Need some help
I’ve had recurring, sometimes very severe abdominal symptoms since around 2018. The symptoms occur in episodes and are not constantly the same in intensity. Typical features are cramp-like abdominal pain that often starts shortly before or during bowel movements and then temporarily improves afterward. During some episodes, the pain is very intense and is accompanied by cold sweats, strong discomfort, and autonomic reactions. There are often multiple bowel movements in a row with renewed urgency shortly after temporary relief.
The pain location varies: sometimes it is more in the upper right abdomen, sometimes in the lower left abdomen, or more diffuse across the whole abdomen. There is a clear connection with eating, as symptoms often start after meals or become worse after food intake. In addition, I repeatedly notice an oily or greasy appearance in the stool, sometimes even when eating a low-fat diet. Occasionally, the stool is lighter or clay-colored.
Diagnostic workup has included several abdominal ultrasounds of the gallbladder, all of which were unremarkable (no gallstones or clear structural abnormalities). Inflammatory markers in stool, especially calprotectin, have also been normal, so an active inflammatory bowel disease has not been confirmed so far.
Various treatments have been tried. Pancreatic enzyme supplementation (pancreatin) showed only inconsistent or minimal effects. Bile acid binders such as cholestyramine did not lead to any clear or stable improvement. Dietary adjustments, especially low-fat diets, also resulted in only limited changes. Overall, the symptoms have largely persisted despite these measures.
Amitriptyline at low to moderate doses led to a partial improvement in baseline symptoms, especially in reducing constant pain intensity, but it did not fully control the acute pain or cramping episodes.
Overall, the condition consists of recurrent, meal-related, sometimes severe cramp-like abdominal pain with autonomic symptoms, shifting pain locations, and noticeable oily/greasy stools, without any clearly identifiable structural cause so far.
What do you think about it?