instruction: hello doctor I have been struggling with a lot of upper abdominal pain since six months I have constant chronic pain in my upper right abdomen and chest I was adamant it was my heart but have had all heart tests done and everything is fine except for palpitations they think are from anxiety gallstones have also been discovered but that pain would be on my right side and not on my left the left side pain is unbearable sometimes it hurts to breathe in deep it is very tight there is popping sensations a lot and I really struggle with constipation and then I can have a couple of days with diarrhea I have completely changed my diet and lifestyle given up smoking and alcohol for two months now I only drink water and the occasional green tea have cut out all other drinks I eat clean now and have lost 20 labs in the last two months my bloating has dramatically gone down but the pain has not I have taken so much gaviscon since four months that it does not work for me anymore I have cut out nightshade vegetables gluten unhealthy fats and dairy except for the occasional non fat greek yoghurt in my smoothie the pain is still there I have been to the hospital multiple times and they just say it is gastritis I know I have indigestion problems but I feel like there is something else going on an endoscopy showed nothing wrong just told to continue gastritis medication but the medication does not work the change of lifestyle is also not working any advice on what could be wrong would really help
output: hello I have reviewed your concern thank you for the extensive details I am happy to know there is no sinister problem going on all you are suffering is functional problem you have mixed features of dyspepsia and is and both have unknown causes most of the people have underlying anxiety or depression my recommendations for you would be continue sertraline and propranolol take buscopan as per need if you feel colicky abdominal pain because it can cause constipation if taken frequently take ispaghol husk two teaspoons put in a glass of water keep it for four hours and then drink it to make your bowels regular avoid foods that you think that troubles you most so you have to decide which are those foods for you keep yourself well hydrated take capsule esomeperazole 40 my once in the morning before breakfast take tablet levosulpiride twice per day before meal take ecotec sachet once a day follow up after seven days stress is dyspepsia avoid lying down after meals remain active stay cool and calm chew food well take a small but frequent diet after seven days