Gastrointestinal Discomfort: Causes and Solutions - Gastroenterology and Hepatology

Gastric discomfort?

Hello Doctor: I am 26 years old, do not smoke or chew betel nut, but occasionally drink alcohol during work-related social events.
I have been experiencing symptoms of gastroesophageal reflux disease (GERD) for two years.
I have undergone gastroscopy and abdominal ultrasound, and aside from some scarring from a previous gastric ulcer, everything else is normal, with no Helicobacter pylori or stones found.
I have two questions for you:
1.
I eat very slowly and do not consume much food, but I always experience bloating and burping after meals.
Sometimes I feel dry mouth and want to drink water continuously.
When GERD symptoms occur, I feel cold in my hands and feet, sometimes with a tingling sensation, and I have a constricted feeling in my neck, along with slight dizziness and a rapid heartbeat.
The liquid I regurgitate from my throat has a foul odor and is very sticky (similar in texture to mucus).
After these symptoms, I often feel hungry again.
I have visited multiple hospitals and taken medication, but I do not feel any improvement.
Is the mucus I frequently expel a normal symptom of GERD?
2.
I have a habit of exercising, and since last year, I have experienced gastric spasms three times during workouts (the symptoms involve rapid contractions of the stomach, continuous burping, and a feeling of needing to breathe heavily, lasting about 10 to 20 minutes before stopping).
Although this has not recurred, I often feel strong spasms in my stomach accompanied by nausea, as if a hand suddenly squeezed my stomach.
This occurs more frequently during stressful moments or while exercising and even when climbing stairs.
When I mentioned this symptom to a doctor at a local hospital, they simply responded with "Oh, really?" and prescribed medication only for bloating and to increase gastrointestinal motility, which was quite frustrating.
I would like to ask if these symptoms should be evaluated by a gastroenterologist.
What could be causing these symptoms? They are significantly affecting my daily life.

Mr. Lin, 20~29 year old female. Ask Date: 2019/02/09

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the described condition, there is chronic gastritis, gastroesophageal reflux disease (GERD), along with dyspepsia and gastric spasms.
In addition to dietary adjustments, it is recommended to consult a gastroenterologist.

Reply Date: 2019/02/09

More Info

Gastrointestinal discomfort can be a complex issue, especially when it involves multiple symptoms like bloating, gastroesophageal reflux disease (GERD), and abdominal cramping. Based on your description, it seems you are experiencing a combination of symptoms that could be attributed to functional gastrointestinal disorders, particularly related to GERD and possibly irritable bowel syndrome (IBS).

Understanding Your Symptoms
1. Bloating and Belching: Your experience of bloating and frequent belching after meals could be linked to several factors. Eating slowly and in smaller portions is generally beneficial, but if you are still experiencing these symptoms, it may indicate that your body is having difficulty digesting certain foods or that you are swallowing air while eating. This can lead to excessive gas production and discomfort.

2. Dry Mouth and Thirst: The sensation of dry mouth and the urge to drink water frequently could be related to dehydration or a side effect of medications you might be taking for GERD. Additionally, the reflux of stomach contents can sometimes cause a dry or sticky feeling in the throat, which may explain the unpleasant taste you mentioned.

3. GERD Symptoms: The symptoms of heartburn, a feeling of tightness in the neck, and the presence of thick, sticky mucus could indeed be related to GERD. The reflux of stomach acid can irritate the esophagus, leading to inflammation and discomfort. The sensation of cold hands and feet, along with dizziness and a rapid heartbeat, may also be stress-related or could indicate a vagal response to discomfort.

4. Abdominal Cramping and Nausea: The episodes of rapid gastric contractions and the feeling of nausea you described, especially during physical exertion or stress, may suggest a functional gastrointestinal disorder like IBS. Stress and anxiety can significantly impact gut motility and sensitivity, leading to symptoms such as cramping and discomfort.

Recommendations for Management
1. Dietary Modifications: Keeping a food diary to identify potential triggers can be helpful. Common culprits include spicy foods, caffeine, alcohol, and high-fat meals. Consider adopting a low-FODMAP diet, which has been shown to alleviate symptoms in many individuals with IBS.

2. Hydration: Ensure you are adequately hydrated, as dehydration can exacerbate gastrointestinal symptoms. However, try to avoid drinking large amounts of water during meals, as this can contribute to bloating.

3. Stress Management: Since stress appears to play a role in your symptoms, incorporating stress-reduction techniques such as mindfulness, yoga, or regular exercise may help. Cognitive-behavioral therapy (CBT) has also been effective for managing anxiety and its physical manifestations.

4. Medication Review: If you are currently on medications for GERD or other gastrointestinal issues, it may be worth discussing with your healthcare provider whether these are the most appropriate for your symptoms. Sometimes, medications can have side effects that exacerbate gastrointestinal discomfort.

5. Follow-Up with a Specialist: Given the complexity of your symptoms, a consultation with a gastroenterologist is advisable. They can perform further evaluations, such as motility studies or additional imaging, to rule out any underlying conditions and tailor a treatment plan specific to your needs.

Conclusion
Your symptoms are indeed indicative of gastrointestinal issues that warrant further investigation and management. By addressing dietary habits, stress levels, and possibly adjusting medications, you may find significant relief. It’s essential to work closely with healthcare professionals who can provide a comprehensive approach to your gastrointestinal health. Remember, you are not alone in this, and many individuals experience similar challenges. With the right support and management strategies, you can improve your quality of life and reduce the impact of these symptoms on your daily activities.

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