<s>[INST] A friend of mine has had severe pain just under the sternum, vomiting (including yellow bile ), diarrhea . He experienced just symptoms about a year ago, but it s back and worse. Doctors have taken Ultrasounds, CT Scans, but seem to have ruled out Gall Bladder problems. He s feeling pretty desparate right now, and has had several appointments with doctors, but no answer yet. He has an appointment with a kidney doctor and an internist. HELP!! [/INST] HiT hanks for your query As gall bladder issues are excluded as per your version then its most important now to exclude now gastric pathologies. Two important entities are consistent with symptomatology. One is gastric or duodenal ulcer and another is gastroesophageal reflux disorder (HERD). To exclude gastric or dimensional ulcer the investigation of choice is upper G I endoscopy with rapid crease test to exclude H. pylori infection. To diagnose HERD It's important to measure 24 hr pH monitoring at the lower end of esophagus. To start with pantoprazole tablet 40 mg twice daily before food and modify your treatment after availability of the test results. Another important entity is pancreatitis which should have been detected in USG or CT abdomen, though it will be better to go for serum amylase and lipase assay. Heart diseases should also have to be excluded. Therefore, an ECG should be done at least to exclude them. I think by all theses you will get the answer. Thank you. </s>