Suggest Treatment For Persistent Nausea And Abdominal Pain

Posted on Fri, 31 Mar 2017

Question: Hi, I'm a 44yo female with gradual onset of severe nausea temporarily relieved by eating strong-flavoured food & esomeprazole for GORD (that I've had for 3 years) abdo pain, normal bowels, urinary frequency, excessive thirst, enlarged papillae on rear of tongue (feel like I have something stuck in my throat but it's not sore) & a terrible irritable mood
With low energy. I can't even stand someone touching me, I feel ferocious!!!! Any ideas?

Answered by Dr. Prof. Kunal Saha (3 hours later)

Brief Answer:
Get your thyroid levels checked

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone very carefully through your query. Your problem seems to be due to gastritis or gastroesophageal reflux. Such a condition is often precipitated by mood instabililties and anxiety.

In order to relieve yourself, you need to do the following:
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take esomeprazole once daily before breakfast.
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep 20 mg tablet (long term anxiolytic) once daily for at least 2 months (it may take time for the action to set in). This medicine can also help in reducing your mood instabilities.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
* Get your blood tested for thyroid profile. Low thyroid levels could also contribute to such a condition.

Hopefully that should help.

Let me know if I could help further.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (1 hour later)

hello, thank you for your reply. In addition, I have become intolerant to alcohol because it affects me too quickly & makes me feel so unwell. I normally eat yoghurt daily but even the smell of it increases my nausea at the moment due to an altered taste sensation. I have had my thyroid tested a few months ago & all seemed OK. Other symptoms I have include insomnia but terrible fatigue, heart palpitations, intolerance to heat but also feel cold very quickly, problems with memory/mental clarity. i already take Fluoxetine 20mg daily for anxiety (I started this about 1 month ago, after being on 150mg Sertraline for 6 months. i switched to Lovan due to weight-gain, fatigue). anxious +++

Answered by Dr. Prof. Kunal Saha (2 hours later)

Brief Answer:
Lifestyle modification is needed

Detailed Answer:
Thanks for writing back. You have just confirmed on my apprehensions. Try to take care of the mentioned factors. Fluoxetine takes time to respond and you would have to wait a bit longer.

Feel free to write back in case of further queries.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (1 hour later)

so do you mean confirmed your suspicions of gastritis moreso than thyroid hormone levels? I googled my symptoms and thought Adrenal fatigue might be a cause too? I will stick with Fluoxetine yes - do you think an increased dose is indicated? I take 20mg. I will run it by my GP first of course but I'd like your opinion on dosage. thank you so much.

Answered by Dr. Prof. Kunal Saha (1 hour later)

Brief Answer:
Get the blood test done

Detailed Answer:
Thanks for writing back. My suspicion about gastritis got confirmed. The thyroid issue awaits confirmation through blood tests. I would not consider adrenal fatigue as of now. I would insist you to continue with the same dose of Fluoxetine. Let me know once you get the thyroid profile reports. Till then follow the suggestions given.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Prof. Kunal Saha (2 minutes later)

OK thank you so much. Do you think Esomeprazole is the best PPI for me? What do you recommend for the pain I am experiencing. Also should I ask my GP for a short-course of Diazepam to help my mood please?

Answered by Dr. Prof. Kunal Saha (9 hours later)

Brief Answer:
Questions answered

Detailed Answer:
Thanks for writing back. Esomeprazole acts pretty well and I would say that the best idea would be to stick to it. You may take some liquid antacid for the pain. I doubt if you need a short course of diazepam.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar