and Managing Symptoms of Gastroparesis and GERD - Gastroenterology and Hepatology

Gastric ptosis, gastric tightness, and abdominal bloating significantly affect daily life. How can these conditions be improved?

Symptoms: The most troubling symptoms are 1.
A feeling of gastric ptosis (a sense of heaviness in the abdomen).
2.
A sensation of gastric sensitivity, as if there is a balloon inside my stomach (a foreign body sensation), which I also feel in the morning, knowing that the "balloon" in my stomach hasn't inflated yet.
After drinking water or eating, I immediately feel bloated, even if I only drink a little water, which is very uncomfortable.
If I bend over or tighten my abdomen, the feeling of tightness and bloating alleviates somewhat, allowing for deeper breaths.
However, if I relax my abdomen to take a deep breath, the bloating and tightness become more pronounced and uncomfortable (I also experience this feeling when hungry, and it does not go away just because I am hungry; for example, after having a lunch box, I still feel like the food is in my stomach four hours later).
3.
Sometimes I experience heartburn, a warm sensation in my throat, and abdominal pain, which can occur regardless of what I eat.
4.
Occasionally, I feel a sensation of food regurgitation.
Current treatment: I underwent an endoscopy at a clinic, where the doctor noted signs of gastroesophageal reflux, bile reflux, and Helicobacter pylori.
The clinic physician prescribed Pantoprazole for three months along with other adjunct medications (antacids, medications for bloating, and digestive aids), and I also underwent a triple therapy regimen for Helicobacter pylori.
After taking Pantoprazole, the feeling of gastric ptosis almost disappeared, but the improvement in other symptoms was limited, and I felt that my digestion had slowed down.
Subsequently, I visited a hospital where the doctor reviewed my previous abdominal X-ray from a health check-up and found that I had severe constipation, with stool in my intestines appearing as hard lumps, so I was prescribed Lactulose (a stool softener).
After listening to my symptoms, the doctor also prescribed Gastroprotective agents, a digestive aid, and half a dose of Zantac (originally a full dose, but I experienced mild systemic weakness after taking it, so it was reduced to half).
However, the doctor did not specify a diagnosis, only stating that the symptoms were complex and prescribed medication for about a month.
Recently, my physical and mental condition has worsened, and I have become very anxious and irritable.
My father passed away from pancreatic cancer in 2020, and he was repeatedly told by doctors that he had gastroesophageal reflux.
He later discovered his CA 19-9 levels were over a thousand, but by then it was already stage four, and he passed away six months later.
As a result, now that I am experiencing gastric discomfort, relatives and friends keep urging me to get a CT scan, MRI, or to see a larger hospital.
Initially, I thought it was just something to consider, but now I feel very angry.
I know they care about me, but I feel they are constantly implying that I have a serious illness, which feels like a curse.
I can't stop thinking about it, and my abdomen becomes hot and painful, making me feel even worse, but I cannot control my thoughts and feel anxious and distressed.
Questions: 1.
Why do I have the above symptoms? Is it gastroesophageal reflux? Why do some symptoms not improve with medication? 2.
Should I undergo additional tests (CT, MRI, endoscopy)? If I request to pay for these tests out of pocket, will they be beneficial for the physician's diagnosis? 3.
Could it be autonomic nervous system dysfunction? What tests should I undergo to rule out other possibilities and confirm autonomic nervous system dysfunction? 4.
Should I seek help from a mental health specialist for my physical and mental condition? I hope you can provide answers to my questions.
Thank you.

ANN, 30~39 year old female. Ask Date: 2023/02/10

Dr. Chen Shidian reply Gastroenterology and Hepatology

The preliminary diagnosis is likely related to reflux and abnormal (slow) peristalsis.
A diet of small, frequent meals and medication management is recommended.
Additionally, an abdominal ultrasound and Ca 19-9 test can be performed, and a CT or MRI can be done at the patient's expense.
It may also be beneficial to schedule an appointment with a psychiatry department for anxiety management.

Reply Date: 2023/02/10

More Info

Understanding and managing symptoms of gastroparesis and gastroesophageal reflux disease (GERD) can be quite complex, especially when symptoms overlap and affect both physical and mental well-being. Based on your description, it seems you are experiencing a range of gastrointestinal symptoms, including a sensation of fullness, bloating, heartburn, and possibly food regurgitation. These symptoms can be indicative of conditions like gastroparesis and GERD, but they can also be influenced by other factors, including anxiety and stress.

1. Understanding Your Symptoms
The sensation of a "heavy" or "balloon-like" feeling in your stomach, especially after eating or drinking, is characteristic of gastroparesis, a condition where the stomach takes too long to empty its contents. This can lead to bloating, nausea, and a feeling of fullness after eating only a small amount of food. The fact that you experience relief when bending over or tightening your abdomen suggests that physical positioning may help alleviate some of the pressure or discomfort.

