Steely Asked :
Can you give me some advice on a longstanding stomach complaint I’ve been suffering from for about 3 years now.
Over that time, I’ve had three extended periods (several months each) during which I’ve been experiencing a lot of belching (continuously throughout the day, beginning when I get up in the morning) and pretty much constant nausea.
I went to see a gastroenterologist during the first bout, who gave me a sigmoidoscopy and gastroscopy, and decided (since he’d seen spasms in the colon) that I must be suffering from IBS. He then prescribed a series of IBS treatments (colofac, mebeverine etc), none of which worked, until he started me on a course of amitriptyline. This seemed to work, and I was symptom free for about 8 months.
Then the symptoms kicked off again, with amitriptyline this time having no effect. After a few months, deciding that this was probably still IBS, and following up on a suggestion on the internet, I dropped my high (insoluble) fibre breakfast cereal and switched to porridge oats. Again, the symptoms went away.
However, the symptoms have now come back for the third time, with porridge having no effect.
I’m wondering whether the symptoms have nothing to do with IBS (I was always suspicious of this diagnosis, since I have absolutely no bowel issues from the waist down – I go regularly and don’t suffer from diarrhoea or constipation), and that the symptoms went away for some reason other than the amytriptyline and porridge. Could I be suffering from H.Pylori or SIBO instead? Is it possible that my gastroenterologist might not have spotted these problems during the gastroscopy? I did have an HP blood test, but if I understand correctly this isn’t as reliable as a breath test, which I don’t believe I had.
This question was posted under the Excessive Belching and Bloating Causes and Treatment article.
Any response by the Health Hype team does not constitute a medical consultation and the advice should be viewed purely as a guide. Always consult with your doctor before making any changes to your current treatment program. The information provided in this article is not an authoritative resource on the subject matter and solely intends to guide the reader based on the questions asked and information provided.
Dr. Chris Answered :
Yes, it is quite possible that your symptoms resolved on its own in the two previous bouts and that they may not have been related to the drug you were using or the dietary change. The condition you may have is self-limiting and episodic and it may be useful to try to identify events, foods, drinks or drugs that precede the onset of an episode.
IBS is very vague in its presentation and does not always appear as one would expect of a typical case. So in this regard your doctor may not have been mistaken and only took note of what he observed at the time. IBS is a functional disorder and not a disease as such. So when your doctor cannot detect any abnormalities upon conducting investigations like a colonoscopy and if the symptoms are related, a diagnosis of IBS may be made.
This does not mean that you will have episodic disturbances of your bowel movements but this is a common feature of IBS. Remember that spastic colon is another term for IBS and this may help you understand your doctor’s findings a bit better. Many IBS sufferers experience relief with anti-depressants and anxiolytic drugs.
You could be suffering with an H.pylori infection and you could have small intestine bacterial overgrowth (SIBO) but rather speak to your doctor about these conditions and testing before making any assumption. The H.pylori blood test is quite effective in chronic infections especially as it indicates immune activity specifically against this bacteria but may not always be conclusive in recurrent acute episodes. The breath test may be more helpful in this regard but it is up to your gastroenterologist to decide whether this test is warranted.
There are two other aspects to your condition that is worth considering. Air swallowing (aerophagia) is a very common cause of excessive belching. During times of stress or even due to nasal congestion, one tends to swallow more air than usual. It could be a possibility that during these times you were experiencing a stressful period or you were suffering with a bout of nasal congestion for whatever reason and this led to aerophagia. Stress could account for why you responded well to the amitryptiline at the time. The nasal congestion could be due to a seasonal cause like perennial rhinitis and when this eased, the air swallowing may have subsided.
Another point to consider here is gastroesophageal reflux disease (GERD). Not every patient will experience the typical heartburn associated with acid reflux and at times other symptoms like nausea or belching may be present. GERD will also aggravate with stress and can occur in episodes rather than being constant. These are just two possibilities and it may be helpful to look at other causes of your symptoms rather than focusing entirely on gastrointestinal conditions. Of course your doctor would have considered these possibilities and there should have been some indication of GERD at this point.
You do not mention your age or other aspect of your medical history but it would also be advisable to have a diabetes test. I will not go further into why I suggest a diabetes test but some of the scenarios that you mention do raise concerns about conditions like diabetes or impaired glucose tolerance. Human intestinal parasites are another aspect to consider.
Consult with a gastroenterologist and provide any information that may be helpful for prompting further investigation or making a final diagnosis. There are a host of possibilities for the symptoms you are describing and it would be helpful to seek a second opinion if you are not experiencing any significant relief of your symptoms. If you are keen on a dietary change in the interim until you schedule a consultation with a gastroenterologist, it might be useful to consider a low FODMAP diet. Remember that there are other causes of bloating and gas which may not be very obvious initially.
You may also want to refer to the question on Severe Bloating and Burping Upon Waking, After Meals.