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Suggest treatment for abdominal bloating and heartburn

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Posted on Fri, 5 May 2017
Question: (1) I have had stomach bloating for 5 weeks now. In that time period I lost 20 lbs because any food (even water!) causes severe bloating, pain in the upper abdomen (I feel like stomach is pushing into my diafragm). My diet is very limiting now - chicken broth, avocado, soft boiled or poached egg, gluten-free chia-seed bread, carrot juice. Occasionally I eat bananas, dates or oatmeal (but they seem to slightly worsen conditions).
(2) I've had intensifying heartburn over the past year. Sometimes it was so strong that it felt like a heart attack. It improved significantly since I went onto a diet, but I still sometimes feel pain in my esophagus and was unable to identify what's causing it (despite keeping a very detailed diary of all foods I eat).
(3) Most of the time I feel like food is stuck in my throat. When I swallow, I can feel and hear fizzing in my throat (as if I am quenching stomach acid with alkaline saliva!). However, I do not taste acid in my throat.
(4) I have a lot of gases - I often hear the gargling sound inside my stomach and burp after the meals.
(5) My stool is more or less regular (every day or every other day). Flaky and orange in appearance (even when I don't drink carrot juice).
(6) My vitamin D level has been low for the past two years, and had declined even further despite taking daily supplements along with omega3.
(7) I have had a severe hair loss over the last 1.5 years.
(8) I have always had a very high cholesterol level (around 300).
(9) I had been taking 5-HTP, 100 mg (one of the side effects of which includes bloating) to treat insomnia for a prolonged period of time, before the onset of the stomach issues.
(10) I had also been self-treating myself with omeprazol way too often over several years, so it lost its "power" or possibly even caused some harm?
(11) I tried both - baking soda (which has helped to relieve bloating in the past) and apple cider vinegar (which seemed to improve digestion in the past). I don't think they make any difference now.
Here are the tests I have done so far:
- Barium swallow without CINE
- Liver panel
- Pancreatic enzymes
- Breath test for H. pilori
- CBC
All of these tests came up normal. (I have endoscopy and colonoscopy scheduled in about two weeks.)
Any idea of what is the possible root cause of my symptoms and what is the best way to alleviate the symptoms?
doctor
Answered by Dr. Antoneta Zotaj (2 hours later)
Brief Answer:
Some tests recommended and advises given

Detailed Answer:
Hello,
I carefully read your question and understand your concern.

It is good you have done those tests and I am glad you have scheduled an endoscopy of the stomach and colonscopy to be done soon. These tests will check the mucosa of your oesophagus, stomach and bowel and see if there is a specific cause of the symptoms.

It is good news CBC is normal and test for H.Pylori is negative. I don't see any results of sugar tests. I would expect you to have those done already but in case not I would recommend you to have it checked.

Some other tests I would recommend is stool tests for ova and parasites, stool culture, tests for gluten intolerance, and stool examinations for fat and leucocyte presence. These will try to rule out some other causes of problems with bowel and stomach. Oesophagus PH monitoring might be a good test to document the presence of acid in the oesophagus and verify that it might be causing some of the symptoms. TSH might be a good test to do routinely if you have not had it done before. Some food allergy tests and intolerance might be good to consider if all tests come out normal.

1. Omeprazole is a good treatment for acid in the stomach and it does not generally cause loss of effect with time. Anyway I would recommend you to try Lansoprazole (is in the same family with omeprazole but is believed to be a little more effective) regularly every day for a few weeks (not sporadically)- this would give time for the mucosa to heal in case there is some local irritation.
2. Take frequent small amount of food during the day and do not eat the last 3 hours before bed time at night.
3. Lift the head of the bed with bricks to keep your head a little higher (do not use extra pillows as this would hurt the neck).
4. Avoid spicy, fried and fatty food. Take fruit and vegetable daily. Avoid milk for a while and see if any difference (yogurt should be ok).
If you smoke or use alcohol this is a very good time to consider to quit.
5. When you have the results of the test and would like another opinion i would be very glad to answer to your questions.

I hope this is helpful and answers to your question but please feel free to write back if anymore clarification is needed.

