staci asks:
I am 38 years old. Three months ago I started having severe stomach pains on my right side. I had a colonoscopy during which my doctor found seven polyps, but he said everything looked good. I was concerned about IBS, but he said I didn't have it. I ruled out gastroenterology problems until I had a laparoscopy done two weeks ago and scar tissue was found on my small and large intestine.

I was told by this doctor he didn't know why I have scarring since I've never had GI surgery. I am still in a lot of pain on my right side, but my doctor wants me to give it time to heal and see if the pain goes away. What could this be? And is it normal to still have this much pain?

Anil Rustgi, MD responds:
There are a number of different problems that can cause pain on your right side, but if you are experiencing severe abdominal pain you should seek prompt medical attention. Some of the pain you're having now may resolve itself once your abdomen is completely healed from the laparoscopy.

Keeping track of your symptoms will help your doctor form a diagnosis:

• When do you have pain?
• Exactly where is the pain is located?
• What type of pain (such as aching, stabbing, throbbing or cramping)?
• How long does the pain lasts?
• What triggers the pain?
• What helps relieve the pain?
• How does the pain impact your life (such as limiting activities or missing work)?

Kashyap Panganamamula, MD is a Penn gastroenterologist who can evaluate your condition and recommend the best treatment. To make an appointment, please call 800-789-PENN (7366) or you can also request an appointment online.

Penny asks:
I have been diagnosed with a floater. My organs are not attached to my abdominal wall. So my intestines float and get twisted up. I would like to know what specialist or who is experienced in this situation to seek medical care.

Anil Rustgi, MD responds:
I recommend you schedule an appointment with a Penn gastroenterologist who can evaluate your condition. Please call 800-789-PENN (7366) or request an appointment online.

Pam asks:
Does your facility have a back-up scope in case the first one malfunctions?

Anil Rustgi, MD responds:
Yes, all of our facilities have multiple endoscopes on hand.

Diane asks:
For the past week, every afternoon for about two or three hours I get bad gas. Also, my intestines are very noisy. Then it goes away and starts up again the next afternoon.

Anil Rustgi, MD responds:
Flatulence — commonly known as gas — accompanied by noisy intestines can indicate a number of causes. These include swallowing air while eating, lactose intolerance, irritable bowel syndrome, malabsorption or simply eating foods that are difficult for your body to digest.

Here are some simple ways to improve your problem by adjusting your daily habits:

• Eat more slowly.
• Chew your food thoroughly.
• Avoid chewing gum.
• Relax while you eat.
• Avoid beans, cabbage, and carbonated beverages.
• Walk for 10 to 15 minutes after eating.
• Drink peppermint or chamomile tea after a meal.
• Try Beano® if you eat a high-fiber diet.

Pinkjade asks:
I made a dish that included pimiento in its ingredients. I had that for dinner along with homemade cheesecake with strawberries. I went to use the bathroom and noticed there were some red objects in my stool. I've had some rectal bleeding before. I do know that I have external hemorrhoids — which I've been told is the cause.

I have become increasingly concerned about the possibility of colorectal cancer. I am a 26 year-old healthy female. I examined the red objects and thought them to be pimiento or possibly strawberries. Four days later I used the bathroom and once again saw this red "thing." It seemed to be the same as what I saw before. Could it be blood? Is it normal to see things you've eaten days ago in your stool?

Anil Rustgi, MD responds:
There are many possible reasons for blood appearing in stool. Some are harmless and temporary, while others may signal a more serious condition. Anytime you find blood in your stool, it is best to see a healthcare provider.

In addition to blood in the stool, hemorrhoids can cause:

• Anal itching
• Anal ache or pain, especially while sitting
• Pain during bowel movements
• One or more hard, tender lumps near the anus

A Penn gastroenterologist can evaluate you and determine if your symptoms are a result of hemorrhoids or indicate a more serious problem. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

D asks:
I was diagnosed with IBS-C spasmodic colon last year. Each month following my menstrual cycle, I have extreme pain, spasms and burning sensations in my abdomen for the next two to three weeks. I take over 800 mg of ibuprofen to cope. I am pain free for about a week and then the cycle starts all over.

