Object01 2008-01-25 07:12:06
In the last several days I’ve experienced extreme nausea after eating
an evening meal. I kept reducing the amount I ate, but even last
night’s meal of a single breadstick and lots of water caused enough
subtle nausea to make me afraid of eating more. I belched more than a
few times after that, once with some acid in my throat, which seems
odd considering I ate so little.
I seem to be able to eat anything I like during lunch without
problems. The nausea in the evening doesn’t seem connected to what I
eat at lunch.
I’m taking nizatidine twice a day now, typically when I wake up and
after I finish eating dinner. I used to take Nexium, and didn’t have
this problem at that time unless I drastically overate.
At it’s worst, the nausea is accompanied by a rapid heartbeat and
sweating. Sometimes I wonder if it’s inducing a panic attack.
I would -love- to eliminate this problem without revisiting my GI, but
every round of nausea makes me more worried about a serious
condition. What boggles my mind is the timing of it: it’s so
rhythmic. Why only at night? Why can I eat in the afternoon but not
eat at night?
Howard mccolli 2008-01-25 07:12:14
Everybody’s digestive physiology is different. It would be impossible to do
anything more than speculate on a half-dozen-or-more reasons for *your*
situation without knowing more about your specific physiology. If you want
to avoid the testing necessary to proviode the actual answer your question,
the best approach is likely to be empirical treatment, and I’d start by
eating no later than 8PM, stop all intake of alcohol, nicotine, caffiene,
eat a small evening meal, lose weight to a BMI of 27 or less, and start back
up on Nexium (or similar PPI – the entire class of which is far more
effective than H2 receptor antagonists such as nizatadine).
Jmc 2008-01-25 07:12:18
Suddenly, without warning, Object01 exclaimed (18-Feb-07 12:51 AM):
Howard’s right about speculating – you should see your doctor and tell
him/her about these new symptoms.
FYI though, I get pain instead of nausea, but when I have a bad-ish
gallbladder attack (haven’t had a *really* bad one yet), it does include
a rapid heartbeat and sweating.
How much fat is in your diet? You could try eating really low fat for a
few days, see if your symptoms change. If they do, definitely see your
Object01 2008-01-25 07:12:20
Overall, I think my diet is relatively healthy. I have cut out much
of the fat in my diet, sticking mostly to plain sandwiches or baked
foods. I’m 6’6″ and 220 lbs., slowly losing weight toward my goal of
210. My worst habits are a single coffee in the morning, and
typically a glass of red wine at night. I refrain from caffeine and
alcohol the rest of the time. I recently started boycotting beer, as
it seems to lead to painful bloating.
I recently moved off Nexium onto Nizatidine after my GI suggested that
a dependence on Nexium was to be avoided. He characterized it as a
“very strong” medicine that is not intended for long-term treatment.
When I was on Nexium, I had very few bouts of discomfort. Only if I
stupidly overate at a meal would I suffer. Nizatidine, on the other
hand, seems very ineffective at controlling discomfort.
Yesterday I drank probably half-a-gallon of water between noon and
6:00, urinating only at the end of that stretch. At about 4:00 I
noticed feeling very bloated, as if I’d eaten a huge meal. I found
that I was belching quite a bit even though I wasn’t eating anything.
(All this made me wonder if I’m not abnormally retaining water; 57.3%
water-weight measurement on the scale this morning.)
My GI once suggested I may be swallowing too much air, though he
couldn’t offer any suggestions for treatment. I’m trying to ready
myself for another trip to the doctor, but want to make sure I have
something to tell him/her. The only consistent physical symptom is
nausea toward the end of the day that seems triggered by eating
anything after about 6:00pm. All other symptoms (bloating, heartburn,
sweating, rapid heartbeat, etc.) are random and impossible to
predict. I can try again, but in my experience conveying those types
of symptoms to a doctor leads to little useful advice.
I’m looking for another GI that’s closer to me since I moved last
year. To start that process I’m going to visit a nearby general
practice. I plan on relating to them the nighttime nausea, bloating /
gas, and the panicky symptoms that seem to come with it, in hopes they
can offer more than the usual restrict-your-diet advice. I also plan
on asking the doctor for recommendations about revisitng Nexium as
well as an anti-anxiety medicine, perhaps Zanex, which my mother has
Howard mccolli 2008-01-25 07:12:30
The only cure for GERD is surgery. If your doctor wants to cure you, he
should recommend that. If he wants to manage your symptoms to your
satisfaction, he should recommend whatever medication it takes to do so. He
doesn’t want to prescribe Nexium because “it shouldn’t be used long term”.
