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What Does Intermittent Nausea Indicate Despite Normal HIDA Scans And GB Ultrasounds?

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Posted on Thu, 26 Oct 2017
Question: I have had nausea off and on (more on) for the past several years. It's not any of my meds because I have done without one at the time and the sx's persist. HIDA scan and GB ultrasounds have been normal. Blood work is normal. What COULD it be? I am scheduled to have an abdominal US in the morning. My GI doc thinks it could be my gallbladder... ??
doctor
Answered by Dr. Ramesh Kumar (1 hour later)
Brief Answer:
Dyspepsia.

Detailed Answer:

Dyspepsia, in layman's language is known as indigestion. It is a term that describes discomfort or pain in the upper abdomen. However, it's not a disease in itself. Dyspepsia is a group of symptoms which often include vomiting nausea and other gastroc problems.
Take a proton pump inhibitor like Esomeprazole 40 mg once daily along with anti nausea medication zofran 4 mg thrice daily. This will provide you symptomatic relief from symptoms.

Any over counter probiotic should be taken for few days to provide relief in symptoms of indigestion.

Apart from this, some dietary restrictions are to be followed-

- Avoid alcohol or smoking.
- No aerated beverages.
- Take light non spicy easily digestible food for few days.
- No Fast food like pizza or burger should be taken.
- Drink a cup of cold milk daily.
- Avoid fatty foods

Investigations to be done for IBS, slow gastric emptying, gastritis and reflux.

As previous ultrasound was normal i dont think its related to bladder.

Thanks!


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar (34 minutes later)
I forgot to mention that I have been taking Nexium 40 mg for years. Seems like I can't live without it because of my GERD. Also, past EGD only showed mild gastritis, and no further treatment was offered, as I was already taking Nexium. I certainly thought something else should have been offered at that time, but nothing was. Have further comments or recommendations? Thank you SO much for your time!!
doctor
Answered by Dr. Ramesh Kumar (15 hours later)
Brief Answer:
follow up.

Detailed Answer:
Hi there as you were already on Nexium i would suggest you a better approach.

See as the name suggests ACID REFLUX should be treated in two phases-
1)Control production of acid-For which you are on Nexium.
2)To prevent the acid formed inside stomach to reflux back into esophagus-(This part of treatment is not covered by your doctor)-I would suggest you to add Levosulpiride. It is a prokinetic drug and is very effective in controlling reflux of acid back into esophagus.
A better way is to take it with Rabeprazole trials have shown that its very effective when combined with Rabeprazole.So you can switch over to Rabeprazole from Nexium.

It should be taken in combination with Rabeprazole once daily in morning 20 minutes before breakfast and would play wonders in a week.

Secondly an antacid like mucaine gel containing (ALUMINIUM HYDROXIDE-0.291MG+MAGNESIUM HYDROXIDE-98MG+OXETACAINE-10MG) should be taken two times a day with half cup of XXXXXXX warm water before big meals.


Thirdly Acotiamide at a standard dose of 300 mg/day did significantly stimulate esophageal motor function. Although the frequency of swallows with weak contraction tended to decrease with acotiamide administration.
So you could take it 100
mg per day before lunch dinner and breakfast.

Apart from that some life style recommendations are-

Food and beverages like chocolates, fatty food, coffee, alcohol and peppermint should be avoided in order to reduce the weakening of the lower oesophageal sphincter. Several food items irritate the damaged oesophageal lining and should also be avoided. They include citrus fruits, tomato and pepper.
Smoking cigarettes results in weakening of the lower oesophageal sphincter and should be stopped to reduce GERD.
One should elevate the head of the bed on which he or she sleeps on blocks measuring 6 inches. This reduces the heartburn as gravity minimizes stomach reflux to return to the oesophagus.

Try this for 10 days and you would feel much better.
Warm regards.
Above answer was peer-reviewed by : Dr. Kampana
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Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2805 Questions

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What Does Intermittent Nausea Indicate Despite Normal HIDA Scans And GB Ultrasounds?

Brief Answer: Dyspepsia. Detailed Answer: Dyspepsia, in layman's language is known as indigestion. It is a term that describes discomfort or pain in the upper abdomen. However, it's not a disease in itself. Dyspepsia is a group of symptoms which often include vomiting nausea and other gastroc problems. Take a proton pump inhibitor like Esomeprazole 40 mg once daily along with anti nausea medication zofran 4 mg thrice daily. This will provide you symptomatic relief from symptoms. Any over counter probiotic should be taken for few days to provide relief in symptoms of indigestion. Apart from this, some dietary restrictions are to be followed- - Avoid alcohol or smoking. - No aerated beverages. - Take light non spicy easily digestible food for few days. - No Fast food like pizza or burger should be taken. - Drink a cup of cold milk daily. - Avoid fatty foods Investigations to be done for IBS, slow gastric emptying, gastritis and reflux. As previous ultrasound was normal i dont think its related to bladder. Thanks!