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Suggest Treatment For Acid Reflux, Fatigue And Diarrhea
Question: My 16 year old daughter seems fatigued and has been experiencing abdominal/stomach issues with gas and diarrhea as well as acid reflux. She does take Paroxetine and is on the BC pill for PMS and heavy menstruation.
Brief Answer:
Questions so that I can help:
Detailed Answer:
Hello and welcome,
How long have the gastrointestinal symptoms you described been going on?
Did they start around the time of starting either of the medications?
How long has she been on paroxetine?
How long on the oral contraceptive?
What time of day does she take these meds and is there a time of day when her symptoms are worse?
How many diarrheal stools is she having each day?
Also, is she having pain, where is it located (upper left abdomen, middle upper abdomen, upper right, lower abdomen, etc) and how severe is it?
Any additional information you can provide (or the more detailed you can be) about the stomach issues will help me to advise.
Thanks -
Questions so that I can help:
Detailed Answer:
Hello and welcome,
How long have the gastrointestinal symptoms you described been going on?
Did they start around the time of starting either of the medications?
How long has she been on paroxetine?
How long on the oral contraceptive?
What time of day does she take these meds and is there a time of day when her symptoms are worse?
How many diarrheal stools is she having each day?
Also, is she having pain, where is it located (upper left abdomen, middle upper abdomen, upper right, lower abdomen, etc) and how severe is it?
Any additional information you can provide (or the more detailed you can be) about the stomach issues will help me to advise.
Thanks -
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
How long have the gastrointestinal symptoms you described been going on?
A: Five days ago; began with diarrhea and reflux, as well as gas cramps.
Did they start around the time of starting either of the medications?
A: No.
How long has she been on paroxetine?
A: A little over 2 years.
How long on the oral contraceptive?
A: 2-3 months.
What time of day does she take these meds and is there a time of day when her symptoms are worse?
A: Peroxetine in a.m.; BC at night. Cramps usually after lunch and reflux during physical activity and eating.
How many diarrheal stools is she having each day?
A: It was just last Thursday only.
Also, is she having pain, where is it located (upper left abdomen, middle upper abdomen, upper right, lower abdomen, etc) and how severe is it?
A: She said it's more upper-middle gut; once was mid-lower right side (her right); also, chest/throat because of reflux.
Any additional information you can provide (or the more detailed you can be) about the stomach issues will help me to advise.
A: Got a little dizzy during cross country practice; however she does occasionally have moments of brief dizzy feeling (peroxetine was prescribed due to severe anxiety...has helped). Reflux worse during running. Admits she has not drank much water. Lots of belching w/reflux after. General discomfort more in upper gut. Thank you.Also...she has to "suck in" her gut because it has been rumbling since BEFORE last Thursday. Could be stress/anxiety. Been a hectic summer: uncle killed in XXXXXXX (motorcycle wreck); we moved; she started new school; started the pill.And of course, this all stirs her anxiety (even though med does control it nearly all the time).
A: Five days ago; began with diarrhea and reflux, as well as gas cramps.
Did they start around the time of starting either of the medications?
A: No.
How long has she been on paroxetine?
A: A little over 2 years.
How long on the oral contraceptive?
A: 2-3 months.
What time of day does she take these meds and is there a time of day when her symptoms are worse?
A: Peroxetine in a.m.; BC at night. Cramps usually after lunch and reflux during physical activity and eating.
How many diarrheal stools is she having each day?
A: It was just last Thursday only.
Also, is she having pain, where is it located (upper left abdomen, middle upper abdomen, upper right, lower abdomen, etc) and how severe is it?
A: She said it's more upper-middle gut; once was mid-lower right side (her right); also, chest/throat because of reflux.
Any additional information you can provide (or the more detailed you can be) about the stomach issues will help me to advise.
A: Got a little dizzy during cross country practice; however she does occasionally have moments of brief dizzy feeling (peroxetine was prescribed due to severe anxiety...has helped). Reflux worse during running. Admits she has not drank much water. Lots of belching w/reflux after. General discomfort more in upper gut. Thank you.Also...she has to "suck in" her gut because it has been rumbling since BEFORE last Thursday. Could be stress/anxiety. Been a hectic summer: uncle killed in XXXXXXX (motorcycle wreck); we moved; she started new school; started the pill.And of course, this all stirs her anxiety (even though med does control it nearly all the time).
Brief Answer:
Information
Detailed Answer:
Thank you for the additional information.
I asked about the meds because paroxetine can cause gastointestinal problems including stomach irritation and diarrhea, but given the time course, I do not think that is what is going on.
Most likely her symptoms are from a gastrointestinal virus as it started with diarrhea which has resolved. A history of anxiety can contribute to irritable bowel symptoms, and I am assuming she just started the school year which is stressful, but as she hasn't had IBS before and these symptoms and time sequence aren't particularly classic for it, I still think a GI bug is more likely.
Here are some suggestions:
1. Given the gas symptoms, avoid for now, eating a lot of dairy, and possibly also gas forming foods (legumes, etc).
2. Simethicone (Gas X, etc), can help with the gas too.
3. For the reflux and upper middle abdominal discomfort, consider taking an H2 blocker such as Zantac 150 mg twice a day. It will reduce acid production in the stomach to allow it to heal and decrease reflux (and belching). You can buy this over the counter. It can take several days to start to see improvement, but she should start to notice it helping soon. There are also PPIs such as Prilosec and Nexium, but I generally use PPIs as a second step because they have more risk of rebound on discontinuation, and side effects.
