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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35798
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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32 yrs old with a lot of medical issues. To help understand

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Hi Dr,My name is ***** ***** old with a lot of medical issues. To help understand me a little better let me give you a quick medical background.I was diagnosed with JRA at the age of three. Unfortunately because of the lack of understanding and availability of medicine, I am now in a wheelchair. I was also diagnosed with diabetes1 at the age of 23. With that came a diagnoses of gastro peresis. In 2010 came RSD & recently a pain pump. I've been very bloated n not passing gas for over 6 months.

Hello Emily,
I am Dr. Arun and will be helping you today.

Gastroparesis or slow emptying stomach needs a very comprehensive management regime. Judicious and persistent intervention by various measures should be able to control the symptoms quite nicely. Following is the management plan. If the initial conservative plan does not help, surgical intervention should be considered.

1) nutritional modifications,

a) multiple small meals,

b) favor liquids over solids,

c) avoiding indigestible solids,

d) consuming low-fat meals

2) medications to stimulate gastric emptying,

a) metoclopramide,

b) erythromycin,

c) domperidone,

d) phenothiazines (prochlorperazine, thiethylperazine),

e) Ginger

f) Acupressure

g) Nitrates, buspirone, sumatriptan

3) endoscopic and surgical approaches,

a) Injection of botulinum toxin

b) gastric electrical stimulator implantation

c) surgical pyloroplasty

4) psychological interventions

a) treatment of anxiety and depression

b) biofeedback and/or hypnosis

So a comprehensive approach is essential for controlling of the symptoms and various specialists like gastroenterologist, primary care physician, psychologist, etc would be needed to work in cohesiveness to get the optimal outcome.

The bloating and gas can also be due to;

1) Irritable bowel syndrome (IBS)

2) Diverticulosis

3) Gall bladder dyspepsia (poorly functioning gall bladder).

4) Sub acute intestinal obstruction

Following may help you;

1) Avoid

a) Cabbage

b) Beer

c) Legumes

d) Cheese

e) Beans

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) Investigations by your physician (if not done recently); Ideally you should consult a gastroenterologist who can perform the following investigations which are the mainstay of the evaluation and which will give true perspective of the cause;

1) Blood investigations do give the clue. A complete blood count, biochemical profile, serum calcium, blood glucose, and thyroid function test.

2) Depending on these blood results further blood work is done; serum protein electrophoresis, urine porphyrins, serum parathyroid hormone, and serum cortisol levels, may be done to identify or rule out myeloma, porphyria, hyperparathyroidism, and Addison's disease. These causes are not common causes so clinical manifestation and physical examination clues are important.

3) Barium enema or barium meal with follow through study

4) Colonic transit time; it can provide a better understanding of the rate of stool movement through the colon.

5) Other investigations like Anorectal manometry, balloon expulsion test, Defecography etc.

6) Colonoscopy / sigmoidoscopy

7) CT scan of abdomen.

Discontinue the following if you do them;

1) gum chewing,

2) smoking,

3) drinking carbonated beverages, and

4) gulping food and liquids.

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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Customer: replied 4 years ago.

My gastroenterologist has me on domperidone. I have had most of those tests done. I also forget to mention that I have collagenous colitis, which I am on medicine for as well. I am not having trouble having bowel movements, it is just the inability to pass gas, and the severe bloating.

Customer: replied 4 years ago.

i thought Beano was for excessive gas?

I also forgot to mention that I have hypothyroidism and am on medication for it.

Hello Emily,

Yes, Beano also helps for excessive gas too, especially if some specific food is the causative.

Your doctor may also consider any of the following medications;

1) Bethanechol
2) Tegaserod
3) Cisapride
4) Methylnaltrexone helps decreasing the side effect of pain pump medication (if the bloating and gas is supposed to be the causative).

Dietary measures as discussed may also help. Physical activity on a wheel chair is limited but some sitting exercises may also be beneficial.

It is privilege assisting you.

Dr. Arun
Customer: replied 4 years ago.

But I don't have excessive gas. I have the opposite problem, NO GAS!! I can try bean for that too? Any other over the counter medications?

Customer: replied 4 years ago.

Also, I am not having problems emptying my bowels


These medicine are efficacious for the bloating too. Actually these are regulators of the intestinal motility (movements). It is a hit and trial by using these medications one by one.
Customer: replied 4 years ago.

But if I'm already regular can't it cause diarrhea?


No these do not cause diarrhea. Bloating is a pointer that intestinal motility is not co-ordinated. Thus these medications just regulates them and do not cause diarrhea or increased number of bowel movements.
Dr. Arun Phophalia and 2 other Health Specialists are ready to help you
Hello Emily,
Let me know, how you are doing and if you have any follow up queries.
Thank you.
Best wishes and kindest regards,