I'm 44 years old and I have two small fibroid cysts on my right ovary. Could my menstrual cycle be causing my IBS to flare up and cause me this additional pain for weeks at a time? What can I do?

Anil Rustgi, MD responds:
IBS-C or irritable bowel syndrome with constipation is a common intestinal disorder. The typically smooth and regular contractions of muscles in the intestines are replaced by irregular and sometimes painful contractions. Many women report that their symptoms worsen around and during the time of their menstrual period. It is believed to be the result of heightened hormone activity, but the exact reason is unknown.

Geoffrey Spencer, MD, is a Penn gastroenterologist who specializes in irritable bowel syndrome. To schedule an appointment with Dr. Spencer, please call 800-789-PENN (7366) or request an appointment online.

OnHigh4Him asks:
Is there a permanent feeding tube to the large bowel for persons not able to have the tube in their stomach?

Anil Rustgi, MD responds:
Yes, a feeding tube can also insert into the small bowel. Gregory Ginsberg, MD is a national expert on this procedure. To make an appointment with Dr.Ginsberg, please call 800-789-PENN (7366) or request an appointment online.

Mike asks:
I am an asymptomatic 40 year-old male. However, a recent physical blood test showed an aspartate aminotransferase (AST) in the mid 80s and glycosylated serum protein (GSP) near 270. All other numbers were within normal ranges. (ALP near 60, ALT near 30, CGT near 15, TBIL 0.5mg/dL, total protein 7.5, albumin just under 5.0 and ALB/GLO of 1.8) Are these results worthy of seeing a gastroenterologist, and what, if any, concerns could there be?

Anil Rustgi, MD responds:
Elevated aspartate aminotransferase (AST) and galactose single point (GSP) levels involve enzymes of the liver and can sometimes be an indication of a more serious problem. There are too many potential scenarios to list here, but I recommend getting further testing done.

Karen Krok, MD, is a Penn hepatologist – a doctor who specializes in liver disease. She sees patients at the Perelman Center for Advanced Medicine at the Hospital of the University of Pennsylvania. You can schedule an appointment with Dr. Krok by calling 800-789-PENN (7366) or you can also request an appointment online.

Emily asks:
I had a colonoscopy today that was normal. On the comments, the doctor wrote, "A vascular pattern found in the hepatic flexure, transverse colon, descending colon and sigmoid colon."

Anil Rustgi, MD responds:
Since your colonoscopy was normal, then the vascular pattern found in the hepatic flexure, transverse colon, descending colon and sigmoid colon are not a cause for concern.

If you would like further explanation of the procedure or a second opinion on your findings, you can schedule an appointment with one of our Penn gastroenterologists specializing in colonoscopies by calling 800-789-PENN (7366) or you can also request an appointment online.

Angel asks:
A family member is in his early sixties and has not been able to eat for almost two months. He has a feeding tube because he cannot eat anything without food entering his lungs instead of his stomach. Prior to his eating trouble, he discovered he had suffered from two strokes without knowledge of them at the time. He had an episode of fainting because his blood pressure dropped and soon after that his inability to eat began.

He has visited two different hospitals and been hospitalized for six weeks without an answer. He has lost a significant amount of weight and just wants help. Could you tell me what we should do and who we should see at Penn?

Anil Rustgi, MD responds:
Difficulty swallowing is a condition also known as dysphagia.To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Heather asks:
Do you test and treat for food allergies such as gluten intolerance?

Anil Rustgi, MD responds:
Gluten intolerance is a lifelong disorder also known as celiac disease, an inherited, autoimmune disease. Celiac disease occurs when there is damage to the small bowel from consumption of gluten, wheat, barley, rye and possibly oats. In the small bowel there are threadlike projections called villi, which absorb nutrients from food we ingest. If left untreated, these villi become flattened and can not absorb nutrients properly.

There are several ways to diagnose celiac disease, such as:

• A complete blood count (CBC), which indicates common symptoms like anemia and bone loss.
• Malnutrition.
• Antibody screening tests.
• Small bowel endoscopy, which shows the flattened villi.

The only treatment for Celiac disease involves elimination of gluten, wheat, barley and rye from your diet.

