Are my gastric symptoms signs of illness anxiety disorder?

Hello doctor,

First of all, apologies for the lengthy query, but I desperately need detailed reassurance and a diagnosis. I am a 42-year-old male with no diabetes or hypertension, etc, and a teetotaller. I had a generalized anxiety disorder, mild depression, and panic attacks six to seven years back and was treated with Sertraline, and I recovered (have slowly tapered it last year and stopped).

I used to get gastritis-like symptoms on and off for the last more than 10 years. I had done endoscopy nine years back, which was normal., abdomen CT five years back which was normal, and annual master health checkup which have been normal till now (last done 8 months before). These flare-ups happen two to three times a year.

I have had a few loose stools (just in the morning and rarely a couple of times a day), grumbling in my intestines, and bloating for the past four weeks, and was given Rifaximin 400 mg, pancreatic enzyme supplement (Enzar Forte), and Rabeprazole 20 mg for seven days. Still, there has been no improvement in symptoms and in fact, after the medicine duration of one week was over, I am experiencing gastritis or stomach ulcer kind of symptoms in my upper abdomen like pain, and bloating after eating, etc, and in the last month, have lost around 2.6 pounds of weight (a bit scared to eat full capacity like before).

The following are my test results:

1. A stool test is normal (one to two pus cells seen and the reaction is acidic), whole abdomen USG (ultrasonography) was normal (just an incidental finding of grade one fatty liver and one to two tiny gall bladder polyps).
2. Blood work: LFT (liver function test), RFT (renal function test), thyroid, and lipid profiles are normal. In CBC (complete blood count)-
3. Hemoglobin was 13.7 mm/Hb (normal range was 13-17 mm/Hb), but they mentioned an alert! Predominantly normocytic normochromic with ovalocytes. Hs CRP (high sensitivity C -reactive protein) - 2.65 (Average risk - one to three), electrolytes are normal.
4. Lipase is 60 U/L (the normal range mentioned is 5 - 51.6 U/L), and Amylase is 80 U/L (28-100 U/L is the normal range).

The following are my queries:

1. Are the elevated Lipase levels a cause of concern, and is something serious like pancreatic cancer being missed to be picked up from the blood work/Ultrasound, etc?

2. What does the alert message in the CBC signify? Is it something to worry about? Since I have not had anything like that during my past annual checkups.

3. Do I need to rule out any serious gastrointestinal issues for my current symptoms or let them settle down?

4. Can I just ignore my stools and live life as usual, for five years now, my depressive or anxiety symptoms started with digestive issues first and they settled down after the SSRI (selective serotonin reuptake inhibitors) therapy for a few months.

5. By nature, I have a lot of health anxiety and if any pain or discomfort appears, the first thought comes of worst diseases.

Please guide.

Hi doctor,

Thank you doctor for the reply.

I have more questions to ask given below:

1. I am already lean with a body weight of 116.3 pounds and in the past month, has come down around 2.3 pounds to 4 pounds. Is this alarming and signifies anything serious? Should I take any digestive enzymes or supplements?

2. For my current gastritis or ulcer kind of symptoms, I am taking Pantoprazole (Pantop) 40 mg in the morning & Sucrafil (Sucralfate+Oxetacaine+ Oxethazaince) syrup at night. Will this heal the condition?

3. During the stool test, the H Pylori antigen test also was done and it came negative. In spite of that, is there any possibility of having an ulcer in the stomach? I do not have any history of NSAID (non-steroidal anti-inflammatory drugs) abuse too.

Thank you.