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Suggest treatment for abdominal bloating, constipation and acid reflux

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Gastroenterologist
Practicing since : 1986
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My symptoms are bloating, gas, constipation, discomfort in abdominal area. I was diagnosed with IBS several years ago, but this seems different. My sister has celiac disease. I thought I was tested once for celiac and it was negative. Should I be retested as my symptoms seem to point to celiac disease? I thought that I was told if the celiac test was negative that it would not need to be repeated as you would not get celiac?
Posted Wed, 11 Oct 2017 in Digestion and Bowels
 
 
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Actually, IBS is not a disease rather its a collection or clustering of symprtoms.Though there is no gaurantee that if test was normal once you can't have the same disease again but its very unlikely.However a colonoscopy should be done initially as IBS is a diagnosis of exclusion. Only when alll other causes are excluded a patient can be labelled as having IBS.

Detailed Answer:
Hello Dear,
Thanks for choosing HealthcareMagic for your query.

I've gone through your details and I appreciate your concerns.

Most likely you are suffering from irritable bowel syndrome with overlapping problems.Actually, IBS is not a disease rather its a collection or clustering of symptoms of the gut and when despite all possible investigations we can't find any anatomical or structural problem we label the problem as functional and all symptoms are clustered under a name IBS.

Firstly small briefing for Irritable bowel syndrome and why every patient is a unique case when we deal with IBS.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility, and autonomous nervous system dysfunction. The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding, and psychosocial factors.

Some patients have symptoms of unformed stools some have bloating and some may have severe constipation. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.So as seen above every patient is different. Intensity of symptoms in every patient is different as so is the response to medicines and life style change. A patient may respond good to one medication while other patient is totally unresponsive to the same.

Have you ever had a colonoscopy done? After the age of 58, it is recommended that all individuals should have a colonoscopy every 5-10 years. Even if you have had this test in the last 5 years it might be recommended to repeat it.

All symptoms can be interrelated to each other.

See my dear patient its not likely that you have celiac.Once your tests had already been negative for celiac. As expalained above presentation of IBS are very different and there may be bouts of attacks followed by long intervals of relapses.

Initially I'd suggest going for a colonoscopy (it will automatically rile out any inflammatory condition like celiac) if it turns up to be normal then you may have IBS and treatment would be started on protocol.

Treatment would be:
Dicyclomine is an anticholinergic drug. . Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.It would be given to reduce spasms in intestines and would provide you with relief in pain.

Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by the patient with minimal side effects. Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.


For constipation you can take a laxative once daily like laculose before going to bed.

Please discuss all these with your doctor.

Hope I explained to you things in detail. Let me know if I can assist you further.

Thank you!
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for abdominal bloating, constipation and acid reflux 1 hour later
I have had three colonoscopies, most recently in 2014 and to have my next in 2019.
I was diagnosed a long time ago with IBS, but the symptoms I have now are much different and much more intense. My IBS was mainly constipation/bloating, but now I have much stomach discomfort. I didn't have the gas, cramping, bloating like I have now. I have been very uncomfortable for 5 weeks now and feel like I am not getting any better. Gas-x, miralax, Metamucil, culterelle have all not made a difference and actually I feel worse. At times it seems worse after eating and others not. I get some relief with a bowel movement, but my stomach still is very uncomfortable,
 
 
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
follow up.

Detailed Answer:
Hi there my dear patient,
See if there is spasm in intestine you have to take an antispasmodic otherwise no amount of treatmemt would help.
Its not the number of medicines which matters but its the dosage and mechanism of action of a particular medicine which is important.
For eg gases are formed due to constipation.When you are constipated a number of bacterias act on food to ferment it.This fermentation causes production of toxic gases,So unless you deal with constipation gasex won't help.
But initially i would like you to go for following tests-

Small Intestinal Bacterial Overgrowth can be a reason of severe flatulence .
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine, and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestines causing improper and disturbed food digestion.


Tests suggested-
Small bowel imaging and a gastric-emptying scan.
Right now don't go for colonoscopy.Initially go for bowel imaging.
Thanks!
Above answer was peer-reviewed by
 
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