Seeking Guidance on Gastrointestinal Challenges
Hello, I apologize for the lengthy message, but I find myself in need of some advice regarding my health situation. I’m a 24-year-old female with a complex medical background that includes gastroparesis, recurrent bowel obstructions (eight instances between January and May of last year), gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), Sjögren's syndrome, and dysautonomia. I underwent a G-POEM procedure for my gastroparesis in January 2025, which followed a problematic pyloroplasty in October 2024 impacted by adhesions, and prior to that, an adhesion surgery in March 2024. My history includes intussusception as an infant, two instances of sepsis, and extensive surgery resulting in the removal of much of my intestines and appendix due to a perforation. Currently, my medications include 50mg of Strattera taken twice daily, 200mg of acebutolol twice daily, 40mg of pantoprazole once daily, 25mg of amitriptyline once daily, 5mg of ivabradine once daily, and 40mg of Caplyta once daily. The G-POEM I had earlier this year went relatively smoothly aside from an edematous pylorus which was nearly obstructed. The surgeon managed to enlarge it but indicated that its size still falls short of optimal. Before the procedure, I was on a regimen that included Reglan, Zofran, Scopolamine, and Promethazine, but I was struggling with my ability to eat. Post-surgery, I initially felt great, but this changed about a month ago. Approximately three weeks ago, I began experiencing nausea roughly 20 to 30 minutes after meals, making it nearly impossible to keep food down. I consulted my gastrointestinal specialist, who prescribed Zofran and Scopolamine; however, these medications provided minimal relief. A week following this onset, I started dealing with diarrhea occurring every hour to three hours, often accompanied by blood. This prompted a hospital visit, where I spent a week receiving IV fluids and Compazine. The medical team checked for hemorrhoids to explain the bleeding but found none. They introduced oral Compazine for my nausea, which was effective. Despite my discharge, I struggled with solid foods but was okay with full liquids. Since leaving the hospital a week ago, I've faced continued difficulties with eating; I've inadvertently lost about 15 pounds in the past three to four weeks due to persistent nausea and the severe diarrhea that follows eating. I was given Xifaxan upon discharge in case my symptoms were linked to SIBO, yet I haven’t noticed significant improvements. I have an appointment with my GI tomorrow, during which we will plan an endoscopy and colonoscopy. I’m reaching out to see if anyone else has experienced similar issues or has suggestions on what might be happening, as I feel quite lost. Thank you for taking the time to read my concerns!
Answers (1)
7/23/2025, 6:11:04 PM
OpenHealth AI
Thank you for sharing your detailed medical history and current concerns. It sounds like you're navigating a very complex situation with multiple gastrointestinal issues. Your persistent nausea and diarrhea coupled with weight loss are understandably distressing, and I want to help you focus on actionable steps to manage your symptoms while you await further evaluation.
Main Points:
- Nausea and diarrhea post-meals are significant issues that require monitoring.
- Keep track of your symptoms as you prepare for your upcoming GI appointment.
- Prioritize hydration and nutritional support to address weight loss and prevent further complications.
Explanation:
Your symptoms of nausea shortly after meals and diarrhea, especially with blood, can indicate several underlying issues, including possible exacerbation of SIBO, changes in your gut motility due to recent surgery, or complications related to your existing conditions. The G-POEM procedure may also contribute to altered gastrointestinal function, especially in the early stages of recovery. It's vital to monitor these symptoms closely, especially since you've noticed a significant weight loss and difficulty with solid foods.
Next Steps:
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Hydration and Nutrition:
- Focus on staying hydrated. Consider electrolyte drinks to help replenish fluids lost from diarrhea.
- Since solid foods are currently challenging, try incorporating easily digestible full liquids or soft foods. Options such as broths, smoothies, and pureed foods may be easier to tolerate and provide some nourishment.
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Symptom Diary:
- Keep a detailed diary of your food intake, nausea symptoms, and timing of diarrhea. Note any specific triggers (certain foods or activities) that seem to worsen your symptoms. This will be valuable information to share with your GI specialist.
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Medication Review:
- Discuss with your GI doctor the effectiveness of medications like Zofran and Scopolamine, particularly in light of your recent experiences. Ask if additional or alternative therapies might be available, considering that your symptoms have persisted despite your current regimen.
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Preparation for Upcoming Procedures:
- Ensure you have a clear understanding of the endoscopy and colonoscopy procedures and what they aim to investigate. It's essential to communicate your recent changes and concerns during your appointment to guide the doctors in their assessments.
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Immediate Concern Handling:
- If you experience worsening symptoms, such as increased blood in your stool, severe abdominal pain, or signs of dehydration (like dark urine, dizziness, or confusion), seek immediate care.
Your health challenges are considerable, but I encourage you to take proactive steps and communicate openly with your GI specialist. You're not alone in this, and sharing your experiences will help others understand your situation better. Please feel free to reach out again if you have more questions or need further support.
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