Why not? Instead he wants to prescribe a drug he thinks is safer, but
doesn’t work. Hmmm…..the logic is escaping me. I think your doctor is
jerking you around. I acknowledge that he’s not doing it intentionally, out
of malice, he’s doing it out of ignorance.
Yes, you’re swallowing too much air. That’s common in GERD patients…they
swallow air unconciously to clear the lower esophagus of refluxate. That
works…for a moment or two…but unfortunately the resultant belching
results in more reflux, which in turn results in more air swallowing ->
belching -> air swallowing etc etc etc. Unfortunately, it’s a common habit
GERD patients learn over time and there is no treatment other than to stop
Vanny 2008-01-25 07:12:38
When you are drinking – sip slowly and don’t gulp – you should thus avoid
swallowing even more air. Also if you are drinking sodas (cola and co.) and
highly sugared drinks then you will have bloating.
You must make all the necessary life-style changes for GERD, which include
no coffee (not even decaff.), no black tea, no sugar, no sweets, no honey,
no chocolate, and no alcohol, etc., http://www.gicare.com/pated/ecdgs39.htm
.. If you don’t make these changes in full for your severe GERD then no
medication is going to help you. You could change to an alkali diet and see
how that goes for you.
The PPIs are the next best thing to surgery for curing severe GERD. I was on
Nexium for a year and then switched to Protonix (since Dec. 2004) and I am
Your doctor is basing his treatment on outdated literature. There are plenty
of people like me who have taken PPIs for years and there are an increasing
number of long-term (over a few years) studies of treatment of GERD with
PPIs. A recent publication indicates that the long-term use can lead to
increased attrition of bone leading to hip fracture, but so can other
have been no cases of death from PPIs that I know. Any chronic disease and
long-term medication use is going to take its toll on the body.
There is currently a CME on www.medscape.com , which your doctor would
apparently benefit from: “What the Family Physician Needs to Know, in 2006,
to Optimize the Management of Acid-Peptic Disorders CME Seymour M. Sabesin,
MD; A. Mark Fendrick, MD; James M. Scheiman, MD; John M. Inadomi, MD;
Benjamin D. Gold, MD”
Comprehensive article on GERD:
I suggest that you change your doctor.
Object01 2008-01-25 07:12:47
Having visited a general practicioner yesterday, I’ve been put back on
PPIs (Prilosec this time). After observing tenderness in my abdomen
she scheduled me for a barium swallow tomorrow. We’ll see.
With regard to swallowing too much air, I’m sure that’s occuring, but
the problem is I seem unable to belch when needed. Lately I only seem
to be belching after extended periods of not eating.
About the lifestyle changes: that’s something I’m still wrestling
with. The simple fact of the matter is that the degree to which my
quality of life suffers by eliminating all of the above mentioned
foods may outweigh any relief I get from doing so. I was happy to
find that Nexium -did- allow me to eat at my leisure so long as I
moderated it. Diet colas, alcohol, sweets, etc. all went without
complaint. Perhaps it means my GERD is (or was) not so severe. I’m
anxious to see if returning to a PPI will help me return to that
In the meantime, I’m concerned that there’s another problem, so I’m
addressing that. Refraining from those foods during this phase is
resulting in both internal and external stress, which no doubt makes
indigestion worse. One step at a time go I.
Howard mccolli 2008-01-25 07:12:52
I feel it necessary to clarify that no medication, PPI’s included, will
actually “cure” GERD. That can only be done (currently) by some procedure
that fixes the fundamental defect in the LES. There is (currently) no
medication that will accomplish that. Medications such as PPI’s might help
“manage” the *symptoms* of GERD, however.
Vanny 2008-01-25 23:50:12
My apologies – a slip of the fingers there. I don’t know what I was thinking
at the time. My GERD is certainly not cured by PPIs and I have no
expectations. Perhaps, it was wishful thinking.
I just know that I have applied all the lifestyle changes and am managing on
a maintenance dose of 20 mg Protonix, but it can still be a challenge with
the nocturnal GERD.
Howard mccolli 2008-01-25 23:50:15
I knew you knew that, Vanny…:)
Object01 2008-01-25 23:51:11
The problem turned out to be carrots. I’m a huge fan of carrots and
in an effort to eat healthier, I’d been increasing the number of
carrots I ate at lunch each day. After eliminating them from my diet,
all the discomfort in my abdomen has gone away.