[25M] With persistent bloating, stomach pain, and early fullness

Patient Description

A 25-year-old male has been experiencing significant bloating, stomach pain, and discomfort for the past two months. The most troubling symptom is early fullness after eating, which started suddenly two months ago and persists for about an hour or sometimes a couple of hours, but the bloated feeling remains all day, every day. The patient has lost 30 pounds during this period and has visited the ER three times without any resolution. He reports constipation, typically having a bowel movement once in the morning, which can be a struggle. The stool is usually dark brown and varies in consistency. He also experiences nausea and sometimes induces vomiting to relieve the fullness. There is no blood in vomit or stool. The patient has limited heartburn or acid reflux and no difficulty swallowing. His appetite has changed completely, but he has not experienced any fever or chills. He has no history of gastrointestinal disorders or surgeries and has always been sensitive to hot foods. He uses marijuana but does not consume alcohol, tobacco, or recreational drugs. He has not traveled recently and has no family history of gastrointestinal disorders, heart disease, stroke, autoimmune diseases, diabetes, cancer, or psychiatric illnesses. Currently, he is taking Fdgard (2 pills before meals, twice a day) and Align probiotics (once daily). He has no known allergies to medications.

Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

Gastroparesis

Explanation: Gastroparesis is a condition that affects the stomach muscles and prevents proper stomach emptying. Symptoms include early fullness after eating, bloating, nausea, and weight loss.
Typical Treatments/Testing: Diagnosis often involves gastric emptying studies, and treatment may include dietary changes, medications to stimulate stomach motility, and sometimes procedures or surgeries.

Functional Dyspepsia

Explanation: This is a common disorder that causes discomfort or pain in the upper abdomen. Symptoms include early fullness, bloating, and nausea.
Typical Treatments/Testing: Diagnosis is usually clinical but may involve endoscopy to rule out other conditions. Treatment often includes dietary changes, medications to reduce stomach acid, and sometimes prokinetics.

Irritable Bowel Syndrome (IBS)

Explanation: IBS is a common disorder affecting the large intestine, causing symptoms like bloating, constipation, and abdominal pain.
Typical Treatments/Testing: Diagnosis is usually clinical, based on symptom patterns. Treatment includes dietary changes, fiber supplements, and medications to manage symptoms.

Unifying Diagnosis

Explanation: Given the combination of symptoms, a unifying diagnosis could be a motility disorder affecting both the stomach and intestines, such as a combination of gastroparesis and IBS.
Typical Treatments/Testing: Comprehensive testing including gastric emptying studies, colonoscopy, and possibly motility studies. Treatment would be tailored based on specific findings.

What you can do

Early Fullness and Bloating

Dietary Changes: Eat smaller, more frequent meals. Avoid high-fat and high-fiber foods, which can slow stomach emptying.
Medications: Continue taking Fdgard and Align probiotics as they seem to help. Discuss with your doctor about other medications that can improve stomach motility.
Lifestyle Changes: Stay upright for at least 2 hours after eating to help with digestion. Gentle exercise like walking can also aid in digestion.

Constipation

Hydration: Drink plenty of water throughout the day to help soften stools.
Fiber: Gradually increase your fiber intake with foods like fruits, vegetables, and whole grains, but do so cautiously as too much fiber can worsen bloating.
Over-the-Counter Remedies: Consider using stool softeners or mild laxatives as recommended by your doctor.

Nausea and Vomiting

Dietary Adjustments: Stick to bland, easy-to-digest foods like bananas, rice, applesauce, and toast (the BRAT diet).
Medications: Over-the-counter anti-nausea medications may help, but consult your doctor for appropriate options.

General Tips

Symptom Journal: Use MDandMe to journal your symptoms, track progress, and get insights. This can be very helpful for your healthcare provider to understand your condition better.
Medical Follow-Up: Given the severity and persistence of your symptoms, it's crucial to follow up with a gastroenterologist for further evaluation and tailored treatment.

What you should look out for

Given the severity of your symptoms and the significant weight loss, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Severe Abdominal Pain: If the pain becomes unbearable or is accompanied by fever, vomiting, or signs of infection.
Inability to Eat or Drink: If you are unable to keep any food or fluids down.
Signs of Dehydration: Such as dry mouth, dark urine, or dizziness.
Unexplained Weight Loss: Continued weight loss despite efforts to manage symptoms.

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and treatment plan.

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3 mo ago

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