Geoffrey Spencer, MD is a Penn gastroenterologist specializing in the diagnosis and treatment of celiac disease, please call 800-789-PENN (7366) or request an appointment online.

Rachel asks:
My father has pancreatitis with cysts on the pancreas and a blood clot in his lung. He is in severe pain and being treated with Coumadin®, antibiotics and morphine for pain. What is normally the outcome of such severe pancreatitis, and what should we expect along the road to recovery?

Anil Rustgi, MD responds:
Pancreatitis is inflammation of the pancreas – an organ whose function is to release certain hormones and help with digestion. Cysts on the pancreas are a complication of chronic pancreatitis, meaning there is long term inflammation. This inflammation causes irreversible scarring of the pancreas, inhibiting its production of enzymes to digest food.

The treatment for chronic pancreatitis is pain medication and rest. Abstaining from solid food gives the pancreas a break from producing the enzymes needed for absorption, which can help relieve severe episodes of pain. In some cases, surgery is required to remove the pancreatic cysts or to remove dead pancreatic tissue.

Nuzhat Ahmad, MD and Gregory G. Ginsberg, MD are Penn gastroenterologists who specialize in pancreaticobiliary disease. To schedule an appointment with either of them, please call 800-789-PENN (7366) or request an appointment online.

CreativeWriter27 asks:
I've been having a lot of pain on my right side, which a nurse practitioner thinks may be deferred pain from cysts that I have. My ob/gyn doesn't think the cysts are large enough to hurt, so I'm getting another test. Do you think it could be gastrointestinal pain?

Anil Rustgi, MD responds:
There are many different problems that could cause pain on your right side, but if you are experiencing severe abdominal pain you should seek prompt medical attention. Tracking the following information will help your doctor form a diagnosis:

• When you have pain
• Exactly where the pain is located
• Type of pain (such as aching, stabbing, throbbing or cramping)
• How long the pain lasts
• What triggers the pain
• What helps relieve the pain
• How the pain affects you (such as limiting activities or missing work)

Kashyap Panganamamula, MD is a Penn gastroenterologist can evaluate your condition and recommend the best treatment. To make an appointment, please call 800-789-PENN (7366) or you can also request an appointment online.

Ann asks:
Do you perform capsule endoscopies at Penn Medicine at Radnor?

Anil Rustgi, MD responds:
Unfortunately, capsule endoscopies are not done at our Radnor location.

David Jaffe, MD is a Penn gastroenterologist who performs capsule endoscopies at the Hospital of the University of Pennsylvania. Capsule endoscopies are also performed at Penn Presbyterian Medical Center. To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Joelee asks:
I had a G-tube put in two weeks ago. Now I experience mental fatigue and confusion constantly, which gets worse when I use the tube. I have tried varying supplements and amount of food and calorie intake. I've even tried continuous feeding.

My symptoms improve somewhat when the time between meals is greatest and get worse whenever food enters the stomach. I don't understand what is happening or how to correct the problem. How can this be remedied? Are there sub-specialists who deal with such issues?

Anil Rustgi, MD responds:
The gastrostomy tube (G-tube) is a type of feeding tube insertion in which a tube passes through the skin and the stomach wall, directly into the stomach. A feeding tube transports liquid nutrition to the stomach. The G-tube is a more permanent type of feeding tube and is used for many patients that have difficulty swallowing.

Following a G-tube insertion, the stomach and abdomen generally heal in 5 to 7 days. In most cases, pain is managed with medications. If you are taking new medications for pain, check with your doctor about any possible adverse reactions to the medications you are already taking.

Alternatively, the symptoms you describe may be caused by not getting enough nutrition from your feedings or the feeds may be causing the dumping syndrome characterized by sweating, belly discomfort, low blood sugar and diarrhea. Dumping is caused by undigested sugars flooding the small bowel and may occur with highly concentrated feedings being delivered too quickly. Check with your gastroenterologist to ensure your G-tube is functioning correctly and you are using the correct type and amount of nutritional formula.

Penn gastroenterologists are experienced in both the insertion of feeding tubes and care for patients with feeding tubes. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Kimberly asks:
I was diagnosed with a transmesenteric hernia after a colonoscopy and CT scan showed a compression on the transverse colon. I actually saw the bulge on the screen and felt severe pain on my left side when it was pressed during the procedure.

