Q. I have issues with digestion and need a treatment. Please help.

Answered by
Dr. Ajeet Kumar
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Dec 05, 2020 and last reviewed on: Jun 16, 2021

Hello doctor,

I have been having some issues with digestion and mucus. I completed a stool screening that came back with high-fat levels in my stool (steatocrit). I started taking digestive enzymes to help with that, which has really helped shape my stools. However, it has not helped all of my issues. My symptoms are feeling really full with a small meal, a lot of burping, a lot of mucus and phlegm, trouble swallowing. It seems to be worse at the end of a meal, and I feel like I have something stuck in the back of my throat. Does this sound like anything to you, and if so, is there something I can ask my doctor to prescribe? Or better yet, is there a more natural solution? Kindly give your opinion.



Welcome to

Well, the symptoms you mention indicates a problem at three levels of the gastrointestinal tract. First, fat in stools suggests a problem with absorption, which can occur in the small bowel, and pancreatic diseases. Second, excessive gases can occur due to disease of the above part of the digestive system, plus can occur due to small intestinal bacterial overgrowth or SIBO (small intestine bacterial overgrowth). Thirdly feeling of food stuck at the back of the throat suggests a problem with the esophagus.

If I need to tell you only one diagnosis that encompasses all the above areas of the GI (gastrointestinal) tract, it is systemic sclerosis or scleroderma. But since this condition is very rare and often follows a detailed history and lab investigations before establishing this diagnosis. So no, I do not think any natural remedy or a single pill will solve your problem. Firstly it has to be established. Then a treatment is guided.

Other various possibilities can explain your symptoms and not necessarily scleroderma. Like, weight, diabetes, use of previous antibiotics, prior surgeries. So I want you to answer various questions that would help us include the most probable and exclude less probable conditions. I hope this was helpful.

Hi doctor,

Thank you.

I have attached some files of my test results for you to have a bit more information. Although I had fat in the stools, which would lead to the conclusion of malabsorption, all my blood tests came back normal, indicating I was not deficient in anything. The doctor here also said that according to the tests, I was producing the correct enzymes. I also had a SIBO test that came back negative. I am not saying that is conclusive, but I did have one done. I am not sure I fit the symptoms for sclerosis, but you mentioned antibiotic use. While traveling through the asian country a few years ago, I contracted giardia, and it took many antibiotics to get rid of it. I do not have diabetes. I am 170 cm tall, and my weight is 62 kg, so not overweight. I do not have any surgeries besides shoulder surgery. Kindly give your opinion.



Welcome back to

I have seen the reports that you have uploaded (attachments removed to protect the patient's identity).

1) You do not have SIBO. However, the sudden upsurge of H2 (hydrogen) at 120 minutes of breath testing suggest colon bacterial problem (colonic dysbiosis). Dysbiosis means an abnormal composition of the colon microorganism. This seems because of deficient lactobacillus species. And this is common to have a deficiency of these species after the use of antibiotics. They decline with advancing age (as 70% of the adult population have deficient organisms). The common problem with this microorganism deficiency is that the person is unable to digest milk (which contains lactose) or milk-based diets like ice cream, sweets, sometimes coffee, and milk tea.

2) Now, your steatocrit suggests fat malabsorption. But as you rightly pointed out that there is nothing abnormal within your pancreas, and nor your blood testing indicate that you have vitamin deficiencies, gluten allergy, or pancreatic disease (normal amylase level). To confirm that you actually have this fat malabsorption, we should repeat only this test now (possibly that was a false-positive result) and with certain other tests in the blood and stools like stool steatocrit, stool for Sudan stain, and blood carotene levels.

3) So as far as to conclude things, it seems your symptoms of indigestion and excessive gas seems to be due to deficiency of lactobacillus, which can replenish by using probiotics for at least six months, Plus using Lactase (which is an enzyme supplement) with a brand name of tablet Lactaid 9000 FCC to help you to digest milk whenever you eat anything containing milk. Take one tablet just before having milk or milk-based things. It would help if you started taking tablet Ecotec (bacillus coagulans-inulin) twice daily. This is a probiotic medication. Or any other probiotic available in your country containing lactobacillus species.

4) Lastly, if your symptoms do not improve, then I would ask you for motility testing. Smart pill is a new technique that is now being performed to assess the movement of the stomach and small and large bowel. You just search this on the internet, you would get an idea because gastroparesis (slowing of the stomach) or small bowel pseudoobstruction (slowing of the small bowel) and slowing the large bowel are the other possible explanations for your symptoms. I suggest some prokinetic (which improves the bowel movement) to see if it improves your symptoms, tablet Itopride-SR 150 mg, once daily half an hour before breakfast. Avoid foods with high-fat content, such as red meat.

I hope this was helpful. Please get back if you have further doubts.

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