Hi XXXXXXX

Thanks for this follow up precision and question. I know the process of getting answers here is more complex because she cannot really provide much information.

Acid reflux is a common cause of abdominal/chest pain and vomiting. It could be the answer here. The reason why I am moving away from a common cause like this is because of the duration of illness and the extensive workup that has not shown any possible pathology. I am assuming that the common causes must have been excluded and we need to think beyond the common causes. This is why I called porphyria. It is not what I would call first if you had said your sister just developed symptoms similar to what you reported. Also, patients withe reflux often present signs of inflammation just above the entrance into the stomach and this is evident on endoscopic exams. Sounds like your doctor didn't mention this.

However, treatment of this condition is straight forward. You may want to try drugs for it and if it is the cause, then you will get relief of symptoms within a week's time. It consist of using a proton pump inhibitor like Omeprazole, avoiding fatty foods, chocolate, coffee, alcohol which aggravate this condition. Also, avoiding lying flat especially after meals. If these fail and the suspicion is still high, then we may want to do a test (24H PH monitoring) to document any possible reflux occurring. Depending on the response to treatment, other options can be proposed if the diagnosis is confirmed.

Honestly, long term problems need a little more patience to get them sorted out entirely. Progressively, let's consider various possible cause once at a time and work towards confirming or ruling out the possibility. In so doing, we either get a response or we are left with a shorter list of possibilities than we started off with.

Hope this helps. Please, you still have the possibility to ask more questions using this same credit that you have paid. Please, don't recharge all the times to ask a new question when you can still actually continue using the previous links. Please feel free to ask me more questions and I will gladly provide answers to them.

Wish you both well as you search for answers to this.
Let me hear from you.
Dr. Ditah,MD

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