Dr. Ghulam Fareed
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have developed a situation where I have the urge to pass motion, but nothing comes out, and at the same time, I have mild nausea. So I have been recommended tablet Rifaximin 400 mg for 12 days, tablet Pantoprazole, tablet Itopride Hydrochloride, and Mycolon C at bedtime. Also, I have been given one lactulose syrup at bedtime. All my tests have been done, including endoscopy, RUT (rapid urease test), colonoscopy, and biopsy. I have been operated for SRUS (Solitary rectal ulcer syndrome), also. The report says mild gastritis. Now doctor tested me for celiac disease, which came out negative, but when I took off gluten, many of my nauseated symptoms were reduced. I am still on the 10th day of Gluten free diet. Starting today, I have added VSL#3 to the above medicine. What do you recommend in such a case?
Hi,
Welcome to icliniq.com.
I understand your concern.
I have reviewed your case history in detail; As per history, this seems to be a functional GI (gastrointestinal) disorder leading to constipation because if you read about solitary rectal ulcer syndrome, this occurs in patients with uncoordinated contractions between rectal muscles and anal sphincter. This is common in patients having sensitive personalities or anxiety/restlessness. For better effects, you can switch to Lactulose syrup with either a Polyethylene Glycol sachet or Laxoberon syrup. Consult a specialist doctor, discuss with them, and take medications with their consent. Meanwhile, if you have a sensitive personality, as per your solitary rectal ulcer syndrome history, you should be managed for this too. Biofeedback and pelvic floor muscles exercises will help youaswell.
Patient's Query
Hi doctor,
Thank you for the reply.
Also, note that the symptoms up big time after I had the Whey protein a year back and strangely subsided big time ten days back when I took off gluten from my diet. However, the prime complaint is that while on this medication for the last three days, I am fat intolerant and still have the urge to pass the bowel with slight nausea after three to four hours. My appetite is less than normal. My calprotectin test was also done, and it came out negative.
Hi,
Welcome to icliniq.com.
I understand your concern.
Yes, you are right; fecal calprotectin levels are normal and functional gastrointestinal disorders. However, I do not think so; this is related to a gluten-free diet. Also, your endoscopy was normal; they must have seen your duodenum (small intestine); if it was normal on endoscopy, there is less chance that you might have celiac disease or gluten allergy. Regarding your appetite, you are already on proton pump inhibitors and itopride; this should improve your appetite within a few days. Another point is that you can also try probiotics rather than restricting your diet; this may cause micronutrient deficiencies.
Kind regards.
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Medical Gastroenterology
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