How to manage nausea, heartburn, and epigastric pain?

Hi,

Welcome to icliniq.com.

I can understand your concern.

As per your history, you have had persistent nausea and post-prandial vomiting for one month, worsened by movement, bending, and activity. Vomit is non-bilious and non-bloody, containing food, water, and mucus.

I have checked your reports (attachments removed to protect the patient’s identity). Your UGI (upper gastrointestinal) endoscopy shows esophagitis, gastritis, and duodenitis. H. pylori is negative. Laboratory tests show HbA1c 5.7 (prediabetes range), raised CRP, low vitamin D and B12, and dyslipidemia (raised LDL (low-density lipoprotein) or total cholesterol).

The most likely diagnosis of your condition is non–H. pylori erosive gastroduodenitis with reflux esophagitis, compounded by functional dyspepsia and gastric dysmotility, with symptoms amplified by physical exertion and stress. Persistent nausea without bile, blood, or weight loss makes obstruction or CNS (central nervous system) causes unlikely.

You should take the following steps:

1. Stop Ranitidine. Start a PPI (proton pump inhibitor) twice daily (e.g., Esomeprazole or Pantoprazole) for six to eight weeks.

2. Add a prokinetic (Domperidone) for nausea and post-meal vomiting.

3. Short course Sucralfate if erosions are present; avoid unnecessary antibiotics.

4. Consider a low-dose neuromodulator (e.g., Amitriptyline at night) if nausea remains refractory.

5. Small, frequent meals; avoid spicy, fatty food, caffeine, and lying down for two to three hours post-meals.

6. Correct vitamin D and B12 deficiency, address dyslipidemia, and borderline glycemia.

7. Stress management and adequate sleep are essential.

8. Lifestyle modifications, including exercise and a low-calorie diet.

With optimized acid suppression plus prokinetic therapy, symptomatic improvement is expected within one to two weeks, with gradual resolution over four weeks.

I hope this information will help you.

Thanks.