Kind regards

Antoneta Zotaj, MD
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Antoneta Zotaj (17 hours later)
Thank you for your reply. I have had actually been on omeprazol before these symptoms worsened. I suspect prolonged use of omeprazol might have had something to do with this as some of the side effects described by the manufacturer list, stomach blitheness and nausea, so I stopped using it when my symptoms worsened. I also tried twice to go back to it for several days, but it made bloating worse.
Also I have already been following your recommendations.
No, I have not done any blood sugar tests recently. (1) Why do you think it might be important? (so that I can approach my primary care physician to request this test).
(2) What are your thoughts on 5-HTP being a possible cause? It is meant to suppress appetite and make you feel full. I have been taking it for a long time. Its side effects are inline with my symptoms.
(3) Also do you see any connection with low levels of vitamin D and hair loss in relationship to the gastrointestinal issues, or do you think these are separate issues? (4) Can it be explained by possibly low levels of bile (also the orange color of my stool)? Even though my liver panel was normal, there was a significant drop in ALT levels compared to historic data, and its level (19 U/dL) is close to the lower limit (15 U/dL).
(5) Shall I consider taking ox bile as a supplement? (Note: I have already taking digestive enzymes with every meal).
Thank you.
doctor
Answered by Dr. Antoneta Zotaj (4 hours later)
Brief Answer:
Specific answers for the questions- please see below

Detailed Answer:
Hello,
Thank you for the reply, they are all very good questions.

It is true that long term use of omeprazole can in rare case cause a condition called atrophic gastritis and in this case symptoms might get worse, it is the endoscopy that will definitely say if you have developed this or not.

5 HTP is a sleep medication but is not first line and as you have already checked can also cause some problems with sleep. There are other options for treating sleep problems. This is a condition that needs a step by step approach but shortly sleep hygiene, different relaxation techniques, cognitive behavior therapy, and medications like Zolpidem and melatonin receptor blockers are first line.

Stool color can be caused by some food also like if you consume a lot of carrot. Lack of bile is also a cause as when you have problems with absorption in the bowel it also affects the absorption of bile also and they come out in the stools and cause orange color. So the same condition causing the bowel problems might be causing the issue with the bile. Liver tests you mention are in normal ranges. Finding the cause of the symptoms and treating it specifically will help with this also. Enterogernmina are good as they stabilize the bowel flora and help with some symptoms.

I don't think the vit D levels are directly causing the problems you are having but bile is important for absorption of fat soluble vitamins like A D E K so that is very likely that if you have low bile due to not well absorbing them in the bowel that it might be also causing some of vit D deficiency also and if this is the case you might also be at risk of A E K vit deficiency also.

Sugar test is recommended to be done routinely every 5 years in every patient over 35 years of age as a routine medical care. If you have never done it, would be good. Also rarely diabetes can cause problems with the nerves in the stomach and bowel and cause some symptoms related to this also.

I hope this is helpful and answers to your questions and is helpful but please let me know if anymore clarification is needed on this.

Kind regards

Antoneta Zotaj
Above answer was peer-reviewed by : Dr. Kampana
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Dr. Antoneta Zotaj

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Practicing since :2004

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Suggest treatment for abdominal bloating and heartburn

Brief Answer: Some tests recommended and advises given Detailed Answer: Hello, I carefully read your question and understand your concern. It is good you have done those tests and I am glad you have scheduled an endoscopy of the stomach and colonscopy to be done soon. These tests will check the mucosa of your oesophagus, stomach and bowel and see if there is a specific cause of the symptoms. It is good news CBC is normal and test for H.Pylori is negative. I don't see any results of sugar tests. I would expect you to have those done already but in case not I would recommend you to have it checked. Some other tests I would recommend is stool tests for ova and parasites, stool culture, tests for gluten intolerance, and stool examinations for fat and leucocyte presence. These will try to rule out some other causes of problems with bowel and stomach. Oesophagus PH monitoring might be a good test to document the presence of acid in the oesophagus and verify that it might be causing some of the symptoms. TSH might be a good test to do routinely if you have not had it done before. Some food allergy tests and intolerance might be good to consider if all tests come out normal. 1. Omeprazole is a good treatment for acid in the stomach and it does not generally cause loss of effect with time. Anyway I would recommend you to try Lansoprazole (is in the same family with omeprazole but is believed to be a little more effective) regularly every day for a few weeks (not sporadically)- this would give time for the mucosa to heal in case there is some local irritation. 2. Take frequent small amount of food during the day and do not eat the last 3 hours before bed time at night. 3. Lift the head of the bed with bricks to keep your head a little higher (do not use extra pillows as this would hurt the neck). 4. Avoid spicy, fried and fatty food. Take fruit and vegetable daily. Avoid milk for a while and see if any difference (yogurt should be ok). If you smoke or use alcohol this is a very good time to consider to quit. 5. When you have the results of the test and would like another opinion i would be very glad to answer to your questions. I hope this is helpful and answers to your question but please feel free to write back if anymore clarification is needed. Kind regards Antoneta Zotaj, MD