Thanks for the further information.
His symptoms are suggestive of intestinal motility disorder. One of the commonest is called as irritable bowel syndrome (IBS). Following investigations may be considered (if not done);
1) The complete blood count (CBC); altered in irritable bowel disease (in whom leukocytosis / high WBC count is the more frequent result).
2) Protein electrophoresis pattern may show alterations of both albumin and globulins (especially alpha-1 and gamma globulins) in IBS.
3) Thyroid function tests; an high thyroid may cause loose and frequent bowel motions.
4) A barium meal is a helpful study in the diagnosis of intestinal motility disorders (which is done, I believe).
5) Computed tomography (CT) and nuclear magnetic resonance examinations are also necessary.
7) Scintigraphic study of the small bowel or colonic transit time is currently most preferred investigation for his symptoms. It shows the intestinal progression of the meal.
Medications like neostigmine, bethanechol, metoclopramide, cisapride, may help him.
Following measures collectively may help;
1) Fiber supplementation may improve motions. Citrucel and FiberCon may produce less flatulence than psyllium compounds (Metamucil).
2) Caffeine avoidance may limit exacerbation.
3) Lactose and/or fructose should also be limited or avoided.
The reasons for excessive intestinal gas formation can be;
1) excessive air swallowing.
Anxious people swallow air when they are stressed or anxiety supervenes.
2) increased intraluminal (inside the intestine) production from mal absorbed (improperly absorbed) nutrients,
3) decreased gas absorption due to some pathological condition of intestines like diverticulitis
4) expansion of intestinal gas due to changes in atmospheric pressure
A solitary reason or combination can be responsible for the excessive gas.
Following may help him;
2) This may help;
a) Bismuth subsalicylate
b) Activated charcoal
c) Simethicone; (Maalox, Mylanta); Simethicone causes gas bubbles to break up.
d) Beano; contains an enzyme (alpha-galactosidase), which helps to breakdown certain complex carbohydrates.
All are available without prescription.
Avoid foods that appear to aggravate symptoms. These may include milk and dairy products, certain fruits or vegetables, whole grains, artificial sweeteners etc. But this is based on the personal observation for the aggravating food.
3) Further investigations by his physician;
a) Healthy people pass gas up to 20 times per day. If the frequency of passage of flatus is more than 20 times per day, gas chromatographic analysis of flatus collected via a rectal tube can differentiate air swallowing (which is nitrogen predominantly) from intestinal production of gas (which is hydrogen and carbon dioxide).
b) Colonic transit time.
c) HIDA scan; to rule out poorly functioning or non functioning gall bladder.
d) Magnetic resonance cholangiopancreaticography (MRCP)
Discontinue the following if he does them;
1) gum chewing,
3) drinking carbonated beverages, and
4) gulping food and liquids.
The gas formation and mild discomfort in his age would need to look for the following causes also;
1) Gallbladder disease (gallstones)
For acid reflux following would be helpful;
1) antacids; Maalox
2) acid blocker; Prilosec
3) loosing weight, if overweight.
4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products
5) avoiding large meals. Eat 5 small meals in a day.
6) wait three hours after the meal before you sleep.
7) elevate head end of the bed by 8 inches.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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