Reflux, GERD, Stress, Prilosec, Questions

  History- 34 y/o female experiencing early satiety, queasiness, burning stomach with weight loss, since July.  Prior to that was diagnosed with Giardia due to mucous diarrhea also present.  Treated with Flagyl, diarrhea disappeared.  Had flex. sig (normal).  Upper GI symptoms continued into September with continued weight loss and worsening of symptoms.  Had upper endoscopy and diagnosed with reflux and mild esophagitis.  Given Prilosec (20 mg/twice per day).  Felt an immediate 80% improvement.  Regained appetite, regained some weight, and was doing well; however, still noted that I couldn't eat large portions of food as I used to.  Prilosec reduced to once per day (20 mg).
  Over the Columbas Day weekend I had to go out of town for a family reunion.  I was nervous because I knew I would have to eat all my meals at a restaurant.  By Sunday, I was hurting--dull pain in upper left side, belching, feeling of fullness.  I've doubled back up on the Prilosec in an attempt to get my stomach back to normal but it is just not working.  I've also had a very stressful week.  On top of being tired from the reunion, I had to take a quick, one-day trip out of town to attend a funeral.  So I have been tired/stressed all week and the fact that my symptoms are back are not helping the stress.  I find that my stomach is "declining rapidly" and I am back to a loss of appetite.  Can stress really do this and what can I do to reverse this setback?
  Also, I've been reading some of your posts on gastroparesis and you mention that, often times, an MRI should be done to rule out intracranial pressure or central nervous system problems.  When you discuss this are you referring to brain tumors causing nausea, gastroparesis?  Or are their other neurological conditions that can cause this besides tumors that an MRI would pick up on?  Just curious.  I've not been tested for gastroparesis; however, I do experience some of the symptoms intermittently.  (Mostly due to stress I think).
  Prilosec--When I take 40 mg per day I notice that I have generalized water retention.  Is this normal?  I really notice it on the 40 mg.  Today, I woke up and my eyes were very puffy.  When I just take 20 mg, I still have it but to a lesser degree.  Have  your patients reported this and why would a drug cause this?  Also, if I take 40 mg I note some feelings of being off-balance but not on 20 mg.  I am just concerned because I want to make sure that the drug is causing this and not an underlying condition.  I don't want to stop the Prilosec to find out though!!
  Thanks for your help.
  Christine  
______
Dear Christine,
I think that you should be checked for gastroparesis because this condition could account for your symptoms.  Most patients with gastroparesis have primary gastroparesis i.e. it is not associated with other conditions.  An MRI is not indicated for patients with gastroparesis unless you are considering multiple sclerosis among the conditions that could cause he delayed gastric emptying.
Our patients have not complained of water retention or  of balance problems associated with the Prilosec.
This information is presented for educational purposes only.  Always ask specific questions to your personal physician.
HFHSM.D.-rf
*keywords: gastroparesis, Prilosec
0.2