Epigastric pain

Patient is 68-year-old female who was suggested to come in to us to evaluate possible food allergies. She states that at the beginning of May 2015 she began having some severe burning sensations in the epigastric region. She then went to a gastroenterologist who diagnosed multiple ulcerations as well as gallbladder dysfunction. She underwent a cholecystectomy and was placed on proton pump inhibitors. She however could not tolerate the proton pump inhibitors and tried various ones. She then was placed on 600 mg of Zantac as well as Carafate for two months time. It did seem to help at first but then she did not want to take so much medications, so she reduced it to half of the dose of Zantac and she continued to have some gagging feelings and nausea, so she stopped completely. She did begin Bio-Kult a natural remedy of digestive enzymes to help with her GI symptoms and it does seem to be helping. She does not take any other medication for this as of now. She does not feel that she has certain sensitivity to foods but that she is interested in finding out if there are foods that are bothering her more than others. She has never had any allergic reaction to foods, itching all over the body, hives all over the body, or trouble breathing due to foods. She has heard of IgG food intolerance test and would like to pursue this; however, I did discuss with her that this is not recognized by the Board of Allergy and Immunology as being an adequate test.

She denies any problems with seasonal allergies causing nasal congestion or eye irritation. She also denies any history of asthma or wheezing. She denies any allergic skin problems. She has had a previous allergy evaluation and she currently is on vespid immunotherapy due to an allergic reaction to a yellow jacket sting. She has been on this for quite some time and goes once a month.

ASSESSMENT:
1. Epigastric pain.
2. GERD with esophagitis.
3. Status post cholecystectomy.
4. Concern for food allergy.
5. History of vespid allergy, currently undergoing vespid immunotherapy.

PLAN:
1. At this time, patient and I discussed the possibilities of testing for any food allergies. She however declined testing today due to the fact that it is not covered under her insurance and would cost a significant amount of money and she does not have the classic symptoms of having significant food allergies.
2. I also discussed with her that we do not honor the IgG food intolerance testing through the Board of Allergy and Immunology as being an appropriate test to identify food allergens. I did however discuss with her introducing FODMAP diet, using low sugars and starches in that category and trying to repopulate her GI tract with healthy bacteria in this manner. I also discussed with her The Gut Balance Revolution book that she could read to help with her future goals of maintaining good GI health. We did discuss that she would like to undergo an endoscopy again to see how her ulcerations are healing and she would like to start there.
3. If there is anything else we can do for patient, she will let us know and we will follow up as needed.

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