Persistent Bloating and Discomfort: Is It Just GERD or Something More?

Q: Persistent Bloating and Discomfort: Is It Just GERD or Something More?

Hello, sir： It appears that you have a disorder of gastrointestinal motility, so medication treatment and dietary adjustments are still necessary. <br>The necessity of continuing the PPI can be discussed with your physician. <br>Additionally, it may be worthwhile to check for any

For the past six months, I have been experiencing constant bloating, belching, difficulty breathing, and it is also accompanied by nausea and loose stools?

For the past six months, I have been experiencing constant bloating, belching, and shortness of breath.
Sometimes I feel nauseous and have soft stools.
Initially, I underwent an endoscopy which revealed a duodenal ulcer.
The doctor prescribed antibiotics and a proton pump inhibitor (PPI).
After taking the medication, the ulcer and Helicobacter pylori infection improved, but I started experiencing persistent abdominal bloating, difficulty breathing, belching, and nausea, along with a frequent lack of appetite (because eating even a little makes me very bloated, and sometimes I even vomit).

Later, I had another endoscopy, and the doctor mentioned that I have gastroesophageal reflux disease (GERD), so I was prescribed Pariet 20 mg, mopride, and Gascon, which I have been taking for almost four months now.
However, my symptoms have not improved.
I would like to ask the doctor if my condition, which is not just occasional but constant bloating for several months, and the lack of improvement despite medication, could be solely due to GERD, or if there might be other underlying conditions.
Additionally, should I continue taking the PPI? It has been four months with no improvement.

24-year-old male, 20~29 year old female. Ask Date: 2015/07/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, sir: It appears that you have a disorder of gastrointestinal motility, so medication treatment and dietary adjustments are still necessary.
The necessity of continuing the PPI can be discussed with your physician.
Additionally, it may be worthwhile to check for any liver, gallbladder, or pancreatic issues.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2015/07/19

More Info

Persistent bloating, discomfort, and associated symptoms such as belching, nausea, and loss of appetite can be quite distressing, especially when they persist despite treatment. In your case, it seems that you have a history of a duodenal ulcer and have been treated for Helicobacter pylori infection, which is a common cause of ulcers. After successful treatment, you developed symptoms consistent with gastroesophageal reflux disease (GERD), for which you have been prescribed a proton pump inhibitor (PPI) and other medications.

While GERD can certainly cause symptoms like bloating and discomfort, your ongoing symptoms raise the question of whether there might be additional underlying issues at play. Here are some potential considerations:
1. Functional Dyspepsia: This is a common condition characterized by chronic or recurrent pain or discomfort in the upper abdomen. Symptoms can include bloating, early satiety, and nausea. It can occur independently of GERD and may not respond well to PPI therapy.

2. Gastroparesis: This condition involves delayed gastric emptying, which can lead to bloating, nausea, and a feeling of fullness after eating only a small amount of food. It can be caused by various factors, including diabetes, certain medications, or idiopathic reasons.

3. Irritable Bowel Syndrome (IBS): Given your history of gastrointestinal issues, IBS could also be a possibility. It can present with bloating, changes in bowel habits, and discomfort, and is often exacerbated by stress and dietary factors.

4. Food Intolerances: Sometimes, specific food intolerances (like lactose intolerance or gluten sensitivity) can lead to bloating and gastrointestinal discomfort. Keeping a food diary may help identify any potential triggers.

5. Other Gastrointestinal Disorders: Conditions such as small intestinal bacterial overgrowth (SIBO), celiac disease, or inflammatory bowel disease (IBD) could also present with similar symptoms.
Regarding your question about the continued use of PPIs: While PPIs are effective for reducing stomach acid and treating GERD, long-term use can have side effects, including potential nutrient malabsorption and increased risk of certain infections. If your symptoms have not improved after four months of treatment, it may be worth discussing with your healthcare provider whether to continue this medication or consider alternative treatments.

Given the complexity of your symptoms and their persistence, it is advisable to follow up with a gastroenterologist. They may recommend further diagnostic testing, such as an upper gastrointestinal series, gastric emptying study, or even a breath test for SIBO, to better understand the underlying cause of your symptoms. Additionally, a tailored approach that includes dietary modifications, lifestyle changes, and possibly psychological support for stress management may be beneficial.

In summary, while GERD is a significant factor in your symptoms, the persistence and nature of your discomfort suggest that further evaluation is warranted to rule out other gastrointestinal conditions. Working closely with your healthcare provider will help you find the most effective management strategy for your symptoms.

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