My GI doctor said there's no reason to fix the hernia because it's not obstructing anything. I've had chronic pain for several years – it has been continuous and very bad for one and a half years. Do you think I should just live with it and try to ignore it, or get another opinion?

Anil Rustgi, MD responds:
A hernia occurs when part of an internal organ or body part protrudes through an opening into another area where it ordinarily should not be located. There are many different types of hernias. A transmesenteric hernia is a type of internal abdominal hernia.

These hernias are rare and more difficult to diagnose. Although not all hernias need to be operated on, hernias that cause symptoms or that become larger should be repaired by a surgeon. Significant pain at the site of a hernia can be the first sign that it is incarcerated or strangulated.

A Penn gastroenterologist can evaluate your condition and provide a second opinion. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Kate asks:
I have an issue with bowel movements. Whenever I eat, within 15 to 20 minutes of starting the meal, I have to run to the bathroom. I usually will go 2 or 3 times within the hour. I have had blood work, an endoscopy and a colonoscopy. All the tests came up with nothing. I am a 24-year-old female and this problem is causing my quality of life to suffer. Any suggestions?

Anil Rustgi, MD responds:
Altered bowel movements are usually caused by bacteria, viruses, parasites, certain medicines, food intolerances and diseases that affect the stomach, small intestine or colon. If this is a chronic problem, you should see a gastroenterologist, as this may be an indication of a more serious problem.

If you experience abdominal pain in addition to the symptoms you describe, you may have irritable bowel syndrome (IBS). As many as 55 million Americans – the majority women – suffer from IBS.

Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in motility and bowel disorders, including inflammatory bowel conditions. To schedule an appointment with Dr. Osterman, please call 800-789-PENN (7366) or request an appointment online.

Mel asks:
My mom has a condition where her esophagus is always having spasms. She's had the Botox® injections, with no relief, and also had the esophagus dilated twice and still had no relief. Is there anything else that can be done for this condition?

Anil Rustgi, MD responds:
Esophageal spasms occur when the muscles in the esophagus irregularly contract. This causes difficulty swallowing food or drink and can sometimes cause severe chest pain. The cause of esophageal spasms is unknown, but eating very hot or very cold foods can trigger them, as well as an esophageal disease, like GERD (gastroesophageal reflux disease) or achalasia. Achalasia is a rare motility disorder of the esophagus that can present with spasms and difficulty swallowing. Achalasia can be diagnosed by barium X-ray but the best test is an esophageal manometry which should always be done before considering dilation or Botox® injections.

In very rare cases, surgery can become necessary. The surgery options are a myotomy or an esophagectomy. A myotomy is performed to weaken the contraction of the muscles in the esophagus, whereas an esophagectomy is removal of part, or all, of the esophagus. This is an extreme measure and all other treatments should be exhausted before coming to this decision.
           
I recommend your mom see one of our esophageal specialists – David Metz, MD or Geoffrey Spencer, MD – for further evaluation. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Beth asks:
I have recently been diagnosed with eosinophilic esophagitis (EE) and have been trying to avoid the trigger foods as recommended. However, I have now lost 15 lbs. in a month and still am having chest pains, which was the reason for having the endoscopy that led to the diagnosis of EE. Are foods always the trigger for EE? Do you have anyone on staff who has experience treating adults with EE?

Anil Rustgi, MD responds:
Eosinophils, a type of white blood cell, are a part of the immune system, helping our bodies fight off certain types of infections. When a large number of eosinophils occur in the body without a known cause, an eosinophilic disorder may be present. Many different problems, including gastrointestinal disorders, can cause high numbers of eosinophils in the blood.

• Eosinophilic esophagits  is a recently recognized disorder that is thought to stem from an allergic response to ingested foods. Although an elimination diet is often helpful, many adult patients also require immunosuppressive therapy to reduce the immune response that causes the eosinophils to infiltrate the esophagus. Pediatric patients are sometimes treated with an elemental diet which is often difficult to tolerate. Many gastroenterologists treat EE with swallowed asthma inhalers containing steroids (rather than inhaling the medication as designed for asthma).

