Question: Hello,

32 year old male , single , living n XXXXXXX
GERD , IBS for last 12 years , worst in last 5 years.

My weight loss is consistent when my symptoms are bad. gaining weight seems impossible and i stress over my unintentional weight loss (same thing for last 5 years , on and off) , now i am 55 kg hight is 5 ft 6 inch.

My sleep is disturbed due to discomfort in the upper stomach (from below ribs to little low) and the pressure in chest at time.
gargle like sound in tummy , always bloated , sometimes dizzy and weak.
not able to sleep for more than 5 hrs a day , due to the stomach disturbance .Sweating at night sometimes.
I feel hunger pangs easily and i am really weak unles I dont eat anything.
I am trying low fodmap diet , but i guess i made it worse my trying to have too much of lactose free milk (250 ml per day) and chicken (250 gms per day) (the fat in chicken leg pieces)

My question:
1) Can I take digestive enzymes ? I feel i cant digest fat .
2) Is low fodmap worth it?
3) How to know i am not having low HCL in stomach and dont need acid supplements? can i get diagnosed for it?
4) How to balance the bacteria of my stomach. VSL3 I am not sure anymore.
5) I dont find any dietitian in XXXXXXX who understands my problem , do you suggest any sort of help with my food habit.
6) I feel I have problem with fibre and fat both . At the slightest i start passing smelly winds ,my stomach bloats and pass lumpy stools. And my weight reduces , and all my discomfort centres around my upper stomach . And the worst is I cant sleep due to the discomfort. On a temporary basis , can i take any sedative to sleep? Any muscle relaxant or anti depressants?
7) I am trying to stop PPI and 2 and half years is already way too long. I am scared of developing tumor . Please tell if i can try any alternatives.

Please let me know what can i chew on when i am hit by hunger pangs?

And suggest anything that help me live better :(

Hello Klerida ,

Let me thank you 1st , how nicely you have replied to all my queries with patience .
Somehow in XXXXXXX , the doctors dont want to use any medical terms with patients , it is only about listening to symptoms and prescribing . It gets concluded as "its IBS , you have to deal with it" .
Diet suggested is "no alcohol , cofee , fried food " and thats about it .

Anyways :)

My symptoms were pretty much same 5 years back also. I would pass smelly wind and some noise in stomach , and lumpy stool. And my weight will be reducing .
Early morning i would wake up with pressure in upper chest . If I am not on any anticids or any acid reducing medicine , i will start having heart burn in 4 to 5 days of no medication.
All these symptoms almost vanish if i start taking PPI , and not many complains.
When i was on PPI for 2 nd half years without any miss , i got back my weight from 53 kg to 60 kg.

And when i am not having enough motion , i have lower back pain at night which again vanishes as i start moving.

But if my food is bad in the day or night , early morning there will mild to severe discomfort in my upper tummy , from below the ribs to little low. And That discomfort is there only when i am lying on bed , if i sit up and stand its gone. As a result I am sleep deprived. This discomfort go with PPI also.But happens only with over eat or bad food (too many eggs , fatty stuff , lot of meat at night)

In last 8 years i have gone through endoscopy 5 times , and 2 times colonoscopy.
The 1st endoscopy found out H Pylori , i was medicated , 3rd also again H pylori.
The last dignosis from endoscopy was that I have dyspesia , they could not find out any other issues. There was a CT scan done 2 and half years back , same result. Once i was tested for TB as there were some infection found through Endoscopy , report came negative so it was "non specific mild ulcer "

I didnt want to consider the sugery or the manometry test as of now for GERD. As its not just acidity , i have severe indigestion issue , which cant be fixed by operation i feel.What do you say?

>> Yes you can take digestive enzymes like Creon. It will help to improve digestion and food absorption.
But firstly you need to do upper endoscopy plus biopsy of the duodenum to rule out Celiace disease.

Do u think i still need to get one more endoscopy right away?
Creon , what is the dosage like? and how long can one take it without any severe side effects.

>>.I can't explain the reason why Fodmap diet worsened your symptoms.
I am not used to milk , last few days everyday 250 ml of lactose free milk and chicken leg pieces (with fat in it) might have made it bad. I have always seen any creamy fatty stuff is my worse enemy . The symptoms come after 1 to 3 days of consumption and remains there .

>>with regards to low HCL , yes you can be diagnosed by testing a sample of stomach secretion. it will measure how acid is your stomach secretion.
What is this test called ? As PPI does improve my condition , do u think this is a possibility?

>> Hydrogen breath test to rule out ? confirm SIBO
Last month without the test i was medicated with Rifagut dosage and the issues didnt quite improve much .

>>Gastrointestinal disturbance like malabsorbtion may be related with sleep disturbances. to my opinion you can satrt to use sedatives like melatonine on bed time.
I will take melatonine after dinner?
Fructose , gluten lactose , theer are so many mal absorption theories are there and on top of that my GERD issues , so diet is really tough job. And the fat absorption is such a problem for me . DO you suggest any dietician ? sadly i dont have much hope on local dieticians :( .

Can i get B12 over dosage if i take injection on per week again?

Thank you again for listening to my questions and not reducing it to few "brief answer" .
I feel too lonely with my IBS as none understands how frustrating , embarrassing it is.
Thanks & Regards XXXXXXX

Hello Doctor ,

Thanks for the reply.

Does PPI give relief to symptoms caused by low acid production also?

>>measure digestive enzymes in pancreatic juice.
Is there any name for the test ? I am planning to go to a pathological centre and ask for the tests without any prescription . so any more specific info?

Can Creon cause further unwanted weight loss? Google is confusing with so many information. Should I have the tablet after meal? I amalready 55 kg (5ft 6 inch) , so little concerned about weight.

And over the counter what do you think of my PPI usage?
Do you also suggest manometry test? I am being too dependant on PPI , atleast twice a week one nexium 20 , so worried about its long term side effects. What is your thought in this?

Thanks & Regards XXXXXXX

Hello Doctor ,

Thanks for the reply.

1) Can I use Creon occasionally when i am eating outside , fatty , creamy or fried stuff only and not on a regular basis? The dosage says everyday 3 times .

2) I am trying to reduce PPI as I am way too dependant on this medicine . Can I take b12 injection every week once?Scared of B12 and calcium deficiency due to PPI .

3) Lactaid , Beone , are they good if I wanna take occasionally .

Thanks & Regards XXXXXXX