Nausea and Vomiting: Insights on Esophageal Ulcers and Treatment

Nausea and vomiting?

Hello Doctor, I would like to inquire about my gastroscopy performed in April this year.
Previous gastro-camera or fiberoptic findings: Premedication: Buscopan 20 mg intramuscularly and local use of 10% Xylocaine spray.
Esophagus: 1.
ONE CORD OF LINEAR ULCER.
Stomach: 1.
SUPERFICIAL GASTRITIS.
Duodenum: NEGATIVE FOR 2ND PORTION CLO: ■ YES □ NO.
Impression: ESOPHAGEAL ULCER.
I have been taking Pantoprazole and Sucralfate for almost three months, but I still experience nausea and reflux.
Could this be related to autonomic nervous system dysfunction? This symptom has made me afraid to eat anything, and I have lost 7 kilograms in three months.

A-Wen, 20~29 year old female. Ask Date: 2023/07/27

Dr. Zheng Weijun reply Internal Medicine

Hello, based on the results of your gastroscopy, you have a history of esophageal ulcers and mild gastritis.
The symptoms of nausea and regurgitation you mentioned may indeed be related to autonomic nervous system dysfunction.
Symptoms that can arise from autonomic nervous system dysfunction include nausea, stomach pain, and may lead to loss of appetite, resulting in weight loss.
However, if esophageal ulcers remain untreated for a long time, it is important to monitor for early signs of esophageal cancer.
If necessary, you may need to follow up with a gastroenterologist for further evaluation of the gastroscopy and biopsy results.
Additionally, patients with long-term autonomic nervous system dysfunction may sometimes develop complications such as anorexia nervosa; therefore, it is advisable to return to your psychiatrist for further assessment if needed.
Regarding dietary recommendations for patients with esophageal ulcers, it is suggested to avoid irritant foods such as spicy, acidic, and greasy items.
Limit excessive caffeine and alcohol intake.
Adopt a small, frequent meal approach to reduce the pressure on the stomach.
Consume well-cooked foods and avoid hard, dry, or crunchy foods to prevent scratching the esophagus.
Do not lie down immediately after eating; wait at least 2-3 hours.
Despite these recommendations, persistent symptoms and weight loss still require further examination.
It is important to mention that according to Article 11 of the Medical Practitioners Act, physicians must personally examine patients when providing treatment, prescribing medications, or issuing diagnoses; they cannot delegate this responsibility to others.
Therefore, if you experience ongoing symptoms or have other concerns, it is recommended that you schedule an appointment for a detailed examination to ensure your health.
If you are unable to visit the clinic, our affiliated and cooperating physicians are available to assist you: Dr.
Hsiang Kuo-Wei at Hsiang Kuo-Wei Internal Medicine Clinic, No.
141, Chongxue Road, Tainan City; Dr.
Wu Chong-Han at Hankan Clinic, No.
180, Daqiao 2nd Street, Yongkang District, Tainan City; and Dr.
Shih Yi-Cheng at Cheng Yi Internal Medicine Clinic, No.
189, Section 1, Beian Road, North District, Tainan City.
Wishing you good health!

Reply Date: 2023/07/27

More Info

Nausea and vomiting can be distressing symptoms, particularly when associated with esophageal ulcers. Your previous endoscopy findings indicate a linear ulcer in the esophagus, superficial gastritis in the stomach, and a negative result for the second portion of the duodenum. The presence of an esophageal ulcer can certainly contribute to feelings of nausea and discomfort, as the ulcer can irritate the esophageal lining, especially when food or liquids pass through.

Esophageal ulcers are often a result of gastroesophageal reflux disease (GERD), where stomach acid frequently flows back into the esophagus, causing irritation and inflammation. This can lead to the formation of ulcers. The symptoms you are experiencing, including nausea and a feeling of reflux, may indeed be linked to this condition. The medications you mentioned, such as "耐適恩" (likely a proton pump inhibitor, or PPI), are typically prescribed to reduce stomach acid production, which can help heal the ulcer and alleviate symptoms. However, it can take time for these medications to fully take effect, and some patients may still experience symptoms during the healing process.

In addition to medication, it is essential to consider lifestyle modifications that can help manage symptoms. These include:
1. Dietary Changes: Avoiding spicy, acidic, or fatty foods can help reduce irritation in the esophagus. Eating smaller, more frequent meals instead of large meals can also be beneficial.

2. Hydration: Staying well-hydrated is important, but try to avoid drinking large amounts of fluids with meals, as this can increase pressure in the stomach and exacerbate reflux symptoms.

3. Elevating the Head During Sleep: If you experience nighttime symptoms, elevating the head of your bed can help prevent acid reflux while sleeping.

4. Avoiding Triggers: Identifying and avoiding personal triggers, such as caffeine, alcohol, and tobacco, can significantly improve symptoms.

5. Stress Management: Since you mentioned concerns about autonomic nervous system dysregulation, incorporating stress-reduction techniques such as mindfulness, yoga, or deep-breathing exercises may help alleviate some gastrointestinal symptoms.

Regarding your weight loss of 7 kilograms over three months, this is concerning and should be addressed with your healthcare provider. Unintentional weight loss can be a sign of inadequate nutritional intake due to nausea and may require dietary counseling or further evaluation to ensure you are receiving adequate nutrition.

If your symptoms persist despite medication and lifestyle changes, it may be necessary to follow up with your gastroenterologist for further evaluation. They may consider additional diagnostic tests, such as a repeat endoscopy, to assess the healing of the ulcer and rule out any other underlying conditions.

In summary, while esophageal ulcers can lead to nausea and vomiting, a comprehensive approach involving medication, dietary modifications, and lifestyle changes can help manage these symptoms effectively. It is crucial to maintain open communication with your healthcare provider to monitor your condition and adjust treatment as necessary.

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