How to manage symptoms like nausea and pain after meals?

Question

Hello doctor,

I have been experiencing distressing gastrointestinal symptoms after eating, including nausea, diarrhea, bloating, and pain. These symptoms are severely impacting my ability to obtain the necessary nutrition and hydration. I also have postural orthostatic tachycardia syndrome and undergo saline infusions twice a week.

Despite trying numerous medications to reduce these GI symptoms, I have not found effective relief. I also have a history of celiac artery compression syndrome, and the medical team is exploring a potential diagnosis of superior mesenteric artery syndrome. A recent upper GI series revealed gastromegaly and my gastric emptying test results are within the normal range. Currently, my medication regimen includes Fludrocortisone, Duloxetine, Buspar, and Ritalin.

Kindly suggest steps to manage my complex medical conditions, especially in light of the potential superior mesenteric artery syndrome diagnosis.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have thoroughly reviewed your case history and the attached investigations (attachments removed to protect the patient's identity).

Given your primary diagnosis of Postural orthostatic tachycardia syndrome (POTS), it is important to acknowledge that the autonomic nervous system, which controls various bodily functions, may also affect stomach and gut motility. The recent imaging reveals a significant enlargement of your stomach, which aligns with your abdominal symptoms.

To address your symptoms, you might benefit from adopting specific measures, including having frequent small meals, taking regular walks after eating, and using acid-suppression medication such as Pantoprazole 40 mg half an hour before breakfast. Combining this with pro-motility medication like Metoclopramide (10 mg before meals, twice daily) could be beneficial. Consult your specialist doctor, talk to them, and then take the medications as per their advice.

It is important to be aware that if you have experienced significant weight loss, there is a risk of secondary superior mesenteric artery syndrome (SMAS) due to a lack of intra-abdominal fats. Maintaining your body weight is essential in managing this risk. I would suggest you undergo a CT scan of the abdomen with contrast to assess the current status of your intra-abdominal organs and vasculature. There is no mention of a history of trauma or viral infections as potential triggers for your condition.

Please feel free to share any additional information or ask questions regarding your condition.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The gradual increase in stomach size is often due to distal obstruction, which can include conditions such as superior mesenteric artery syndrome. I trust that your medical team has already conducted a CT scan of the abdomen with contrast to assess the surrounding structures in detail. If so, kindly revert with the reports for further assistance.

Thank you.