Since you are losing weight and still have symptoms, I suggest you consider seeing one of our esophageal specialists – David Metz, MD or Geoffrey Spencer, MD. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Renee asks:
I've had burning and aching abdominal pain for several months. Nothing I take seems to relieve the pain. After evaluating me for less than 10 minutes, my primary doctor claimed it's gastritis and prescribed AcipHex®. I haven't taken the medication because I feel uncomfortable with the diagnosis. Should I see a gastroenterologist?

Anil Rustgi, MD responds:
Gastritis is an inflammation or swelling of the stomach lining. The most common causes are:

• Alcohol.
• Erosion of the stomach lining.
• Infection of the stomach with Helicobacter pylori bacteria.
• Medications.
• Smoking.

In addition to abdominal pain, symptoms often include:

• Indigestion.
• Dark stools.
• Loss of appetite.
• Nausea.
• Vomiting.

Pain is associated with many types of gastrointestinal conditions. A Penn gastroenterologist can properly diagnose these conditions and recommend the best course of treatment. To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

RB asks:
I am at my wit's end with a GI condition that has yet to been diagnosed. I have lost 85 pounds in six months and am in constant pain. All blood work and tests have been negative except for an exploratory surgery which showed an enlarged spleen and accessory spleens (which were removed).

My neurologist thinks I may have Whipple's disease — I have 14 out of the 16 symptoms, including non-epileptic seizures. I am progressively getting worse with weakness, joint pain, memory loss and ability to focus. I have an endoscopy scheduled with Penn Gastroenterology.

Anil Rustgi, MD responds:
An enlargement of the spleen beyond its normal size is called a splenomegaly. Because of its wide variety of functions, the spleen may be affected by infection, cancer, liver disease, parasites and many conditions involving the blood or lymph system. Extra "accessory" spleens are separate from and very much smaller than the main spleen. Failure to remove all of these tiny extra spleens may cause certain spleen problems.

Whipple's disease is an extremely rare condition in which an infection prevents the intestine from properly absorbing nutrients. This disorder primarily affects middle-aged white men, and the onset of symptoms is usually slow. Without treatment, it may be fatal.

An endoscopy is a diagnostic test involving an endoscope (a medical device consisting of a camera mounted on a flexible tube). The endoscope is inserted through the mouth, anus or small incision. A sample of suspicious tissue is removed for testing. Based on the results of your endoscopy, your Penn gastroenterologist will suggest further tests and recommended treatment.

Richard asks:
Is there a connection between having a colonoscopy procedure and then developing a spigelian hernia?

Anil Rustgi, MD responds:
A colonoscopy is an internal examination of the colon and large intestine, using an instrument called a colonoscope (a small camera attached to a flexible tube). The colonoscope is inserted through the rectum and advanced to the other end of the large intestine. Bleeding and puncture of the colon are rare but possible complications of colonoscopy.

A spigelian hernia — named for the Flemish anatomist Adrian van der Spieghel — is located just below the navel, to the side of the abdominal muscles. This type of hernia is relatively uncommon and tends to occur in patients around 50 years of age. This is no known connections between the colonoscopy and a spigelian hernia. In fact, there is usually no obvious cause of a hernia, although they are sometimes associated with heavy lifting.

To schedule an appointment with a Penn gastroenterologist who can evaluate your hernia and recommend the best course of treatment, please call 800-789-PENN (7366) or request an appointment online.

Arthur asks:
I'm constantly bloated. I have irregular bowel movement and there is a lump formed by the left side of my pelvis. What could be the problem?

Anil Rustgi, MD responds:
I recommend starting with your primary doctor. The lump may or not be the result of a gastrointestinal problem. Your doctor knows you best and based on the details of your symptoms, he or she can help diagnose the problem and if necessary, refer you to Penn Gastroenterology.

SK asks:
Last year, I turned 50 and had a colonoscopy. Since then, my stomach is always making gurgling noises – as though liquid is rushing through my intestines. I'm in great shape for my age. Can the colonoscopy procedure stretch or relax your intestines? Could my hormones be causing this? Is there a medical reason to have this checked out?

