Dear Dr. Henry,

I need to get some sound ideas together before seeing my local GP again, after having been referred by her for an endoscopy which I had yesterday. My GP is good, and sympathetic, but not greatly conversant with HIV. My HIV doctor, on the other hand, (more an STD man than an HIV specialist), says this particular problem needs to be attended to by my GP.

For the last six months or so I've been suffering terrible stomach pains (bad "indigestion") after eating anything with even the smallest amount of fat or oil in it. The problem began back in 2003, 3 years after I sero-converted and about 1 year before I began ART.

Immediately after the endoscopy yesterday the specialist said he had found nothing wrong! Ulcers I had years ago must have healed very well, because he said he didn't see any sign of them. He said my stomach lining was not red in colour, so I have not had a recurrence of helicobacter pylori, he said. He said I'm just getting older (I'm 55) and people often produce too much acid as they get older & therefore they suffer indigestion. He told me to just keep taking a proton pump tablet (Omeprazole) once a day.

But this is not satisfactory. Firstly, the proton pump tablets only REDUCE the pain I am likely to feel after a normal meal. Secondly, I don't like the idea of having to take Omeprazole for the rest of my life, in addition to the ART. And thirdly, I only get the pain after I've eaten something with a bit of oil or fat in it. For example, if I have a second breakfast instead of lunch, i.e. cornflakes muesli and milk, I will definitely not experience any pain at all during the afternoon.

I don't understand why eating food with traces of oil or fat in it should cause me such pain. At the moment I am eating completely oil-less and fat-less food until the evening so that I can have two glsses of red wine with my dinner. This is because the red wine completely cancels out the indigestion. This is not a good way of dealing with it, but it certainly works. However, even this strategy is not stopping gradual weight-loss.

I need to be able to eat a good balanced diet containing a reasonable amount of oils and fats to keep my weight up, AND not experience terrible pain afterwards.

Have you any ideas?

My ART is: Tenofovir, Lamivudine, and Neviripine. CD4: 456. Viral Load: Undetectable.

Thanks.

Have you been checked for low level pancreatitis, some form of malabsorption syndrome, gall bladder disease, gluten enteropathy? Sometimes an empiric trial of pancreatic enzymes has proven helpful for patients with symptoms like you describe. Repopulating your gut with normal bacteria (ie active culture yogurt on a regular basis) sometimes helps out hard to explain gut problems. KH