THE CAROLINE CHRONICLES: December 2008

Here are some more sites with info on chronic nausea and/or GERD. It sounds like many people who haven't responded to Prilosec respond nicely to Nexium.

NY Times article about the mechanics of GERD:

http://health.nytimes.com/health/guides/disease/gastroesophageal-reflux-disease/print.html

Good blog with good advice from folks with bad symptoms:

http://dailystrength.org/c/GERD_Heartburn/forum/2692354-new-site-nausea-symptoms

Also, some changes I've made in addition to taking the Prilosec include the following:

- Cut out caffeine, particularly coffee. I'm trying to keep it to half a cup a day in the morning and no colas or anything in the day

- No "red foods" : tomatos, ketchup, spaghetti sauce, red peppers, etc.

- Cut out chocolate

- Nothing spicy

- Decrease sugar intake (this is a constant struggle for me:))

- Try to eat rice at least once a day

- Tons of water

- Lemon in water, or a teaspoon of lemon juice in the morning

- A multivitamin. Any pervasive symptom takes a toll on your immune functioning. Also, a daily vitamin is a nice way of making up for any nutrients you might be losing on account of diet changes, etc.

- Do not eat anything within 3 hours of going to bed

- Always have something in your stomach. Shoot for 5 small meals instead of 3 larger ones

I also take two calcium Tum tablets after I eat anything. Again, these changes are an attempt to treat chronic nausea, not necessarily heart burn, although my understanding is that the same suggestions apply.

If you've talked to me at all in the last few months you know I've been suffering from chronic nausea (it tends to come up in conversation, particuarly when one always looks green and has their hand over their mouth). I had every type of scopy and squeeze test possible and everything was showing up normal. Moreover, nausea has been my ONLY symptom. I didn't have so much as a sniffle to direct us towards a possible diagnosis. That all changed when I went to see the movie Milk starring Sean Penn. This movie was influential for several reasons, not least of which is the fact that it led me to google "involuntary gagging". See, while watching Milk at the Carolina Theater, I was overwhelmed with just about the worst episode of nausea I've had this year (which is saying a lot considering nausea is just about the only constant my life permits). During the movie, I noticed that I was repeatedly having this uncontrollable gag reflex in which my esophagus contracted as though I were going to throw up. I knew I wouldn't vomit, as I've never vomited on account of this persistent nausea, but I was extremely self-conscious about the act that I kept involuntarily looking like was going to hurl all over the people sitting next to me. Over the next few days, I started paying close attention to this gag reflex and realized that I was doing it upwards of 30 times a day. Each time I'd get the taste of alkaline and stomach acid in my mouth. Believe it or not, I'd gotten so used to this reaction that I hadn't really realized how aberrant or pervasive it was. I immediately googled "involuntary gagging" along with "chronic nausea" and came up with several links to recent studies on people with GERD whose only symptom was chronic nausea. I had been treated with acid reducing medications in the summer with no relief from the nausea. However, after reading several blog posts from folks who reported having tried the medications several times before getting a response, I decided to try them again. I began taking Prilosec (20mgs). Within four days the nausea had evaporated. Completely!!!! This is incredible news for me as I was beginning to think that I would feel nauseous for the rest of my life! The only problem with Prilosec is that it sometimes causes a splitting headache. However, I read two studies reporting that exercise can alleviate the migranes caused by Prilosec. I've also found that they respond nicely to over the counter Motrin. I'm including info from a link below in case any of you or the people you know suffer from this insufferable symptom:

"Chronic Nausea Could Be Gerd

NEW YORK, April 30 (Reuters) -- Are you suffering from chronic, unexplainable nausea? Ask your doctor to check for gastroesophageal reflux disease, or GERD. While heartburn is the most common symptom of GERD, a condition in which stinging stomach acid backs up into the esophagus, other symptoms can include angina-like chest pain, coughing, wheezing, hoarseness, shortness of breath -- and now chronic nausea, according to a report in the Annals of Internal Medicine.

"In patients with unexplained nausea, gastroesophageal reflux disease should, therefore, be considered if results on standard tests are normal," reported authors Drs. Ronald Brzana and Kenneth Koch, of the Milton S. Hershey Medical Center in Hershey, Pennsylvania.

The good news is that GERD-related nausea is treatable, with most patients showing improvement after taking medication such as ranitidine or omeprazole, drugs that block acid secretion, or cisapride, a drug that speeds up the passage of food through the stomach.

Brzana and Koch looked at 10 patients who had chronic nausea for periods ranging between three months and six years; six of the patients also vomited two to eight times per week. The cause of the problem was unknown and the patients had not responded to treatment with a variety of drugs. After a series of tests, the researchers found that all 10 patients had gastroesophageal reflux disease.

"After we extensively evaluated a group of patients with chronic intractable nausea, gastroesophageal reflux disease was the only abnormality we could find," the authors wrote.

While the study is limited because it only involved a handful of patients, doctors should still consider GERD after ruling out ulcers, stomach cancer, an obstruction, or pancreas or gallbladder problems as a cause of nausea, they concluded.

SOURCE: Annals of Internal Medicine (1997;126:704-706)