I wish that I could offer you some insight into the possible cause(s) of your chronic abdominal symptoms. However, it is unlikely that any physician is going to be able to provide you with a specific and accurate diagnosis over the Internet when all of your exhaustive work-ups, and by multiple GI doctors, have, to date, failed to provide a diagnosis.

If you are experiencing frequent diarrhea, constipation, or/and blood in the stool (or dark black stools in the absence of iron supplements), then a colonoscopy is certainly warranted. (Given your already extensive work-up for your abdominal and GI complaints, I am actually a bit surprised that you have not had a colonoscopy already.)

In patients with severe gluten intolerance, even minimal exposure to gluten-containing foods may be enough to cause continued GI symptoms.

I am also assuming that your multiple CT scans, ultrasounds, and abdominal examinations have not revealed any abdominal wall hernias, or a fetal remnant known as a urachal cyst.

If your abominal pain is worse around the time of your menstrual period, then it might also be worthwhile for your gynecologist to consider a diagnostic laparoscopy to rule-out endometriosis. If there is no relationship between your symptoms and your periods, however, then endometriosis is a far less likely diagnosis.

Finally, if no "organic" cause for your symptoms can be identified following a thorough GI and abdominal work-up, you should probably also be evaluated for any psychoemotional factors, such as chronic stress or depression, which may be manifesting as abdominal pain.

Sincerely/ Roebrt A. Wascher, MD, FACS

http://doctorwascher.com

Dear Dr. Wascher,

I thank you for your reply.

Yes, I do agree it is a bit wierd I have not yet had a colonoscopy, but the things I think a colonoscopy would show are Chrons and colitis, both of which, if I can remember from school, are not normally found in a young female, which is why maybe I havent had one yet? I am not sure. In the next few days I will be searching for a new GI doc (just got new insurance) and hopefully I can find a proactive doc this time instead of a reactive one like the ones I have come across these past many years.

As far as the following suggestions you have made:
1 - gluten intolerance: it still baffles me of how I am mostly gluten free now and the pains are more severe and more frequent now more than ever. Maybe this is just some wierd new onset of gluten intolerance (?)

2- The urachal cyst is an interesting thought...would they see that on my one CT scan (I have only had one) if they were not looking for it?

3 - As far as endometriosis, that is interesting too, because my mom and her sister suffered from this and other GYN issues. Would I have to ask for a specific test at my GYN for this? I did recently have a transvaginal ultrasound, but it was normal. (I am in a cancer screening program because of my family history of breast and uterine cancers).

4 - And your last suggestion, the psychoemotional factors - is interesting, because when my parents first took me to my pediatrician as a 6 year year old with these similar symptoms, the doc said I was "stressed", which was so weird because I had a lovely childhood. Although I do find myself stressed more than most, (I just graduated med school!), I cannot imagine my stress being much more than anyone elses...

At my age I just cannot let this go and chalk it up to stress, for it is now just about affecting my ADL. When I was in school it was ok to miss a class or two, but it is not ok to miss a day or two from work here and then...so it is becoming a problem now. And the symptoms are lasting longer and are much more frequent, which are now affecting my social life as well (yoga class, dinner and a movie with friends, etc.)

I do appreciate any other offers of advice/suggestions you may have. Thank you