Question:

I've been having problems with flatulence, loud bowel sounds, and belching for years. I cannot seem to find relief. I've had an upper endoscopy and a colonoscopy with negative results. I don't hurt, but the problems are a discomfort and a little bothersome. Have you ever come across a problem like this?

Answer:

It sounds as if your doctors have investigated a number of possible physical causes for your symptoms and have come up with no culprits. The upper endoscopy ruled out gastritis (inflammation of the stomach) and ulcers. A bacterium called

H. pylori

can cause upper abdominal symptoms such as nausea, pain and belching, but I'd assume that's already been ruled out at this point by bloodwork or your upper endoscopy.

Lactose intolerance can cause gas and bloating, so you might try eliminating dairy from your diet and see if your symptoms improve.

If no physical explanation is found by bloodwork, endoscopy and dietary changes, you may have "functional dyspepsia" (nervous stomach) and/or "irritable bowel syndrome" (spastic colon). Both are disorders in which the root of the bowel problem is not in the stomach or colon but in the mind. They're classic examples of how much mind affects body.

People who tend to worry, obsess, stress and become anxious for whatever reason are the most likely to develop those gastrointestinal conditions.

The way to deal with them begins with acknowledging that stress, anxiety and worry do affect your physical health. Relaxation strategies including meditation, yoga and regular exercise are great stress-busters. Antacids and anti-gas treatments don't generally help much because the source of the problem is elsewhere.

If you're having difficulty sleeping (especially middle-of-the night awakenings), ask your doctor to consider trying a low dose of the old-time antidepressant Pamelor (25 to 50 mg at bedtime); it helps those problems even if you're not depressed. If Pamelor fails, a low dose of Zoloft, Paxil or Lexapro might help.

Remember: The better you feel above the neck, the better you'll feel below.

Mitchell Hecht is a physician specializing in internal medicine. Send questions to: Ask Dr. H, Box 767787, Atlanta, Ga. 30076. Because of the volume of mail, personal replies are not possible.