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Suggest Treatment For Indigestion And Acidity
Question: Dear Doctor,
I am a 30 yr old male and have been experiencing digestive issues, on and off, getting chronic lately, for the past 18 months.
The main symptom is unformed stool, as of today about 90% of bowel movements are type 6 or 7 on the Bristol scale, sometimes bulky and sticky (steatorrhea I guess?) the remaining 10% normal/soft (type 4-ish). Other than that, movements are fairly regular, mostly once a day in the morning, with noisy peristalsis (esp. in the evening) and increased gas. No cramps or pain of any kind, but bloating/pressure is felt sometimes in the upper left quadrant, just under the rib cage. Also, I often feel what may be described as twitches/spasms, but no pain at all.
I consume alcohol, about a glass of wine per day on average, have been holding back lately but no marked improvement. Also tried a high-dosage probiotic supplement for 20 days, with perhaps a marginal improvement, but nothing satisfactory.
I was diagnosed with a helicobacter pylori infection (overgrowth?) about three years ago, treated but no follow-up tests. Also checked for celiac markers around the same time, results came back negative.
I have visited my GP about this, he's ordered blood tests, appended below. I have tried my best to translate them, indicating units and reference values, as I'm based in Italy. After seeing the results my doctor was unconcerned, he performed palpation (no pain felt) and prescribed a 2 week course of racecadotril, 3x100mg daily. I took the pills for three days, but they increased rumbling and bloating and caused sleeplessness; on the third night a very unpleasant bloating was felt, which exacerbated insomnia, with only a marginal improvement in stool appearance. I quit the pills and felt immediately better.
Frankly, I am not convinced by his approach and am currently switching to another GP.
I have also lost weight in the past couple months, this may have been caused by unrelated events which resulted in temporary depression and erratic eating patterns. The weight is now stabilized and slowly improving (I'm 190cm tall, went from a stable 78kg to about 72, now 73/74 and hopefully increasing). I am including a fair amount of fiber in the diet, also temporarily increased lean meat consumption and portion sizes to gain weight, while limiting dairy and gluten.
My questions:
- possible explanations, given the data?
- any further tests suggested? Possibly in order of priority.
- any further advice?
Blood test results, format:
result - parameter: value [unit], (lower reference, upper reference)
CBC:
OK - leukocytes: 6.76 [10^3/mcL] (3.50 - 10.00)
OK - erythrocytes: 5.00 [10^6/mcL] (4.30 - 5.70)
OK - hemoglobin: 14.8 [g/dL] (13.5 - 17.0)
OK - hematocrit: 43.8 [%] (39.0 - 50.0)
OK - MCV: 87.6 [fL] (80.0 - 97.0)
OK - MCH: 29.6 [pg] (27.0 - 34.0)
OK - MCHC: 33.8 [g/dL] (30.0 - 37.0)
OK - platelets: 296 [10^3/mcL] (130 - 390)
OK - RDW-CV: 12.5 [%] (12.0 - 15.0)
OK - MPV: 9.8 [fL] (9.0 - 13.0)
WBC COUNT:
LO - neutrophils: 34.1 [%] (40.0 - 75.0)
HI - lymphocytes: 56.1 [%] (18.0 - 50.0)
OK - monocytes: 6.2 [%] (5.0 - 13.0)
OK - eosinophils: 3.0 [%] (1.0 - 7.0)
OK - basophils: 0.6 [%] (0.0 - 2.0)
OK - neutrophils count: 2.31 [10^3/mcL] (1.60 - 7.00)
HI - lymphocytes count: 3.79 [10^3/mcL] (1.00 - 3.00)
OK - monocytes count: 0.42 [10^3/mcL] (0.00 - 1.00)
OK - eosinophils count: 0.20 [10^3/mcL] (0.00 - 0.40)
OK - basophils count: 0.04 [10^3/mcL] (0.00 - 0.05)
OK - ESR: 3 [mm/h] (<28)
STDs:
OK - TPHA: Neg.
OK - HBsAg: Neg.
OK - HCV Antibodies: Neg.
OK - VDRL: Neg.