4. For acid reflux, avoid citrus and tomatoes (because of acid) and caffeine. Eat smaller amounts at a time (but more frequently so that she doesn't lose weight or get hypoglycemic).
I just read your additional note about her uncle (I am sorry!) and the stressful time she has had. It's possible some of this could be from stress. If that is the case, and the recommendations above don't help, then she should see her doctor. It may be the combination of things.
I hope this information helps. Please let me know if I can provide additional information.
Information
Detailed Answer:
Thank you for the additional information.
I asked about the meds because paroxetine can cause gastointestinal problems including stomach irritation and diarrhea, but given the time course, I do not think that is what is going on.
Most likely her symptoms are from a gastrointestinal virus as it started with diarrhea which has resolved. A history of anxiety can contribute to irritable bowel symptoms, and I am assuming she just started the school year which is stressful, but as she hasn't had IBS before and these symptoms and time sequence aren't particularly classic for it, I still think a GI bug is more likely.
Here are some suggestions:
1. Given the gas symptoms, avoid for now, eating a lot of dairy, and possibly also gas forming foods (legumes, etc).
2. Simethicone (Gas X, etc), can help with the gas too.
3. For the reflux and upper middle abdominal discomfort, consider taking an H2 blocker such as Zantac 150 mg twice a day. It will reduce acid production in the stomach to allow it to heal and decrease reflux (and belching). You can buy this over the counter. It can take several days to start to see improvement, but she should start to notice it helping soon. There are also PPIs such as Prilosec and Nexium, but I generally use PPIs as a second step because they have more risk of rebound on discontinuation, and side effects.
4. For acid reflux, avoid citrus and tomatoes (because of acid) and caffeine. Eat smaller amounts at a time (but more frequently so that she doesn't lose weight or get hypoglycemic).
I just read your additional note about her uncle (I am sorry!) and the stressful time she has had. It's possible some of this could be from stress. If that is the case, and the recommendations above don't help, then she should see her doctor. It may be the combination of things.
I hope this information helps. Please let me know if I can provide additional information.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
One more question: she mentioned that she found it "hard to breath" a few times while running. I feel that it is perceived rather than actual, given her history of anxiety and the reflux. But I would put more stock in what you think! Thanks!
Brief Answer:
Thoughts on this
Detailed Answer:
I have been having computer trouble so I want to apologize for not having responded sooner.
Regarding the breathing trouble while running, there a few possibilities to consider:
1. If her weight has gone up and she is dealing with the added burden of more pounds, this can cause some difficulty with breathing compared with the past.
2. Exercise induced asthma can cause this.
3. Reflux of acid into the airways might be causing reactive airway problems (asthma type bronchoconstriction).
4. Anxiety can definitely cause shortness of breath, but unless she is more anxious when running, I would expect her to complain of episodes of shortness of breath when she is NOT running when she is likely to be more anxious.
5. Although rare, there can be serious lung emboli problems. But that is more likely to cause shortness of breath in all situations. However if the difficulty breathing with running increases or she notices shortness of breath at other times, then do take her in to be seen. A test called D-dimer can sort it out. But again, this is uncommon.
Thoughts on this
Detailed Answer:
I have been having computer trouble so I want to apologize for not having responded sooner.
Regarding the breathing trouble while running, there a few possibilities to consider:
1. If her weight has gone up and she is dealing with the added burden of more pounds, this can cause some difficulty with breathing compared with the past.
2. Exercise induced asthma can cause this.
3. Reflux of acid into the airways might be causing reactive airway problems (asthma type bronchoconstriction).
4. Anxiety can definitely cause shortness of breath, but unless she is more anxious when running, I would expect her to complain of episodes of shortness of breath when she is NOT running when she is likely to be more anxious.
5. Although rare, there can be serious lung emboli problems. But that is more likely to cause shortness of breath in all situations. However if the difficulty breathing with running increases or she notices shortness of breath at other times, then do take her in to be seen. A test called D-dimer can sort it out. But again, this is uncommon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
It's okay, I really appreciate your help! You have answered all of my questions thoroughly. I do think you hit the nail on the head with "gastrointestinal virus" due to the quick onset. We have purchased Zantac 150, which she plans to start in the morning. Regarding the "shortness of breath", she hasn't put on weight, so I'm sure that's not an issue; she has been doing cross country for only a week, so maybe she's just not in shape yet! I think the gastrointestinal issue has made her anxious, and her stomach has been acting up more when she runs and "jostles around", so I think it all goes hand-in-hand. Sorry for the long reply...just thinking out loud. Thanks again!
Brief Answer:
Good luck
Detailed Answer:
Best scenario would be if the Zantac takes care of the upper abdominal pain, reflux, burping and makes it easier to breathe. Because if she is having reflux, it is known that reflux can cause a cough and asthma, so it may be causing some respiratory symptoms.
Good luck, and if you are willing, please let me know how she is doing after she has been on the Zantac for a few days.
Best regards,
Bonnie Berger-Durnbaugh, MD
Good luck
Detailed Answer:
Best scenario would be if the Zantac takes care of the upper abdominal pain, reflux, burping and makes it easier to breathe. Because if she is having reflux, it is known that reflux can cause a cough and asthma, so it may be causing some respiratory symptoms.
Good luck, and if you are willing, please let me know how she is doing after she has been on the Zantac for a few days.
Best regards,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I will! Thanks!
Brief Answer:
Thank you!
Detailed Answer:
Thank you.
Just so you know, I need to respond whenever you write, so I don't want to cost you extra money.
Thank you!
Detailed Answer:
Thank you.
Just so you know, I need to respond whenever you write, so I don't want to cost you extra money.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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