Patient B Health History


PATIENT SYMPTOMS (onset 9/2024)

  • Constant dull, diffuse “burning” sensation, roughly a few inches above the belly button, present 100% of waking time.

  • Nausea that fluctuates throughout the day, varying from not at all present (0 out of 10) to fairly intense (7 out of 10). Nausea intensity is unrelated to all of the following: time of day, posture, bowel movements, what foods are eaten, how much food is eaten, posture changes, or dietary fat level. Nausea does not wake the patient up from sleep. The nausea is worse on some days than others, but no pattern has been detected to explain why.

The patient's symptoms cause him substantial suffering. The daily intermittent nausea especially has a very serious negative effect on his quality of life.

No meaningful progress has been made in treating the symptoms or uncovering their cause, despite substantial efforts.

KEY PATIENT INFORMATION

The patient is a male in his forties. Normal weight/BMI. Primarily vegetarian diet. No use of alcohol, tobacco, NSAIDs, or drugs. Exercises 3 times per week. The only health problems prior to this medical problem starting were periodic sinus infections/chronic sinusitis, generalized anxiety disorder (treated with cymbalta/duloxetine), and a propensity not to feel rested after sleep. The patient gets occasional migraines (~every 3 weeks). The patient has always been very prone to motion sickness. The patient's only medications are finasteride (1mg daily) taken for >7 years and Vitamin D3 (4000 IUs daily) taken for >5 years.

The patient had no significant prior infections, food poisoning, or significant GI distress before this problem began (that he is aware of).

KEY POSITIVE (ABNORMAL) FINDINGS

  • Breath tests (11/3/24 & 3/3/25): Elevated methane in breath both when fasting & post-glucose: CH₄ 34–46 ppm (still remains elevated after a full course of rifaximin + neomycin antibiotics).

  • Gallbladder HIDA scan 11/4/24: Ejection fraction 24% (abnormally low, reference range is >35%). But doesn't have classic right upper quadrant pain. Gallbladder surgeon advised against gallbladder removal because of the atypicality of the symptoms.

  • EGD (Upper endoscopy) 9/17/24: "SQUAMOUS MUCOSA WITH MILD CHRONIC INFLAMMATION", "Reactive Gastropathy in the Antrum" and "ANTRAL MUCOSA SHOWING REACTIVE GASTROPATHY." No ulcers, no H. pylori.

  • GI-MAP stool sample testing on 11/2/24 & 12/29/24: High zonulin (286 then 252), low on the following commensurate bacteria: Enterobacter, Faecalibacterium prausnitzii, Roseburia spp,  Bacteroides fragilis

  • Blood tests: Monocytes 11% (vs. 2-8% reference range); vitamin B6 at 27 (high) and then 22 on retest (slightly high)

KEY NEGATIVE (NORMAL) FINDINGS

  • All normal/negative: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), liver panel, pancreatic enzymes, thyroid, cortisol, celiac, ANA, CRP/ESR, lipids, heavy metals, stool parasites, H. pylori, fecal calprotectin

  • All normal: physical exam by gastroenterologist, ultrasound, colonoscopy (including ileum biopsies), brain MRI (with and without contrast), retrograde double-balloon enteroscopy, gastric emptying study, capsule endoscopy, pancreatic elastase-1 

  • All normal: No vomiting, no reflux, no bloating, no diarrhea, no significant constipation (though stool sometimes dry), no weight loss. 

  • Many other normal/negative blood tests (see spreadsheet found here)

  • MR enterography: found a 1 cm polypoid lesion in the small intestines. However, no polypoid was found on retest of MR enterography, nor was it found on capsule endoscopy or during double-balloon enteroscopy.

TREATMENTS TRIED

  • Failed treatments (they had no effect): Proton Pump Inhibitors (3 kinds), Sucralfate, Cholestyramine (bile-acid sequestrant), Miralax (laxative), highly restrictive diet for 2 weeks (just 17 ingredients with no common allergens or causes of food sensitivity), liquid diet, probiotics (Lactobacillus plantarum 299v, Bifidobacterium longum subsp. infantis 35624, Saccharomyces boulardii, Bacillus coagulans GBI-30), rifaximin + neomycin antibiotics, amitriptyline tricyclic (elavil) + PPIs. 

  • The abdominal symptoms neither improved nor worsened when the patient went off anxiety treatment (cymbalta/duloxetine) which he had been on for 3 years prior, though removing cymbalta did cause increases in anxiety

  • Zofran/ondansetron leads to a small, short-lived improvement in nausea symptoms

Details of each test result and answers to any other questions you might have about the patient are available upon request (just contact us by emailing medicalsolutionbounty@gmail.com).