OK - HIV Antibodies: Neg.
OK - serum protein level: normal
OK - folates: 10.8 [ng/mL] (4.0 - 20.0)
OK - glucose: 84 [mg/dL] (70 - 110)
OK - creatitine: 0.79 [mg/dL] (0.70 - 1.20)
OK - total protein level: 7.0 [g/dL] (6.4 - 8.4)
OK - iron: 117 [mcg/dL] (53 - 167)
OK - AST: 21 [U/L at 37 degrees Celsius] [10 - 41]
OK - ALT: 15 [U/L at 37 degrees Celsius] [10-41]
OK - gGT: 19 [U/L at 37 degrees Celsius] [10-71]
OK - amylase: 49 [U/L at 37 degrees Celsius] [28-100]
OK - CRP: <0.1 [mg/dL] [0.0 - 0.5]
Thank you very much for your response. Warm regards,
XXXX
I am a 30 yr old male and have been experiencing digestive issues, on and off, getting chronic lately, for the past 18 months.
The main symptom is unformed stool, as of today about 90% of bowel movements are type 6 or 7 on the Bristol scale, sometimes bulky and sticky (steatorrhea I guess?) the remaining 10% normal/soft (type 4-ish). Other than that, movements are fairly regular, mostly once a day in the morning, with noisy peristalsis (esp. in the evening) and increased gas. No cramps or pain of any kind, but bloating/pressure is felt sometimes in the upper left quadrant, just under the rib cage. Also, I often feel what may be described as twitches/spasms, but no pain at all.
I consume alcohol, about a glass of wine per day on average, have been holding back lately but no marked improvement. Also tried a high-dosage probiotic supplement for 20 days, with perhaps a marginal improvement, but nothing satisfactory.
I was diagnosed with a helicobacter pylori infection (overgrowth?) about three years ago, treated but no follow-up tests. Also checked for celiac markers around the same time, results came back negative.
I have visited my GP about this, he's ordered blood tests, appended below. I have tried my best to translate them, indicating units and reference values, as I'm based in Italy. After seeing the results my doctor was unconcerned, he performed palpation (no pain felt) and prescribed a 2 week course of racecadotril, 3x100mg daily. I took the pills for three days, but they increased rumbling and bloating and caused sleeplessness; on the third night a very unpleasant bloating was felt, which exacerbated insomnia, with only a marginal improvement in stool appearance. I quit the pills and felt immediately better.
Frankly, I am not convinced by his approach and am currently switching to another GP.
I have also lost weight in the past couple months, this may have been caused by unrelated events which resulted in temporary depression and erratic eating patterns. The weight is now stabilized and slowly improving (I'm 190cm tall, went from a stable 78kg to about 72, now 73/74 and hopefully increasing). I am including a fair amount of fiber in the diet, also temporarily increased lean meat consumption and portion sizes to gain weight, while limiting dairy and gluten.
My questions:
- possible explanations, given the data?
- any further tests suggested? Possibly in order of priority.
- any further advice?
Blood test results, format:
result - parameter: value [unit], (lower reference, upper reference)
CBC:
OK - leukocytes: 6.76 [10^3/mcL] (3.50 - 10.00)
OK - erythrocytes: 5.00 [10^6/mcL] (4.30 - 5.70)
OK - hemoglobin: 14.8 [g/dL] (13.5 - 17.0)
OK - hematocrit: 43.8 [%] (39.0 - 50.0)
OK - MCV: 87.6 [fL] (80.0 - 97.0)
OK - MCH: 29.6 [pg] (27.0 - 34.0)
OK - MCHC: 33.8 [g/dL] (30.0 - 37.0)
OK - platelets: 296 [10^3/mcL] (130 - 390)
OK - RDW-CV: 12.5 [%] (12.0 - 15.0)
OK - MPV: 9.8 [fL] (9.0 - 13.0)
WBC COUNT:
LO - neutrophils: 34.1 [%] (40.0 - 75.0)
HI - lymphocytes: 56.1 [%] (18.0 - 50.0)
OK - monocytes: 6.2 [%] (5.0 - 13.0)
OK - eosinophils: 3.0 [%] (1.0 - 7.0)
OK - basophils: 0.6 [%] (0.0 - 2.0)
OK - neutrophils count: 2.31 [10^3/mcL] (1.60 - 7.00)
HI - lymphocytes count: 3.79 [10^3/mcL] (1.00 - 3.00)
OK - monocytes count: 0.42 [10^3/mcL] (0.00 - 1.00)
OK - eosinophils count: 0.20 [10^3/mcL] (0.00 - 0.40)
OK - basophils count: 0.04 [10^3/mcL] (0.00 - 0.05)
OK - ESR: 3 [mm/h] (<28)
STDs:
OK - TPHA: Neg.
