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Suggest Treatment For Persistent Nausea And Stomach Pain When Recovering From Candida Parapisilosis
Question: Hello,
I have been struggling with a culture proven overgrowth of Candida Parapisilosis in my mouth, throat, nasal passages( due to long term use (5 years) of broad spectrum antibiotics for acne )for about a year and have been treating this with topical Amphitericin B mostly successfully. 10 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects. I fully expected this to subside but I am still having the same debilitating nausea and pressure in my esophagus and now some stomach pain 10 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. No hpylori or celiac A quick stain for fungi was also negative but the lab did not see the request for a 4 week culture and was unable to do this after the fact because they used the only tissue biopsy in the stain culture.
My symptoms are:
pain, pressure, gnawing feeling, and nausea in esophagus area
gnawing pain in upper stomach
these symptoms are constant and not affected by eating
I am 26 yrs old, very healthy and have never had any gastro issues in the past. I have been eating 100% organic, preservative free for a year and take probiotics daily. My GI doctor is baffled and has basically given up and told me to get another opinion elsewhere. I feel very miserable all of the time and I am hoping that you will be able to help me. Thanks!
I have been struggling with a culture proven overgrowth of Candida Parapisilosis in my mouth, throat, nasal passages( due to long term use (5 years) of broad spectrum antibiotics for acne )for about a year and have been treating this with topical Amphitericin B mostly successfully. 10 weeks ago I was prescribed Voriconazole (Vfend- 200 mg 2x day) to hopefully eradicate the Candida once and for all. 5 days into this drug I started feeling nausea and pressure in my esophagus area. I stayed on this drug for 14 days and finally had to stop due to these side effects. I fully expected this to subside but I am still having the same debilitating nausea and pressure in my esophagus and now some stomach pain 10 weeks later. I recently went to a GI Dr and had an endoscopy which was normal. No sign of stomach irritation, ulceration, or acid. Lab work and biopsies all normal. No hpylori or celiac A quick stain for fungi was also negative but the lab did not see the request for a 4 week culture and was unable to do this after the fact because they used the only tissue biopsy in the stain culture.
My symptoms are:
pain, pressure, gnawing feeling, and nausea in esophagus area
gnawing pain in upper stomach
these symptoms are constant and not affected by eating
I am 26 yrs old, very healthy and have never had any gastro issues in the past. I have been eating 100% organic, preservative free for a year and take probiotics daily. My GI doctor is baffled and has basically given up and told me to get another opinion elsewhere. I feel very miserable all of the time and I am hoping that you will be able to help me. Thanks!
Brief Answer:
SIBO/amphotericin B side effects/gallbladder issues as possible causes...
Detailed Answer:
HiXXXXX,
I have gone through your medical history carefully and understood your concerns.
From what you are describing, your symptoms might be related to possible:
1. Side effects of using Amphotericin B
2. SIBO = small intestinal bacterial overgrowth caused by using antibiotics for a long period (5 years). Antibiotics have altered all your intestinal flora and not causing candida overgrowth alone.
3. So far, you are not reporting to have run abdominal ultrasound or excluded gallbladder problems. They should be considered too.
For the moment, I'd advise to:
- continue taking probiotics
- take PPIs (e.g. omeprazole) as you might have also developed dyspeptic syndrome due to the use of all medications so far.
- try to eat often and small portions
- avoid foods that would aggravate your symptoms
Hope it was of help!
Dr.Klerida
SIBO/amphotericin B side effects/gallbladder issues as possible causes...
Detailed Answer:
HiXXXXX,
I have gone through your medical history carefully and understood your concerns.
From what you are describing, your symptoms might be related to possible:
1. Side effects of using Amphotericin B
2. SIBO = small intestinal bacterial overgrowth caused by using antibiotics for a long period (5 years). Antibiotics have altered all your intestinal flora and not causing candida overgrowth alone.
3. So far, you are not reporting to have run abdominal ultrasound or excluded gallbladder problems. They should be considered too.
For the moment, I'd advise to:
- continue taking probiotics
- take PPIs (e.g. omeprazole) as you might have also developed dyspeptic syndrome due to the use of all medications so far.
- try to eat often and small portions
- avoid foods that would aggravate your symptoms
Hope it was of help!
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hi Dr. Klerida,
Thank you for your answer. I have a couple more questions regarding this.
Would you please explain in more detail the side effects of using oral amphetericin B?
I tried to find this on the internet and could only find side effects pertaining to IV.
With regard to taking PPI's ... Wouldn't my endoscopy have shown irritation or inflamation if I have developed dyspeptic syndrome?
Also, I have been on a bland diet since this happened 10 weeks ago. Foods don't seem to have any effect or aggrevate my symptoms. I did this just to see if I could make them better but there has been no effect on my symptoms by doing this.
