The patient is a 16-year-old high school student who is referred to "through not any gastrointestinal problems. Vomiting occurs as a result of the nausea. This has been going for about 3 1/2 years."
This story is complex and complicated.
When the patient turned about 12 she started having nausea and vomiting, which began about 4 days before her period. Her menses were regular until about 6 months ago. Because of the premenstrual vomiting she went on Tigan, Elixir, and Donnatal. This was tried for about 3 months and did not help. Then she was tried on low doses of birth control pills on a regular basis. This also did not help much and she was then switched to Torecan and Pepcid.
Apparently over the last 6 months her periods have become more irregular. In addition, she has had vomiting almost everyday. She says that she vomits up "phlegm" and sometimes vomits yellow bile which tastes bitter. She says that she always feels full and does not want to eat. She has not lost any weight.
She vomits in addition, if she eats spicy food. This also results in heart burn by which she means substernal burning. Also if she eats too much she gets the substernal heart burn. It burns substernally for about 10 minutes. If she takes the antacid right away that helps regularly. The patient herself has had EB viral infections and also pleurisy. Past traumas include a sprained wrist, a tore knee cartilage on the left, and an injury to her left eye during a shoe fight at school which...