GERD, on the other hand, is characterized by the backward flow of stomach contents into the esophagus, leading to symptoms like heartburn, regurgitation, and sometimes a sensation of food "sticking" in the throat. The presence of bile reflux, as noted in your diagnosis, can exacerbate these symptoms, as bile can irritate the esophagus.

The lack of improvement in some symptoms despite medication could be due to several factors, including the complexity of your condition, the possibility of medication side effects, or the need for a more tailored treatment approach.

2. Diagnostic Considerations
Regarding further diagnostic tests like CT or MRI scans, these imaging studies can provide valuable information about the structure of your gastrointestinal tract and help rule out other conditions. However, they may not be necessary if your symptoms are consistent with gastroparesis and GERD, which can often be diagnosed through clinical evaluation and endoscopy. Since you have already undergone a gastroscopy, it may be more beneficial to focus on optimizing your current treatment plan rather than pursuing additional imaging unless new symptoms arise or your condition worsens.

3. Autonomic Nervous System and Mental Health
Your concerns about autonomic nervous system dysregulation are valid. Stress and anxiety can significantly impact gastrointestinal function, leading to symptoms that mimic or exacerbate conditions like gastroparesis and GERD. It is essential to consider the mind-gut connection; anxiety can lead to increased gastric motility issues and exacerbate reflux symptoms. If you find that your anxiety is affecting your daily life, seeking help from a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) and other therapeutic approaches can help manage anxiety and improve your overall quality of life.

4. Recommendations for Management
- Dietary Adjustments: Consider smaller, more frequent meals that are low in fat and fiber, as these can be easier to digest. Avoiding trigger foods (spicy, acidic, or fatty foods) can also help reduce GERD symptoms.

- Medication Compliance: Continue taking the medications prescribed by your doctor, and discuss any side effects or concerns you have with them. Sometimes, adjustments in dosage or medication type can lead to better symptom control.

- Lifestyle Modifications: Incorporate stress-reducing techniques such as mindfulness, yoga, or gentle exercise. Elevating the head of your bed can also help with nighttime reflux symptoms.

- Follow-Up Care: Regular follow-ups with your healthcare provider are crucial. If symptoms persist or worsen, further evaluation may be warranted.

In conclusion, your symptoms are likely multifactorial, involving both gastrointestinal and psychological components. A comprehensive approach that includes dietary management, medication adherence, and mental health support will be essential in addressing your concerns. Always communicate openly with your healthcare providers about your symptoms and any changes you experience.

Similar Q&A

Managing GERD and Belching: Seeking Solutions for Ongoing Discomfort

Hello Doctor: I have been suffering from gastroesophageal reflux disease (GERD) and belching for the past five years. I have undergone three esophagogastroduodenoscopies (EGDs), and the doctors have indicated that there are no gastric ulcers. During the first examination in 2018 ...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Currently, treatment involves medication (strong gastric medications available for self-pay in conjunction with National Health Insurance gastric medications) and dietary control. If the condition is severe, endoscopic surgery may be considered in the future when the technology h...

Managing GERD and Stomach Pain: Tips for Relief and Recovery

Due to being in a state of significant anxiety recently, I was diagnosed with Grade B gastroesophageal reflux disease (GERD) and mild gastritis after undergoing an endoscopy in mid-June. I have been continuously taking medication (Takepron and Mosapride) and adjusting my diet and...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Please discuss with your gastroenterologist whether you need to add anti-anxiety medication when your medication is finished.

Managing GERD and Gastroenteritis: When to Seek Medical Attention

I have been taking antihypertensive medication and started experiencing gastroesophageal reflux disease (GERD) since September of last year. After undergoing an endoscopy, the doctor diagnosed me with mild GERD, and at that time, Helicobacter pylori was not detected. I have been ...

Dr. Xu Kaixi reply Surgery
You have previously undergone an upper gastrointestinal endoscopy and were diagnosed with mild gastroesophageal reflux disease. You have been taking the relevant medications, but your condition has not fully improved. It is possible that a peptic ulcer has not healed completely. ...

Managing Gastroparesis: Tips for Relief and Prevention

I have severe gastroparesis and often feel a sensation of my stomach dropping, which is very uncomfortable. Wearing a corset helps a bit. I would like to know if there are any ways to make me feel more comfortable and prevent this condition from worsening or even cure it. Thank y...

Dr. Yang Guojun reply Gastroenterology and Hepatology
Your symptoms should have been present for a while, and despite seeing many doctors, they have not improved. This condition is not life-threatening if there are no underlying causes such as ulcers or cancer. Please consult a gastroenterologist for treatment.