Distension with Weight Gain

[MikeWmi]

Approximately one year ago,  I began to experience continuous and increasing abdominal distension and slowly began gaining weight. This accompanied by upper left side discomfort, including belching.  I was diagnosed with a small peptic ulcer 10 years ago and have been on various PPI's for over six years, but never had a return of previous symptoms.  Yet, I assumed it was the same problem again.  

So, off to the doctor, who ordered an endoscopy, colonoscopy, and complete abdominal CT Scan. To my surprise, everything came back normal. Also, the endoscopy showed no ulcer, inflamation and a sample for H. Pylori came back negative and there was no sign of bacterial or fungus invasion.  Yet, I was told to stay on the PPI and return if things didn't improve. Well, they haven't and I have these symptoms.  Could lifestyle be contributing even though I'm on a PPI?  I haven't tried too hard to change my lifestyle since I've been on a PPI and haven't felt the need to change up until this episode began over the last 12 months. I do drink a couple cups of coffee a day and a glass of red wine with dinner, but nothing abusive.  Could this be contributing to this flare up?  Has the PPI stopped working or could it now be causing the problem?  And the distension itself - would this be fluid or gas or a combination of the two. My doctor palpitated my abdomen but he said it wasn't consistent with fluid retention, but what else would cause the weight gain?  These are perflexing questions causing me a great deal of frustration.  Any help before I return to the Gastroenteroligist would be appreciated.  Thanks.

[boron]

Lifestyle is drinking two pegs of Vodka and 5 cups of coffee per day, and hanging around most weekend nights. Lifestyle is having trouble with putting shoes on because of big stomach. Being on drugs - medicines. "Red wine and nothing abusive" is not enough of life style to get distended abdomen :) .

When a doctor puts a side of the hand on the middle of your stomach, and bunch you from the side of abdomen, he feels a WAVE, if there is a fluid inside. If it's air, there's no wave. Weight doesn't come from the air. So, it could also be fat - no wave here.

You can have a diet test to see, if it's partly air/fluid. Don't eat for a couple of days, or at least don't eat ANY sugar, alcohol, beer, potatoes, pasta (simple carbohydrates), and as least as possible fibers (so, no fruit/vegetables/cereals). Drink only plain water (not tea). If it is bloating, it should go down considerably in two days. Anyway, distension from air goes with either burping or passing gas, at least when you have a bm.

But ultrasound could distinguish among air/fluid/fat, I believe. Or CT.

Main resaons for having free fluid in the stomach are:
- heart disease (you'd feel that)
- kidney disease (would be obvious from blood work)
- liver disease: heavy hepatitis or cirrhosis or heavy cancer etc.

So:
1. Can you describe these PPIs a bit more? It is known that people get resistant to H2 antagonists, like ranitidin, over the time. This shouldn't happen with omeprazol, I think.
2. Drop all PPIs for few days - what happens? Heartburn, burning stomach? If nothing happens, then a stomach is not a likely cause of your problems.
3. One common cause of bloating (from gas) is small bacterial overgrowth (SIBO). A simple BREATH TEST can reveal this.
4. Another cause for bloating is malabsorption, due to small intestinal disease like Crohn's or celiac disease. In this case, excessive fats would be found with a STOOL  FAT TEST. Diarrhea, or white sticky foamy stools would be present in this case.
5. Next cause of bloating: pancreas disease: BLOOD PANCREATIC ENZYMES would probably be elevated.

What to do:
Figure out is it fat or fluid or gas (see above).
Challenge your stomach with some vinegar, vitamin C, cabbage or lemons - if no burning or heartburn - it's not likely a stomach disease. Drop PPS for a while and observe effect.
Have proposed tests.


Fluid is treated with diuretics. Gas is treated with antibiotics (if SIBO, or H. pylori - you say no) or with treating eventual pancreatic or small intestinal disease.  

[jow366]

omeprazole has caused me to gain 2 stone extra weight around my stomach & I felt bloated, looked bloated, Mrs Ugly Old Woman & gave up bothering to wear anything nice because I look so awful - then the doc gave me ranitidine which caused itchy skin and lumps on the back of my neck and non-stop acid reflux - I got fed up and changed my meds to a tablespoonful of raw apple cider vinegar in a mug of warm water twice a day.  Symptoms gone - hopefully the weight goes down as well.

