What Causes Upper Abdominal Pain And Vomiting After Having Meals?

Posted on Wed, 19 Mar 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 19 Mar 2014 Answered on

Tue, 8 Apr 2014 Last reviewed on

Question : My 15 year old grand daughter has been at Chocs hospital for 1 week now with upper abdominal pain and vomiting after each meal. The vomiting (or almost like spitting up) after each meal started about 6 weeks ago. Vomiting occurs anywhere from 10-30 min after meal. She can be sitting or standing or walking and food just comes right up. She is hungry most of time, so she wants to eat. She tolerates a bland diet better then regular food. She has had an endoscopy and colonoscopy done. (Test and biopsies were normal) She also had a test where she swallows some white substance followed by a series of xrays. (Normal) She also did test where they put XXXXXXX in food and xray her while lying still for 90 min. (Normal) She had celiac disease test done, (Normal) so far all test have come back normal. Today they sent a psychologist to see her. They say it can be stress related. We don't think it is that. What else can it be. They don't want to release her until she can keep food down. GI Dr. says she can have anything she wants to eat but the more she eats the more vomiting she does and this is really hard on here. Please, do you have any idea what it can be? Or have any other suggestion? We are desperate for some answers. By the way she also has JRA, diagnosed at 7 years. it has been inactive for 2 years now, but was still taking Naperline or Naproxex as needed for pain. Her last dose was approximately 4 weeks ago.

Answered by Dr. Deepak Kishore Kaltari (1 hour later)

Brief Answer: Possibly due to Gastroesophageal reflux Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day As she is 1 hungry even after vomiting is a good sign, implying her appetite is preserved and there is no generalised sick feeling. Let's analyse her complaint Differential diagnosis depends on whether herVomiting is bilious or non bilious ( no bile ). From the description given by you it appears to be Gastroesophageal reflux which is likely cause of vomiting especially if the vomiting is without any bile in it and is not projectile/forceful. As the upper gastrointestinal contrast (whitish material is contrast barium) is normal it rules out any significant obstruction in upper gastrointestinal intestinal tract. I would suggest the following possibility which could explain her vomiting 1. Gastroesophageal reflux: it appears to be more likely cause 2. Malrotation: Malrotation of Midgut could also cause vomiting especially if the vomiting is bilious. Diagnosis requires assessment of location of Duodenal Outlet On Contrast study. Also Ultrasound abdomen will reveal whirlpool sign. 3. Urinary tract infection: Urinary tract infection can also present with repeated vomiting. Urine routine and microscopy examination will rule it out. 4. Electrolyte imbalance: Electrolyte imbalance can also present with repeated vomiting. In my clinical practice, In majority of cases the cause has been found out by thorough clinical examination, assessment and investigation. I would suggest you to discuss these possibility with your attending Physician fo further management. In case you require any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric Surgeon

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar