Patient's Query
Hello doctor,
My 30-year-old wife has been living with gastroesophageal reflux disease (GERD) for a while, and her symptoms seem to have worsened recently. She has been feeling persistent nausea and mild abdominal pain after meals, even though she has been diligent about taking her proton pump inhibitors (PPIs). She also complains of bloating and frequent burping, which seem to be increasing. We are starting to wonder if this could be more than just acid reflux, maybe something like bile reflux or even small intestinal bacterial overgrowth (SIBO). Would you recommend additional diagnostic tests to rule out these conditions, and could her treatment plan be adjusted to address these symptoms?
Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Worsening abdominal pain despite proton pump inhibitors (PPIs) is an indication for further diagnostic tests. What should be ruled out in such circumstances is a hiatal hernia or the progression of the gastroesophageal reflux disease (GERD) to Barrett’s esophagus. These two major differential diagnoses of your worsening pain can be differentiated using an upper gastrointestinal endoscopy. So, your wife would need to do a diagnostic test to determine the actual cause of her worsening symptoms. Small intestinal bacterial overgrowth (SIBO) comes with features of malabsorption, weight loss, and other gastrointestinal (GI) symptoms.
The probable causes include:
GERD.
Hiatal hernia.
The investigations to be done include:
Upper gastrointestinal endoscopy.
Stool microscopy, culture, and sensitivities test (MCS).
I advise you to do the following things. These include:
Adjust the dose of your PPIs (Let me know what you are taking so that I can adjust accordingly).
Take small frequent meals instead of larger ones at a longer frequency.
Avoid highly spicy foods for now.
Regarding follow-up:
Do let me know when you have the test results.
I hope this helps.
Thank you.
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Answered byDr. Obinna Ugwuoke
Medically reviewed byiCliniq medical review team
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