[MikeWmi]

Hi,  thanks for all of the information you provided. It will certainly be helpful.  I'd like to elaborate on a couple of things and answer a couple of your questions.  As for PPI usage.  I started on Prevacid for two years,  was switched to Aciphex for four years and then switched to Omeprazole last year because of insurance reasons.  The problem started to occur while still on Aciphex, so i don't think switching PPI's has been the problem.

As for going off the PPI. Yes,  I tried this only two weeks ago, because I read on several other blogs that the PPI's themselves can casue the distension and weight gain consistent with my symptoms. But,  within a couple days, I experienced horrible stomach burning and acid reflux at night.   So, I put myself back on Omeprazole immediately and went to see my doctor.  When I told my doctor that I tried this he said not to go off PPI's cold turkey ever again.  That you have to wean yourself off slowly, over a couple of weeks, especially given the length of time I've been on this class of drugs. So, I don't know at this point if the drug is helping me or hindering me.

So, based on this new information, the fact that I experience the belching and comparing all of this against the information you provided, it sounds like my stomach.  BTW, I also had a blood test that shows markers for food sensitivities and this was normal too.

But, can stomach issues, like gastritis, cause the bloating and weight gain?  Can those to associated with stomach problems too?  And, regarding your comments about weight gain and distension.  I thought I read one time,  that highly compressed gas in the abdomen can cause weight gain too.  Because as my stomach gets more distended, I'll gain around two pounds and the abdomen is hard, not sloshy from water. And my doc said it wasn’t water.  Finally, if the stomach, why would I have symptoms, yet show nothing on the endoscopy?  Can something like a a weak musocal linings cause the symptoms, yet not show anything on the endoscopy?  Burning questions that when answered, will hopefully resolve my problem.  Thanks for your help.

[boron]

As you've figured out, it's air, or gas to be correct. Gas causes this hard distended stomach.

Gaining two pounds when you're distended, it's from - food or drink. One big bottle of soda is two pounds, right? After the meal, you weight much, and after bowel movement less, it's like that. Weight is not from the air, that air compression was a joke.

You're using the word "belching" - is this burping? Burping is from the gas, produced by bacteria (usually H. pylori). H. pylori is the most common cause of gastritis, and ulcer, as it was probably in your case. Omeprazole, you're taking blocks secretion of acid, but does nothing to H. pylori. I believe that mild H. pylori infection could be unrecognised on endoscopy. So, I recommend breath test for H. pylori (but NOT blood test, which can't distinguish between old and new infection).

To continue...if H. pylori test will be negative, it's possible that gas is produced by small intestinal bacterial overgrowth (SIBO). This can be recognised by another breath test (maybe both breath tests may be done together, can't say)

In either case, you get antibiotics.

[MikeWmi]

Thanks,  I'll ertainly get these tests done.  But what about Candidia?  Could it possibly be that?  Are how do you tell the difference between a root cause of bacteria or fungus? Does Candidia present itself with different symptoms?

[boron]

There are only few microbes which give so characteristic signs that you may guess them without stool culture test. Guessing exact microbe should not be your concern.

Well, and now I'll say something just opposite.

Candida is special in that it is hard to diagnose - there are many false + or - results. Candida NORMALLY lives in human mouth and colon, also in the skin. So, if someone with diarrhea have a stool test, he might be positive for Candida (which is normal resident in colon), but the real cause of diarrhea might be another microbe. On the other hand someone might have heavy candidiasis in colon, but fungi are not shed in stool, so - negative result.

Officially, the only reliable test for intestinal candida is BIOPSY OF COLONIC MUCOSA, done during colonoscopy.

Symtoms, typical (but not yet diagnostic) for intestinal candida are:
- ORAL THRUSH - thick white patches on the tongue (but not always present!!)
- CRAVING FOR SUGAR.
- dye-off symptoms. When you have a low-carb diet, candida dies massively in the colon and start to release acetaldehyde - the same substance which causes hangover after a heavy drinking session. So, it is typical, when your candida starts to heal (due to diet or drugs), symptoms become WORSE, and you feel like a day after drinking! (tiredness, headache, sleepiness...)

More about intestinal candida overgrowth:
http://www.allhealthsite.com/40/intestinal-candida-overgrowth/

[boron]

As you'll read in that article, you can try a low-carb diet for few days, and see what happens. Bloating and weight gain go with candida, but you should have some more characteristic symptoms...

Try that diet. Note: If you have candida, symptoms will get WORSE on the beginning, so don't be surprised. Read there, how to prevent those die-off symptoms.