Anil Rustgi, MD responds:
A colonoscopy is an internal examination of the colon and large intestine, using an instrument called a colonoscope – small camera attached to a flexible tube. The colonoscope is inserted through the rectum and advanced to the other end of the large intestine. Bleeding and puncture of the colon are rare but possible complications of colonoscopy – this is accompanied by severe abdominal pain and rectal bleeding.

It is usually to your advantage to have any gastrointestinal changes checked by a physician. A Penn gastroenterologist can evaluate your symptoms and recommend a treatment plan if necessary.

It is important for anyone over 50 — or younger if you have a family history of colon cancer — to have a screening colonoscopy. Penn gastroenterologists perform this important test at several locations, including Penn Medicine at Radnor. To schedule an appointment, please call 800-789-PENN or request an appointment online.

Ruth asks:
I am experiencing severe pain in the upper abdomen by the sternum area with pain in the back between both scapular muscles. I have a hiatal hernia and GERD. I do not experience GERD symptoms very often.

About two years ago, I had my gall bladder removed. There were only a few very small stones, but my gallbladder was severely inflamed. I am confused as to what is going on inside of me and need direction on where to proceed to find out what is causing this pain.

Anil Rustgi, MD responds:
If you are experiencing severe abdominal pain, you should seek prompt medical attention. Tracking the following information will aid your doctor in a diagnosis:

• When you have pain
• Exactly where the pain is located
• Type of pain (such as aching, stabbing, throbbing or cramping)
• How long the pain lasts
• What triggers the pain
• What helps relieve the pain
• How the pain affects you (such as limiting activities or missing work)

A Penn gastroenterologist can evaluate your condition and recommend the best treatment. To make an appointment, please call 800-789-PENN (7366) or you can also request an appointment online.

Ruby asks:
My nephew has been in the hospital several times with nausea and pain that makes him double over. Doctors cannot find out what is wrong and discharged him again. He has lost 40 pounds in about five months. They removed his gallbladder, but he still has the same symptoms. What can we do?

Roberta asks:
My son is 45 and has been vomiting continuously for months. He also gets hot and cold sweats. He recently had his gall bladder removed but still getting sick – no matter what he eats. Please tell me what we can do.

Anil Rustgi, MD responds:
Pain and nausea are often associated with many types of gastrointestinal conditions. A gastroenterologist can properly diagnose these conditions and recommend the best course of treatment. To schedule an appointment with Penn Gastroenterology, please call 800-789-PENN (7366) or request an appointment online.

Rob asks:
I am having pain on my right side under the rib cage and dry heaving during the night. I've had an x-ray, CT scan, ultrasound, and endoscope done – they could not find anything. Do you have any suggestions?

Anil Rustgi, MD responds:
Nausea and vomiting can be a symptom of many conditions. Pain near the rib cage can suggest a rib injury, but could be one of many conditions. If these diagnostic tests did not reveal the source of your problem, your doctor may consider an MRI (magnetic resonance imaging) test.

To schedule an appointment with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

Brent asks:
I am a healthy 44 year-old male. Several months ago, I developed symptoms of bloating, lots of gurgling (even after eating) and chronic diarrhea. The gurgling seems to be located on my left side slightly above the belly button. I eat healthy food and quantity does not seem to affect symptoms. Any thoughts?

Anil Rustgi, MD responds:
Diarrhea and bloating are usually caused by bacteria, viruses, parasites, certain medicines, food intolerances and diseases that affect the stomach, small intestine or colon. If you are experiencing chronic diarrhea – lasting more than three days – you should see a gastroenterologist, as this may be an indication of a more serious problem.

To schedule an appointment with a Penn gastroenterologist, please call 800-789-PENN (7366) or you can also request an appointment online.

Penny asks:
My mother-in-law has something called a "frozen pelvis." She has had surgeries but nothing relieves the pain. Now she is on TPN and still vomiting.  Is this something you deal with?

Anil Rustgi, MD responds:
A “frozen pelvis” usually refers to marked inflammation within the pelvic tissues, the most common cause being endometriosis. Endometriosis is a gynecological condition that can cause widespread problems, including bowel problems. She should see a gynecologist and colorectal surgeon.

To schedule an appointment with a Penn physician who can evaluate her condition and recommend the best course of treatment, please call 800-789-PENN (7366) or you can also request an appointment online.