What causes subclinical inflammation of stomach and esophagus?

Posted on Mon, 4 May 2015 in Medicines and Side Effects
Question: Hello,

I have been treated for an overgrowth of Candida Parapisilosis in my mouth, throat, nasal passages( due to long term use (5 years) of broad spectrum antibiotics for acne )for about a year and have been treating this with topical Amphitericin B mostly successfully. 8 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects. I fully expected this to subside but I am still having the same nausea and pressure in my esophagus and upper stomach pain (gnawing pain) 8 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No visable sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. A quick stain for esophageal fungal was also negative. I am so miserable....only able to stomach rice noodles and small amounts of liquid and my symptoms never let up. I am 26 yrs old, very healthy and have never had any gastro issues in the past. My symptoms are not affected by any foods. My symptoms do not fluctuate. My diet for years has been eating 100% organic, no meat, dairy, eggs, or gluten. I eat preservative-free, and take a high quality probiotic daily. I have never had any gastro issues until taking Voraconazole. My GI doctor is baffled and has basically told me to get another opinion. I am hoping that you can help me figure this out. Thanks!
Here are my lab results:
Albumin Level-.3
Alk Phos-51
Bili Direct <0.10
Bili Total-0.20
Total Protein- 7.7
Tissue Tran Iga-1
IgA Total-106
Vitamin B-1309
Folate Serum-13.50
Waiting on Vit D but expect score to be within range as I supplement with this
Answered by Dr. Noble Zachariah 4 hours later
Brief Answer:
Subclinical inflammation of stomach and esophagus.

Detailed Answer:

Welcome and thank you for your query.
As you suspect the symptoms of abdominal pain, nausea and chest discomfort are due to the side effects of Voriconazaole. These side effects occur in about 10% of the patients. GI endoscopy may be normal unless there is severe inflammation or ulceration.
You should take a proton pump inhibitor like omeprazole 20 mg twice a day before half hour before break fast/ dinner and be on bland food till you feel fine. This may take about 2 weeks. I am glad that you eat healthy, organic food but avoid tomatoes, orange, lemon and other acidic foods, coffee, tea, chocolates etc till you are fine.
Do get back to me with further queries, if you have any.
Wish you good health
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Noble Zachariah 3 hours later
Thank you for your response and well wishes.
I am wondering how a PPI would help since there was no acid found on endoscopy. I have firmly avoided all acidic foods including the ones you mentioned and stayed on a bland food diet since this happened 8 weeks ago, just in case my symptoms were due to acid.
I would be thrilled if a 2 week dose of PPI would take care of this, but just wondering how this would work.
Answered by Dr. Noble Zachariah 14 minutes later
Brief Answer:
Symptoms start before obvious lesions

Detailed Answer:
Symptoms can occur even when there is subclinical inflammation before it is obvious on endoscopy.
Many of my patients have been benefitted with PPI in such situations. I feel you would also find relief.
Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Noble Zachariah 7 hours later
Hello again,
I'm sorry...I don't understand...My esophagus biopsy showed no inflammation. My symptoms don't fluctuate at all. My diet has been non acidic and bland for the last 8 weeks. I don't have any burning, just terrible relentless esophageal pressure and nausea all of the time and including a gnawing pain in my upper stomach. I would be willing to take a PPI, but would like to understand how inhibiting stomach acid production would be beneficial. Would you please explain the process of how a PPI would work to relieve my symptoms?

Also, my other biopsy results came in...no H Pylori, no Celiac.

Thank you!
Answered by Dr. Noble Zachariah 1 hour later
Brief Answer:
Explanation follows

Detailed Answer:
I understand your perplexity and concern. You have symptoms of gastritis and esophagitis without demonstrable histopathological changes. This is often called functional dyspepsia. Gastric hypersensitivity is often the reason. Hydrochloric acid is always present in the stomach and its amount varies with food and the type of food. Reducing the acid secretion through the PPI would relieve the symptoms. Another drug used is clonidine which is an alfa 2 agonist. It's also an anti hypertensive and didn't want to take the risk of it affecting your BP. PPI is a relatively harmless medicine in the short run. If it doesn't help you may have to undergo pH and manometric studies.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Noble Zachariah 30 hours later
Thank you so much for your very thorough explaination and suggestions.

What is BP?

Also do you have any suggestions as to what I can do to get immediate relief from the extreme nausea that I am experiencing? I can hardly eat a bowl of rice noodles and sip on a small amount of liquid each day. This is such a far cry from the balanced and healthy diet that I have enjoyed my whole life. I am used to drinking 2-3 liters of bottled Icelandic Spring Water each day along with fresh green and fruit juice and smoothies. I am feeling very dehydrated and sick. I have tried the following:
fresh ginger in spring water, organic cola, pepto bismol, baking soda, emetrol with no relief. I am desperate to get over this and get back to feeling healthy again.
Thank you.
Answered by Dr. Noble Zachariah 27 minutes later
Brief Answer:
Domperidone would help

Detailed Answer:
Sorry for using abbrevation , BP stands for Blood Pressure.
Domperidone ( Motilium) would help you get relief from nausea and the fullness.
Relax, continue a healthy lifestyle and manage your stress well.
Wish you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Noble Zachariah 23 minutes later
Thank you...
Do you have any non-prescription, homeopathic, or over the counter suggestions?
Answered by Dr. Noble Zachariah 29 minutes later
Brief Answer:

Detailed Answer:
Unfortunately all prokinetic agents are prescription medicines.
I am sorry I have no knowledge of homeopathy and am unable to make a suggestion.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Noble Zachariah

Internal Medicine Specialist

Practicing since :1974

Answered : 2276 Questions


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