Brief Answer: Problems are due to fungal/bacterial infection Detailed Answer: Hi there, Thanks for your query. Firstly, in order to PINPOINT the exact cause of your problems; give you a SOUND professional advice; and, TRUE VALUE FOR YOUR MONEY, may I request you to kindly provide additional information as follows :- * Since when do you have these problems? * Are there any whitish spots in the throat? * Do you have associated nausea, vomiting, burning sensation in the center of the chest, fullness of stomach with loss of appetite, abdominal bloating; any mucus discharge or blood in the stools? * Have you been getting frequent attacks of diarrhea? * Any weight loss since the onset of the present problems? Nevertheless, pending receipt of additional information, the possible causes- based on the available details- are:- # A bacterial infection (most likely, H.pylori) of the stomach, intestine and the throat with indigestion # Yeast infection (candida) of the mouth, stomach and intestine. In both conditions : bacterial or fungal (yeast) infection, the bad bacteria/yeast in the intestine have overpowered the good bacteria. # Gastro-esophageal-reflux disease (GERD) with associated H.pylori or yeast infection # Post-cholecystectomy syndrome (symptoms due to gall bladder removal) – due to constant dribbling of bile in to the intestine and stomach. You will need to undergo the following investigations:- - Blood counts - Throat swab culture for yeast or bacteria - Stools examination for presence of ova, cyst, bacteria or yeast - Endoscopy to directly visualize inner lining of esophagus, stomach and duodenum - Ultrasound/MRI of abdomen, particularly to focus on pancreas and common bile duct (CBD) for presence of an impacted gall stone in CBD. I recommend that, till the test-reports are received, a course of anti-protozoal drug (such as, metronidazole or secnidazole) + Proton Pump Inhibitors + Pro-kinetic drug + Probiotics + digestive enzymes be started immediately. Once the causative organism is isolated and identified, a specific anti-fungal, antibiotic or anti-H.pylori therapy should be started. You will definitely improve with the recommended treatment regime. Consult your doctor and apprise him of my opinion. I am certain that he will agree with my opinion; order required tests, and- based on the reports- will arrive at a certain diagnosis and prescribe suitable treatment as advised. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. I will be waiting for additional information as requested. Fond regards and have a nice day, Dr. Rakesh Karanwal

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Brief Answer: Information sought is given below Detailed Answer: Hi, The new information has been very useful. You are apparently suffering from severe indigestion, due to either H.pylori, amebic or yeast infection. However, underlying co-existing Post-cholecystectomy syndrome cannot be ruled out. Helicobacter pylori (H. pylori) is a bacteria, commonly found in the stomach. How it reaches the stomach is not known. It weakens the stomach/duodenum lining and make the stomach more susceptible to damage from gastric acids. It also causes stomach inflammation (gastritis), and thereby stimulate the production of excess stomach acid and consequent ulcers' formation. In males, yeast/fungus can be transmitted through oral sex, or ingestion of food contaminated with yeast. Absorption of water-soluble vitamins- particularly Vitamin B1(Thiamine), Folic acid and Vitamin B12- is grossly impaired in chronic indigestion. Also, the bad bacteria in the intestine digest these ingested vitamins. Hence, deficiency of these vitamins results in pins and needles in the body- among others. It is therefore recommended that you: - increase the dose of Flora - Take 2 weeks' course of anti-H.pylori therapy along with a pro-kinetic drug; followed- with effect from Day 15- by Proton Pump Inhibitors for 3-6 months. It may be noted that anti-H.pylori therapy is equally effective in all possible conditions, except for yeast infection. - High DAILY doses of Folic Acid (5mg), Thiamin 100mg and Vit B12 (1500mcg) preferably in injectable form - Add Digestive pancreatic enzymes for at least 4 weeks. If yeast is isolated in throat secretions, a 3-4 weeks' of anti-fungal agents will suffice to eradicate fungal infection. I will be happy to answer further clarifications, if any. Dr. Rakesh Karanwal

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