<s>[INST] Hi doctor, I have had severe tummy cramps, just under the ribs. For about a month some days I cannot keep any food or drink sown, but other days it is tolerable. I have not been doing much bowel movement and feel constipated, but when I do go it is still soft. At first, it was thought to be GERD, but the medication did not help and has lasted over a month now. My doctor has booked me for an endoscopy to check for gall stones or ulcers. I have not had any pain in the last few days and doing more of BM. Does this mean the gallstones have passed? Do I still need the gastroscopy done? I do not want to do any unnecessary tests. The pain has been pretty severe but at the moment it is not too bad. I am confused. I am currently taking Nortriptyline, Seroquel, Lamotrigine, and Metformin. [/INST] Hi.  It seems you are suffering from acid peptic disease or acid reflux disease. This usually presents with pain in the upper part of abdomen. However, I would like to rule out any evidence of gall bladder stones that can cause pain. If you have any hunger pains, any fullness of stomach or gaseous distension of the abdomen after taking meals, you should go for: 1. Upper GI endoscopy to rule out peptic ulcers. 2. Ultrasound abdomen to rule out gall bladder stones. I would advise you to take a combination of Pantoprazole and Domperidone and to take antiflatulent and antacid syrup like Digene or Gelusil for symptomatic relief. Do not consume any alcohol, as even a small amount of alcohol can precipitate that. There is an infection called H.pylori infection which causes recurrent gastric and duodenal ulcers and such episodes of acidity. So, if during an endoscopy your doctor finds ulcers, he would take a biopsy and rapid urease test done for H.pylori infection and to get it treated. Share my opinion with your doctor before acting upon it. I hope this helps. </s>