Please suggest treatment for indigestion and intestinal worms.

Question

Hello doctor,

I am a 48 year old male, who is in good health. I have a long history of indigestion, mostly experienced as a pressure in the throat. About ten years ago, I had a clear endoscopy, and I took Nexium for six months and cut way back on alcohol drinking, which seemed to do the trick. I had occasional relapses over the recent years, but only after consuming four or more alcoholic drinks at night, which happens once a year. It always clears up a couple of days later. Currently, I consume one to two drinks at a time, twice a month, which causes no problems. About two months ago, I had three drinks a night for three nights in one week, and then I had a few more the following weekend. This caused daily indigestion, which stuck around for more than a week. I self-prescribed a course of Omeprazole and probiotics, but I had to stop around day 10 due to stomach upset. I had gas, bloating, cramps, and gurgling sounds. Things have gotten better over the last 14 days, but sporadic stomach upset persists, mostly after a bowel movement. I do not have gas and bloating anymore, but I have mild cramping. My stool has also firmed up much more than normal in the last week or so, but I am not exactly constipated. I also feel something in the anus, which I assume is hemorrhoid. I do not have pain or itching, but it did bleed once, after a hard bowel movement, several weeks ago. It did not recur even after more than six weeks. Since things were getting better, I planned to ignore it until I had a bowel movement today and noticed what looked like a worm. I have attached a picture of the stool, sorry for the graphic nature. Please suggest treatment for indigestion and worm infestation.

Answer 1

Hello,

Welcome to icliniq.com.

I have seen the attached photo (attachment removed to protect patient identity). For dyspepsia and gastritis, I would suggest you take Nexium (Esomeprazole). Initially, take it 40 mg twice daily, however, if it is not relieved, doses can be increased to 80 mg twice a day. Ask your gastroenterologist to add a prokinetic drug like Levosulpiride, it is a sulpiride isomer and exerts its prokinetic effect by blocking D2 receptors. Recent studies have shown that combining it with Rabeprazole has a good effect in patients suffering from GERD (gastroesophageal reflux disease). Domperidone is very effective in treating GERD when combined with Rabeprazole. Trials have shown that Acotiamide 30 mg, taken for three months, thrice daily, were highly effective in the treatment of functional dyspepsia. Baclofen is normally used for cerebral palsy patients and patients with other neuromuscular diseases. It has been successfully used in patients with reflux. It may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux. Please discuss all these options with your gastroenterologist. I suggest you get the following tests done: Endoscopy to examine the inner part of the esophagus. Ambulatory acid test for monitoring the amount of acid within the esophagus. Apart from that, drastic lifestyle modification and dietary changes are required as follows:

Firstly, stop taking soda or any aerated beverage.
Food and beverages like chocolates, fatty food, coffee, alcohol, and peppermint should be avoided to reduce the weakening of the lower esophageal sphincter. Several food items irritate the damaged esophageal lining, and should also be avoided. They include citrus fruits, tomato, and pepper.
Smoking cigarettes result in weakening of the lower esophageal sphincter and should be stopped to reduce GERD.
Take about 30 g of fiber daily in your diet. Eat one cup of fresh fruits (except banana) and half bowl of green salad daily. This will meet your extra total fiber requirement. Avoid citrus fruits as they can increase the symptoms.
Avoid alcohol.
Exercise daily for 20 minutes at least.
Avoid oily and spicy food.
Drink cold milk.
Yogurt is a very good natural source of probiotic, take it daily.

Adhering to both medicines and strict lifestyle changes will help you in the long term. Last but not the least, keep yourself fully motivated. The problem can be gastritis along with disturbed gastrointestinal flora.The intestinal microflora is a complex ecosystem containing over 400 bacterial species. The flora is sparse in the stomach and upper intestine, but luxuriant in the lower bowel.

The intestinal flora is capable of fermenting indigestible carbohydrates (dietary fiber) to short chain fatty acids such as acetate, propionate, and butyrate. The major source of such fermentable carbohydrate in the human colon is plant cell wall polysaccharides such as pectins, cellulose, and hemicellulose. The acids produced from these fiber substrates by bacteria can be an important energy source for the host.

The gut flora helps to neutralize some of the toxic byproducts of digestion, reduce harmful substances (such as toxins and carcinogens), and discourage bad bacteria and yeasts. It also helps to stimulate the digestive process and aid the absorption of nutrients, as well as producing vitamins including B and K.

So, any problem with this flora causes symptoms like gastric pain, burping, poor digestion, etc. I would suggest you take probiotics regularly. Probiotics will help to restore the depleted intestinal flora along with probiotics, Vitamin B complex is to be taken. Once the flora is replenished, all problems related to digestion will improve.

Soil contaminated by human feces or uncooked food contaminated by soil that contains roundworm eggs can cause worm infestation. I suggest you start therapy with Albendazole 400 mg, once daily at night for seven days.

For more information consult a medical gastroenterologist online.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, it is a hookworm. It is about 3 inches white round parasite in the feces. Hookworm infection is mainly acquired by walking barefoot on contaminated soil.

I suggest taking Albendazole 400 mg for seven days. Consult your specialist doctor, discuss with him or her and start taking the medicine after their consent.

For further queries consult a medical gastroenterologist online.