With regard to the SIBO, would that have come on all of a sudden? And wouldn't that have been detected during endoscopy? My doctor took a biopsy of the duodenum for celiac perhaps that would have shown bacteria?
Thank you for your help!
Thank you for your answer. I have a couple more questions regarding this.
Would you please explain in more detail the side effects of using oral amphetericin B?
I tried to find this on the internet and could only find side effects pertaining to IV.
With regard to taking PPI's ... Wouldn't my endoscopy have shown irritation or inflamation if I have developed dyspeptic syndrome?
Also, I have been on a bland diet since this happened 10 weeks ago. Foods don't seem to have any effect or aggrevate my symptoms. I did this just to see if I could make them better but there has been no effect on my symptoms by doing this.
With regard to the SIBO, would that have come on all of a sudden? And wouldn't that have been detected during endoscopy? My doctor took a biopsy of the duodenum for celiac perhaps that would have shown bacteria?
Thank you for your help!
Brief Answer:
Please follow the suggestions below.....
Detailed Answer:
HI back XXXX
Thank you for follow up.
With regards to dyspeptic syndrome it doesn't have stomach irritation, endoscopy is normal but the patient feels stomach problems like stomach upset.
In these cases we use PPI treatment.
SIBO is not detected with upper endoscopy because it can see only the top portion of small intestine.
The biopsy that doctor has taken from duodenal part doesn't show SIBO or bacteria.
The test that you can do to rule out /confirm SIBO is SIBO breath test.
Breath testing measures the hydrogen (H) & methane (M) gas produced by bacteria in the small bowel.
With regards to Amfotericine B use , if you have used only topical than side effects are not related with it.
Hope it was helpful
Dr.Klerida
Please follow the suggestions below.....
Detailed Answer:
HI back XXXX
Thank you for follow up.
With regards to dyspeptic syndrome it doesn't have stomach irritation, endoscopy is normal but the patient feels stomach problems like stomach upset.
In these cases we use PPI treatment.
SIBO is not detected with upper endoscopy because it can see only the top portion of small intestine.
The biopsy that doctor has taken from duodenal part doesn't show SIBO or bacteria.
The test that you can do to rule out /confirm SIBO is SIBO breath test.
Breath testing measures the hydrogen (H) & methane (M) gas produced by bacteria in the small bowel.
With regards to Amfotericine B use , if you have used only topical than side effects are not related with it.
Hope it was helpful
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello again and thanks for your reply.
I do have a question about PPI usage for my situation. I'm not sure that I understand how suppressing the acid production in my stomach can help in my case.
Additionally, my nausea seems to be coming from my esophagus area. I most definitely would be very happy for this to relieve my symptoms. Would you give me a more in depth explanation of how PPI would work in my situation?
Although the quick slide for fungi was negative, my other cultures were not positive until the samples had a chance to grow in a petri dish for a month. Is it possible for these symptoms to be caused by overgrowth esophageal candidida?
Regarding the amphetericn B, I have only ingested it for the past year, never iv. Would this be considered topical as you had stated?
Thanks so much!
I do have a question about PPI usage for my situation. I'm not sure that I understand how suppressing the acid production in my stomach can help in my case.
Additionally, my nausea seems to be coming from my esophagus area. I most definitely would be very happy for this to relieve my symptoms. Would you give me a more in depth explanation of how PPI would work in my situation?
Although the quick slide for fungi was negative, my other cultures were not positive until the samples had a chance to grow in a petri dish for a month. Is it possible for these symptoms to be caused by overgrowth esophageal candidida?
Regarding the amphetericn B, I have only ingested it for the past year, never iv. Would this be considered topical as you had stated?
Thanks so much!
Brief Answer:
please follow the suggestions
Detailed Answer:
Dear XXXX
With regards to dyspeptic syndrome in my clinical practice I recommend PPI use. In many cases at my clinic PPI is of help to relieve dyspeptic syndrome.
The reason is that acidity is the main cause of dyspeptic symptoms and by reducing acidity PPI will help to relieve dyspeptic syndrome.
With regards to amphotericine B you are writing that you have used it past year so it a long time and you symptoms are not related with it.
IV treatment with amfotericineB has more side effect than other route of administration.
Please discuss with your treating doctor about SIBO and dyspeptic syndrome.
Wishing you all the best
Dr.Klerida
please follow the suggestions
Detailed Answer:
Dear XXXX
With regards to dyspeptic syndrome in my clinical practice I recommend PPI use. In many cases at my clinic PPI is of help to relieve dyspeptic syndrome.
The reason is that acidity is the main cause of dyspeptic symptoms and by reducing acidity PPI will help to relieve dyspeptic syndrome.
With regards to amphotericine B you are writing that you have used it past year so it a long time and you symptoms are not related with it.
IV treatment with amfotericineB has more side effect than other route of administration.
Please discuss with your treating doctor about SIBO and dyspeptic syndrome.
Wishing you all the best
Dr.Klerida
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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