Re: Ongoing Nausea

Posted By HFHSM.D.-ym on March 11, 1998 at 18:40:29:

In Reply to: Ongoing Nausea posted by Erika on February 23, 1998 at 01:13:59:







: A friend of mine has had persistant nausea for the last 6 months.
It started while we were traveling in Cairo, several hours after eating
a meal.  Since returning, he has been to see several specialists.  After
a full battery of tests, including: endoscopy, flexible sigmoidoscopy (?),
ultrasounds, barium swallow stomach x-rays, and the usual stool samples
and blood work, they have basically come up with nothing.  He didn't show
up positive for any parasites or giardia, but has been treated with Flagyl
and Cipro (for 1-2 weeks), along with a combination of Flagyl, Losec (?),
and one other drug (for H. Pylori), and Vancomycin for 3 weeks (for C.
Difficile).  Unfortunately, although those have gone, the symptoms persist.
In addition to the continual nausea, we have noticed that he ocasionally
feels dizzy and has a general flu-like feeling.  It also appears to be
somewhat cyclical: he'll feel not too bad for a few days (although
definitely not normal!) and then relapse and feel horrible for several days.
Basically, the specialists we have seen have no clue what could be causing
this and are adopting a "wait and see" attitude, assuming it will go away
eventually.  In the meantime, he is a 30-year-old (formerly healthy and
active) man who has been reduced to frequent bedrest.  Ideally, we are
looking for ideas or areas to look into in terms of diagnosis - but at this
point, would even be happy with suggestions of drugs to manage the symptoms
(as nothing so far seems to substantially help!).  Thank you!
  


Dear Erika,
      
      Your friends persistent nausea poses a diagnostic dilemma. Although, it seems to be temporally related to the trip to Cairo it is possible that he has a separate condition that by coincidence became symptomatic while you were in Cairo. the trip.
       I  dont feel that I can provide a diagnosis in this case until I personally reviewed all of the tests that were performed.  I would cuation care in taking antibiotic therapy  in the absence of a particular infectious organism being isolated. Giardia is an organism which can be hard to see in stool specimens and may require a duodenal aspirate to be able to make the diagnosis.
      Nausea can be caused by a variety of medications and herbal supplements, gastroesophageal reflux, partial intestinal obstruction, an esophageal or gastrointestinal motility disorder or a variety of medical conditions that affect areas outside of the gastrointestinal tract. Your friend may need to have tests which specifically try to exclude these particular problems  in order to plan further management. I hope you find this helpful.  A gastric emptying study would be appropriate.  IF Gi etiologies are not found, then an evaluation of the ears and central nervous system would be indicated.
     This response is  being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician  when you have a question pertaining to your health.

      If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians Office and  make an appointment to see Dr. Muszkat  one of our experts in Gastroenterology.
HFHSM.D.-ym
keywords: nausea, gastroparesis
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