Brief Answer:
Irritable bowel disease a diagnosis of exclusion.You have already been thoroughly investygated fpr other pathologies.So all your symptoms fit well in irritable bowel syndrome.IBS is still a gray zone and researches can not understand the exact physiology of problem till date.

Detailed Answer:
Hello Dear,
Thanks for choosing HealthcareMagic for your query,
I am a Gastroenterologist and would be addressing your query.

As per your history you are a clear cut case of irritable bowel disease.All symptoms you are having are tell tale signs of IBS.Firstly small briefing for Irritable bowel syndrome and why every patient is a unique case when we deal with IBS.
In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect.

Recent studies by French scientists have indicated that the most important mechanisms include visceral sensitivity, abnormal gut motility and autonomous nervous system dysfunction. The interactions between these three mechanisms make bowel's function susceptible to many exogenous and endogenous factors like gastrointestinal flora, feeding and psychosocial factors.

Further data indicate that according to the above mechanisms, the influence of genetic factors and polymorphisms of human DNA in the development of IBS is equally important.

So in lay mans language till date we are not sure whats the exact cause of this problem.So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other says it can be hormone anxiety age etc etc).

Some patients have attacks of diarrhea and bloating and some may have constipation. Other symptoms that may be present in irritable bowel syndrome include nausea, vomiting, headache, loss of appetite, muscular pains, heartburn, and weakness. Some patients have occasional symptoms whereas others may have symptoms for a long period of time.So as seen above every patient is different.Intensity of symptoms in every patient is different as so is the response to medicines and life style change.A patient may respond good to one medication while other patient is totally unresponsive to the same.

Our goal-
Every drug is not effective in every patient so we have to try different therapies till we find the drug which suits best our patient.


Dicyclomine is an anticholinergic drug.An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.

Mebeverine is an antispasmodic medicine and is very useful in IBS and is well tolerated by patient with minimal side effects.Mebeverine works on certain muscles in the wall of your intestines, causing them to relax.

Clidinium bromide is an anticholinergic (specifically a muscarinic antagonist) drug. It may help symptoms of cramping.

Chlordiazepoxide works by increasing the action of GABA, a chemical messenger which suppresses the abnormal and excessive activity of the nerve cells in the brain.Can be used in combination with above mentioned medicines.Again very effective in cramps.

Another OTC medication is Bismuth sub-salicylate. It belongs to a class of medications called antacids and adsorbents marketed by name of Pepto Bismol. Doses up to 1gram can be taken daily to provide symptomatic relief in bloating and gases


For bloating and gas take Tab Nexium 40mg twice daily can increase it to 80 mg twice daily.Take a probiotic VSL#3 daily with food as proper digestion of food will prevent excess gas formation.When food is not properly digested large amount of gases are produced inside due to incomplete fermentation of food.Hence if digestion improves overall symptoms will also improve.
Food pattern recommended is-
Eat simple and natural home cooked food.
If possible try detox diet (Raw vegans) for at least 3 month. Take normal food in lunch while in supper take uncooked raw (low fiber) natural form of food. This can play wonders.
Avoid taking excessive fibres. A total fiber intake of about 20-25 gram per day would be good for you.
No pizza,Burger, Red meat, and dairies for few weeks.
No alcohol or smoking.

Ask her to take natural food rich in probiotics like Yoghurt, Kimchi,etc.This doesn't mean that you have to take them as much as you can.Follow your body increase their uptake gradually.
Drink lots of juices and fresh water daily. Drink cleaner water, it will help a lot.
Avoid over spicy and heavy food.

If possible go for a detox diet but again don't force your body rather let your body adopt gradually to things.

In case you need any other help feel free to ask.I would be happy to help you.
Hope i answered your query well.

Thanks and Wish her luck.

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Brief Answer:
Follow up.

Detailed Answer:
Hi again,
In regards to your query about medications you are on.

Domperidone is a prokinetc and antiemetic drug but 10 mg per day is not a dose.Life of domperidone is 8 hours only hence either 30 mg slow release is used or 10 mg is used three times a day for maximum effectivity.

Esomeprazole is usually given in twice daily doses as half life of this salt is about 12 hours only.So it should be used as twice daily doses.


Chlorpromazine is an anti pyschotic and is used to treat nausea and comiting also but i don't think we need to give antipsychotics when so many safe options aee there to control nausea.Infact giving domeperidone in low doses does not make sense.

All other medicines you are on are antihypertensive antidiabetic which have no relation as such to your problem.

As already explained earlier IBS is a diagnosis of exclusion.When you can't find any thing wrong with gastrointestinal system you label it as IBS.

All the drugs mentioned by me a very effective in treating the symptoms you are having at present.

However considering the fact that your Gastro is sure that its not IBS then only option left is severe Gastroperesis due to Diabetes mellitus.

Symptoms include Vomiting,Nausea, feeling of fullness after eating just a few bites,Abdominal bloating,Abdominal pain,Lack of appetite,Weight loss and malnutrition.

History of diabetes mellitus is suggestive that it can be gastroperesis also.

Vomiting,diarrhea,bloating,cramping, fatigue all can be explained by it.

Gastric emptying study should be done at the earliest-This test involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach. This is the most important test used in making a diagnosis of gastroparesis.

Have you ever been tested for gastroperesis?
please reply.

Waiting.

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