[30F] With chronic nausea, vomiting, and gastrointestinal symptoms

Patient Description

A 30-year-old female has been experiencing chronic nausea, vomiting, upper abdominal pain, and acute diarrhea for approximately 6-7 months. The nausea occurs most often in the mornings, comes on quickly and violently, and is exacerbated by eating breakfast. Each episode can last from an hour to all day. Vomiting occurs 1-3 times a day. The upper abdominal pain is rated as 5 out of 10 in severity. Diarrhea has been ongoing for 2 months, with bowel movements occurring 3-6 times a day. The patient has not identified any specific foods that worsen the diarrhea and has not traveled recently. She reports extreme hunger and nausea in the mornings, leading to skipped meals. Heartburn and acid reflux are also present. The patient has not experienced weight loss, blood in stool, or fever. Stress appears to exacerbate the symptoms. Medical history includes asthma diagnosed at age 13. Current medications include Nuvaring, Vitamin C, Potassium, Glucosamine, and allergy medications. The patient does not smoke or consume alcohol regularly and has no known drug allergies or family history of gastrointestinal issues.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses that could explain your condition:

  1. Gastroesophageal Reflux Disease (GERD):

    • Rationale: Your symptoms of nausea, vomiting, and heartburn, especially in the mornings and after eating, are consistent with GERD. GERD occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).
    • Typical Treatments/Testing: Treatment often includes lifestyle changes, such as avoiding certain foods, eating smaller meals, and not lying down after eating. Medications like antacids, H2 blockers, or proton pump inhibitors (PPIs) may also be prescribed. An upper endoscopy might be performed to assess the esophagus.
  2. Irritable Bowel Syndrome (IBS):

    • Rationale: Your symptoms of abdominal pain, diarrhea, and changes in appetite could be indicative of IBS, a common disorder affecting the large intestine.
    • Typical Treatments/Testing: Treatment may include dietary changes, such as increasing fiber intake or following a low-FODMAP diet, stress management, and medications to manage symptoms. A doctor might perform tests to rule out other conditions, such as blood tests or a colonoscopy.
  3. Peptic Ulcer Disease:

    • Rationale: Upper abdominal pain, nausea, and vomiting can be symptoms of peptic ulcers, which are sores that develop on the lining of the stomach, small intestine, or esophagus.
    • Typical Treatments/Testing: Treatment usually involves medications to reduce stomach acid and antibiotics if an infection is present. An upper endoscopy may be performed to diagnose ulcers.

What you can do

For Nausea and Vomiting:

  • See a doctor: Given the duration and severity of your symptoms, it's important to consult a healthcare provider for a thorough evaluation and appropriate treatment.
  • Dietary changes: Try eating smaller, more frequent meals and avoid foods that trigger your symptoms, such as spicy or fatty foods.
  • Stay hydrated: Drink plenty of fluids to stay hydrated, especially if you're vomiting frequently.
  • Elevate your head: When sleeping, try elevating your head with extra pillows to reduce acid reflux.

For Abdominal Pain and Diarrhea:

  • Consult a doctor: It's important to get a proper diagnosis to determine the underlying cause of your symptoms.
  • Dietary adjustments: Consider following a low-FODMAP diet or increasing your fiber intake, depending on your doctor's recommendations.
  • Stay hydrated: Drink plenty of fluids to prevent dehydration from diarrhea.
  • Stress management: Since stress seems to exacerbate your symptoms, consider stress-reducing activities such as yoga, meditation, or deep-breathing exercises.

For Heartburn/Acid Reflux:

  • Avoid trigger foods: Identify and avoid foods that trigger your heartburn, such as spicy, fatty, or acidic foods.
  • Eat smaller meals: Eating smaller, more frequent meals can help reduce symptoms.
  • Avoid lying down after eating: Wait at least 2-3 hours after eating before lying down to prevent acid reflux.
  • Over-the-counter medications: Consider using antacids or H2 blockers to manage symptoms, but consult your doctor before starting any new medication.

General Tips:

  • Use MDandMe: Journal your symptoms, track your progress, and get insights. This can help you and your healthcare provider better understand your condition and make informed decisions about your treatment.
  • Seek medical care: If your symptoms worsen or you experience new symptoms, seek medical care promptly.

What you should look out for

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

  • Severe abdominal pain: If your pain becomes severe or unbearable.
  • Persistent vomiting: 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: If you start losing weight without trying.
  • Blood in stool or vomit: If you notice any blood, seek immediate medical attention.

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

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4 mo ago


People Also Ask


What are the common symptoms of Gastroesophageal Reflux Disease (GERD)?

Common symptoms of GERD include heartburn, regurgitation of food or sour liquid, difficulty swallowing, chest pain, and a sensation of a lump in the throat. Symptoms often worsen after eating or when lying down.


How can stress affect gastrointestinal symptoms like nausea and diarrhea?

Stress can exacerbate gastrointestinal symptoms by affecting the gut-brain axis, leading to increased gut sensitivity and changes in gut motility. This can result in symptoms like nausea, diarrhea, and abdominal pain.


What dietary changes can help manage symptoms of Irritable Bowel Syndrome (IBS)?

Dietary changes for managing IBS symptoms may include following a low-FODMAP diet, increasing fiber intake, avoiding trigger foods, and eating smaller, more frequent meals. It's important to work with a healthcare provider to tailor dietary changes to individual needs.


When should I seek medical attention for persistent nausea and vomiting?

You should seek medical attention for persistent nausea and vomiting if you are unable to keep food or fluids down, experience severe abdominal pain, show signs of dehydration, notice unexplained weight loss, or see blood in your vomit or stool.

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