Hello doctor,
I am a 32 year old suffering from anxiety disorder, and I took some related medicines for a few years and still take Mirtazapine. I have weight issues from a couple of years. I do blood examinations regularly, which come back normal. Lately, I am having problems with heartburn. I had a helicobacter infection last year, followed by Streptococcus infection last month. Both have been treated with antibiotics. During my last blood examination, the cholesterol level was 5.7. A gastroenterologist said that I am probably prone to Gilbert's syndrome, due to bilirubin levels coming up on the blood test. I like drinking, but I used to drink during my late 20's much more, than I do now. I am a moderate drinker. I have an appetite of a lion, but I tend to limit my food intake at a minimum, to keep my weight under control. Which I am not being able to do. I do not do any physical activity, so that does not go in my favor. Whatever food I have, I can smell the odor when I burp even after several hours. If I go slightly generous with food for three days in a row, my stomach bloats. I took Espumisan and Pantoprazole tablets about a month ago, for two weeks, and I went on a diet. It was better. Now that I am back to my daily routine, these problems are back again. I am also constipated since a child. I would like to get your opinion. Are these symptoms related? Is this coming from the depression? How can I soothe heartburn and bloating? How to lose weight? Your replies would be greatly appreciated. Thank you.
Hi,
Welcome to icliniq.com.
- All the symptoms are related to bowel disturbance. This is multiple issue disorder, as you are presenting with pain, excessive burping, and heartburn. And you also have constipation. This is called IBS (irritable bowel syndrome).
- All the symptoms are interrelated. See if the bowel does not clear daily, then it will be difficult to maintain other systems properly. Heartburn and excessive burps are also related to this issue.
- I suggest you try doing the following.
- We need to clear your bowel with laxatives. Then, we give maintenance laxatives, with this, you will get it cleared daily. By that time, we need to change food habits like restrictions of junk foods.
- You need to take plenty of water to make the stool softer.
- A high-fiber diet is very important to make stool bulky. Take tomatoes and cucumber daily, if available.
- Avoid coffee and juices.
- Toilet training, try to defecate thrice a day without applying any force, after drinking water. It will regularize your bowel movement.
- I suggest taking Polyethylene glycol, one packet of 137 g with 2 liters of water. you will pass loose stools after this, which will clear your bowel. We may need to repeat if the stool is not coming. Do not take solid foods in between this packet.
- By the second day, continue with Polyethylene glycol 17 g sachet, 2 sachets once a day at night with 200 ml of water.
- Consult your specialist doctor, discuss with him or her and start taking the medicine after their consent. Most of the patients respond well with this regimen. I would like to advise you review the response details. So that, we can hike the medicine or plan to change it in case it is needed. Regular follow-up with a physician is important.
Revert with more information to a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Hello doctor,
Thank you for your detailed answer and diagnosis. Let me inform you that, I tried to find the therapy you prescribed, but I was unable to find it in the whole town. Instead, I found this medicine, the picture of which I have attached. It is called Effecol 3350, its main ingredient is Macrogol 3350. Please let me know your opinion. If this does not work, is there a substitute you would recommend? Thank you.
Hi,
Welcome back to icliniq.com.
I saw the photo of the medicine (attachment removed to protect patient identity).
- Its contents are the same. But, this is a maintenance dose only. For the initial clearance, we need to give a higher dose.
- It should be roughly around 130 g packet. Or you need to take 10 sachets of the small one. Check it if available, otherwise, I suggest you try taking ten sachets. This will be costly. Consult your specialist doctor, discuss with him or her and start taking the medicine after their consent.
Inform me for further assistance.
For further queries consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Hi doctor.
Thank you for your reply. This was the only closest I could get. So for initial clearance, should I put ten sachets in 2 liters of water or less? Do I have to do that in one day? And on day two, should I continue with maintenance dose? And for maintenance, I should take one sachet, that is, 13 g. How many times do I take it in a day? How much water to mix with one sachet? Also, what kind of food do you recommend for me to take on a daily basis? Do you have any suggestion for heartburn relief and stopping of weight gain? Any particular food or natural remedy? Once again, thank you.
Hi,
Welcome back to icliniq.com.
- You can take ten sachets in 2 liters of water over three hours, not in the whole day. Do not take anything in between this regimen. You may need to repeat if clear water is not passed. The maintenance dose should be 2.5 sachets at night, with 300 ml of water.
- Consume 300 to 400 ml water, 15 minutes before defecation. Preferably lukewarm water.
- Your diet should contain high-fibre. It should contain pulses, cereals, and fruits. Try to lose weight, and your target should be 70 kg. Continuous follow-up is the key for this. Tell me about what you eat for seven days, and I will modify it accordingly.
- For now, I suggest taking Pantoprazole 40 mg, once in a day.
- As you are overweight, we need to do an ultrasound of the liver. Then we will plan for more blood investigations based on that because you may be at risk for metabolic syndrome.
Revert with more information to a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
Hello doctor,
Thank you again for your time and quick reply. I will do as per your instructions. I would like to be under close supervision for some time to be able to get over these problems. How long should I take Pantoprazole? Is there any way to reduce my appetite and food or sweet craving? My problem is that I have a big appetite. I do not have any sort of regular food that I take. I usually do not eat breakfast. What would you suggest for breakfast? I love meat, and I could not live without meat. I am not so much into vegetables. I like cabbage, lettuce, broccoli, and eggplant, but I do not eat peppers, tomatoes, or cucumbers. Also. I am not that much of a fruit fan. I eat banana or sometimes apple. I do not like pears, berries, plums, and grapes. I like drinking green tea, and I do not drink coffee. I also would not like to quit wine or alcohol, unless I was strictly prohibited. The last time I met a gastroenterologist, he told me to stop garlic, onion, cabbage, coffee, chocolate, banana, wine, and so much more. There was nothing left for me to eat. As for the liver, I have twice done liver examinations. The bilirubin levels indicate that I may have Gilbert's syndrome. Also, there is a lot of fat around my kidney, and one specialist suggested I have a fatty liver. What do you suggest for that? I was worried because, during the last two years, my cholesterol levels have been slightly up. I am wondering if the liver has anything to do with all these problems?
Hi,
Welcome back to icliniq.com.
- Pantoprazole should be taken for two weeks.
- Avoid meat and gooseberries, rest of the things you can take easily. You need to start eating cucumber and tomatoes. Continue taking the cabbage and broccoli, no issues.
- Yes, I was also worried about fatty liver. It is very important to lose weight now. Otherwise, it may lead to cirrhosis. Alcohol should be stopped. I suggest you get the following tests done:
- Liver function tests.
- Fasting blood sugar.
- Triglycerides.
- Cholesterol.
- HOMA-IR (homeostatic model assessment-insulin resistance).
- Fibroscan, if available.
For more information consult a medical gastroenterologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-gastroenterologist
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