OK - HBsAg: Neg.
OK - HCV Antibodies: Neg.
OK - VDRL: Neg.
OK - HIV Antibodies: Neg.
OK - serum protein level: normal
OK - folates: 10.8 [ng/mL] (4.0 - 20.0)
OK - glucose: 84 [mg/dL] (70 - 110)
OK - creatitine: 0.79 [mg/dL] (0.70 - 1.20)
OK - total protein level: 7.0 [g/dL] (6.4 - 8.4)
OK - iron: 117 [mcg/dL] (53 - 167)
OK - AST: 21 [U/L at 37 degrees Celsius] [10 - 41]
OK - ALT: 15 [U/L at 37 degrees Celsius] [10-41]
OK - gGT: 19 [U/L at 37 degrees Celsius] [10-71]
OK - amylase: 49 [U/L at 37 degrees Celsius] [28-100]
OK - CRP: <0.1 [mg/dL] [0.0 - 0.5]
Thank you very much for your response. Warm regards,
XXXX
Brief Answer:
Following tests are necessary to run....
Detailed Answer:
Hi XXXXXXX
I have gone through your medical history and understood your concerns. I have gone through your biochemical testing results and I did not notice anything worrisome.
However, as you are reporting to have unformed stool for quite a long time now, before running into final conclusions, I'd ask to do some other diagnostic lab tests:
- examination of stool for ova/parasites
- culture of stool for candida overgrowth
- food intolerance tests
- 24 hours barium study of intestines
- abdominal ultrasound
- upper endoscopy
- colonoscopy
Depending on the tests results, specific treatment will be prescribed. As you are also reporting to consume alcohol, its use might also affect intestinal function. Therefore, I'd ask to stop/avoid drinking alcohol. I understand that backing it up is not giving effect for the moment, however, improvement will be soon visible.
If racecadotril is aggravating bloating, I'd suggest to stop using it, and to try simethicone (you might find it as over the counter).
Antacids are also advised to improve pH of stomach liquids as hyperacidity of the stomach might also increase intestinal movements too.
You can schedule an appointment with a GI specialist and to discuss the above-mentioned suggestions with him/her.
Hope it helped! Do write me back if you have further queries!
Dr.Klerida
Following tests are necessary to run....
Detailed Answer:
Hi XXXXXXX
I have gone through your medical history and understood your concerns. I have gone through your biochemical testing results and I did not notice anything worrisome.
However, as you are reporting to have unformed stool for quite a long time now, before running into final conclusions, I'd ask to do some other diagnostic lab tests:
- examination of stool for ova/parasites
- culture of stool for candida overgrowth
- food intolerance tests
- 24 hours barium study of intestines
- abdominal ultrasound
- upper endoscopy
- colonoscopy
Depending on the tests results, specific treatment will be prescribed. As you are also reporting to consume alcohol, its use might also affect intestinal function. Therefore, I'd ask to stop/avoid drinking alcohol. I understand that backing it up is not giving effect for the moment, however, improvement will be soon visible.
If racecadotril is aggravating bloating, I'd suggest to stop using it, and to try simethicone (you might find it as over the counter).
Antacids are also advised to improve pH of stomach liquids as hyperacidity of the stomach might also increase intestinal movements too.
You can schedule an appointment with a GI specialist and to discuss the above-mentioned suggestions with him/her.
Hope it helped! Do write me back if you have further queries!
Dr.Klerida
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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