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Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Endocrinology
Satisfied Customers: 2813
Experience:  Have experience of Endocrinology over the last 3 years
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I need help with some questions - I hope this is the right

Customer Question

Hello I need help with some questions - I hope this is the right doctor for this - I had a endoscopy and a colonosopy done a few weeks ago- my colon was perfect nothing there at all - I tested positive for h. Pylori and gastristis - I finished the 10 day treatment with the antibotics - amoxicillin - flagyl - clarithromycin. And I'm still not better, I'm on the second day after treatment finished and I still have horrible stomach pains nausea and want to vomit but I try my best not too. I worry I may have a condition called gastroprisis which I really don't want because that means I will be nauseous or vomit most of my life and that's no life at all. I fear feeding tubes as medication is hard for me to handle.I took a gastric emptying test - these were my numbers - at 1 hour the stomach retains 74% normal range 37-90% - at 1 1/2 hours the stomach retains 65% of the meal - at 2 hours the stomach retains 57% of the meal normal is 30-60% - at 4 hours the stomach retains 15% of the meal - normal is 0-10% - so I was 5% over - suggesting gastroparsis but my doctors think i shouldn't be feeling this bad with these low numbers - my question is do I indeed have gastroparsis?? - as I'm scared and I hardly can eat. I want to vomit all the time after I eat. What are your thoughts and will I get better in time or is this for the rest of my life ? Please answer thank you
Submitted: 13 days ago.
Category: Endocrinology
Expert:  Dr. Muneeb Ali replied 13 days ago.


Welcome to JA and thanks for this question. My name is***** and i am reviewing your question and will get back to you with a response ASAP!!!

Customer: replied 13 days ago.
Thank you
Expert:  Dr. Muneeb Ali replied 13 days ago.

Well from what you are describing there are a few possibiluties which can cause your symptoms. It is true that you COULD have gastroparesis however the gastric emptying tests numbers are certainly not very concerning. The last test showed that you are only 5% over as you pointed out which usually doesnt mean that you have severe gastroparesis or even gastroparesis at all. If your symptoms persist or get worse after a couple of months, this test can be repeated then and compared to your original test. this will allow us to say definitively whether or not your have gastroparesis.

Even if you do have gastroparesis, there are several treatments which can help here. Medications in mild cases can be very effective. you can be started on domperidone or erythromycin etc which can help in improving teh motility. This diagnosis does NOT mean that you will vomit the rest of your life or will need feeding tubes, it simply means that you will need some medications. Many people are diagnosed with this and an OVERWHELMING majority are treated with drugs and remain perfectly fine, only a small minority develop severe form of teh disease.

Now apart from this it is possible that your h.pyroli and gastritis has not been treated. Some cases can require repeat treatment either due to an increased load of the organism or even due to resistance of the organism to the antibiotics. if this is the case then you can be started on another regimen to control the symptoms. Secondly the gastritis can persist even if the h.pyroli has been cleared out, inflammation of the lining of the stomach will take atleast 4 weeks to get back down to normal. During this time you will need drugs liek omeprazole, pantoprazole on a daily basis. if omeprazole isnt working you can be shifted to rabeprazole or dexilant which are much stronger.

Lastly this can also be due to a small benign gastrin producing tumor in the pancreas which can cause gastritis and ulcers in the stomach. if your gastritis does not respond to normal therapy then you will need a CT scan of the abdomen and serum gastrin levels to rule this condition out. It again is curable with surgery.

So in short you should NOT be worried all of the possibilities here have a solution although it may take some time.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

Customer: replied 13 days ago.
I fear I have the severe kind as I don't handle medications well as they upset me with side effects - I was on all the medications that you listed - I'm also on Klonopin for anixety - and sleep medication amdien CR for sleep and nausea meds that dont help much - and they are trying me on dexilant - once every morning - I just started it today - I fear as it may not work and how long does it take to start working? what will my next step be - doctors need to wait 6 weeks to retest the h plyori infection to see if I need more treatment - I fear it could still be active now and waiting longer will make my symptoms much worse while waiting for the retestAny thoughts of further testing? At this point ? The doctor also wants to do the breath hydro test in two weeks and lactouse breath test also well - and then Maybe a smart pill study ? Any suggestions on this ?
Expert:  Dr. Muneeb Ali replied 12 days ago.

Since you are on dexilant it may take upto 2 weeks in order to truly start working. Secondly i did mention additional testing in regards ***** ***** ellison syndrome (small gastrin producing tumor) which can be done if symptoms dont improve after 6 weeks. Even if the H.Pyroli is in the stomach and has not responded to the treatment, in 6 weeks it will not cause any major damage to your stomach it can cause gastritis in this time frame but usually not an ulcer. 2 weeks is the ideal time frame to hget tested with breath tests etc, this will allow time for dexilant to work and if it doesnt work then we can consider the capsule endoscopy. But right now doing additional tests would not yield any new information. I would suggest that you continue with the dexilant for two weeks and then we can reconsider what needs to be done.

Do you have any more questions?

Please leave a POSITIVE rating by clicking on the stars above, until you do i am not compensated for my time. You can continue to ask follow-up questions even after the POSITIVE rating. You can also ask questions from me directly by going on the link below,

Expert:  Dr. Muneeb Ali replied 11 days ago.

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