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Thanks for providing me further important information about your health. Well, the diet is completely fine, except that she should avoid prune juice. The prunes contain a high level of fructose and other fermentable carbohydrates. If she wishes to take prunes, then give her as whole fruit, rather than juice. This rule applies to all fruits as well. Take whole fruit instead of juices. The meat products like the ones you mentioned are alright. Fish, chicken, and pork are fine. But avoid red meat, lamb, and avoid sausage of all types.
I suggest that she should use a small course of antibiotics for three weeks. Take tablet Rifaxamin 200 mg thrice daily for 21 days. This is a safe antibiotic that works only in the gut. Almost 99% of the drug remains in the gut. This will correct dysbiosis (abnormally high levels of large bowel type bacteria in the small bowel) so once bacteria in the large bowel migrate to infiltrate small bowel, and start producing gases when coming in contact with meal contents, commonly carbohydrates. I recommend that she should use it for three weeks. After that, I would consider her giving twice a day probiotic medicines. The commercially available tablet is Ecotec twice daily after meals. But this would be started once she finishes the above antibiotic course.
Domperidone 10 mg thrice daily half an hour before meals can be taken for four weeks until a definite improvement is seen. Tablet Itopride 150 mg once daily, half an hour before breakfast daily, again for four weeks.
I want you to monitor her sugars twice daily for a week. One before breakfast in the morning, and other in day time two hours after taking lunch (post prandial sugar). Make a chart of it for at least one week. Show it to me the next time you follow up with me. I see her HbA1c is just borderline (0.59%). That is why I am asking for sugar monitoring.
Lastly, I want you to read the FOMAPs Charts. This would be helpful in guiding which foods to be avoided and which foods to be allowed.
I have reviewed her previous history and diagnosis (attachment removed to protect patient identity). I agree with the rest of the medicines you described previously, plus once a day Multivitamin and calcium supplements.
The Probable causes:
Small intestinal bacterial overgrowth /intestinal dysbiosis. Idiopathic gastroparesis. Functional gas and bloating.Investigations to be done:
Sugar monitoring for a week.Probable diagnosis:
Small intestinal bacterial overgrowth /intestinal dysbiosis. Gastroparesis. Functional gas and bloating.Treatment plan:
Tablet Rifaximin 200 mg thrice daily for 21 days after meals. Domperidone and Itopride both for four weeks and Nexium as required. Continue with rest of medicines.Regarding follow up:
Follow up in one week with sugar chart. Or earlier if any concerns.