Brief Answer:
Further evaluation and treatment with prokinetic agents are needed

Detailed Answer:
Hi,
Thanks for posting the concern. As I can understand from the concern posted, the patient is a young male, with a diagnosis of gastritis, who has been having repeated vomiting and belching. No ulcer was noted in the upper gi endoscopy. I will try to help you find a solution to the problem.

Firstly, the history supports a provisional diagnosis of non ulcer dyspepsia. A detailed clinical examination and investigations are needed to confirm the diagnosis.
I would first suggest some general measures -
1. Avoid alcohol, tobacco of any form, carbonated beverage, sweetened drinks.
2. Avoid lying down within 2 hours of a meal, lunch or dinner
3. have plenty of oral fluid, preferably 3 5 lit a day. For each episode of vomiting, additional 150 to 200 ml of ORS should be taken
4. Avoid fasting more than 4 hours during day time. Avoid late dinner.
5. Eat small amount of food at 2-3 hours interval, avoid large meals. A Mediterranean diet may be tried. It has several other benefits.
6. Regular exercise of one hour is needed.
Now, he also needs some investigation apart from conaulting a gastroenterologist.
1. Complete blood count, serum electrolytes, urea, creatinine, LFT, amylase, lipase
2. Fasting sugar, fasting TSH.
3. USG whole abdomen
4. Urine Re
Thirdly, you may continue nexium or any other pantoprazole or other ppi compound. However a prokinetic agent should be consumed alongwith. It may be Tab Domperidone 10mg or Tab Levosulpiride 75 mg one tablet before breakfast. Combinations are also available.
The patient also needs to avoid stress.
For intractable vomiting hospitalisation may be needed. He may also have Tab Zofer MD 4 mg sublingual 8 hourly for 1 to 2 day(s) to stop vomiting.
I hope you have got the answer of your question.
For any other information, please write back to me directly.
If you are satisfied with the answer, please close the thread and rate my answer.
Regards
Dr Kaushik Sarkar

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