Dr. Mark D. Noar

The daily consumption of caffeinated products in reasonable quantities, defined as one or 2, 8 ounce beverages per day, should normally pose no problem especially if throughout the day you are remaining well hydrated. Typically the normal human will require 64 ounces of fluid per day. Excessive amounts of caffeinated products can certainly lead to symptoms such as dizziness or nauseous feelings. Caffeine will tend to increase urinary output and therefore promote dehydration. If you are well hydrated, then the dizziness and nauseous feelings are likely not related to your caffeine intake and should be further evaluated by a physician.

Bloating is a very general symptom and could be a sign of many different underlying problems. For example, if you have become constipated. This could lead to bloating. There can be many reasons for sudden onset of constipation. Other possible symptoms can be due to bowel irregularity, gallbladder disease, small bowel bacterial overgrowth, irritable bowel disease, the development of intolerance to sugars like lactose or fructose, to name a few, gluten intolerance, among many other issues. If you are having bothersome symptoms of bloating that are causing problems. It's best that you see your physician to begin to work through the differential diagnosis and to decide if any particular test may be appropriate.

Depending on your medication, there can significant effects. Most common effects on the gut include constipation and diarrhea.

It is difficult to answer this question, is it depends upon a number of factors. One important one, is that it is not unusual to have a CT scan report inflammation where none exists. If there is inflammation, it must first be confirmed by other studies to determine the cause. Very often we will do investigations after a positive CT scan and nothing will be found to treat or diagnose. In the event that the inflammation is caused by an infection, this will usually be treated by a targeted therapy based upon the type of infection. If the inflammation is caused by inflammatory bowel disease, then of course the therapy is considerably different and will depend upon the severity or staging of the disease.

There are a number of reasons to avoid. There are a number of reasons soda if you have gastroesophageal reflux disease. Most of these type beverages also contain caffeine which is known to decrease the tone of the lower esophageal sphincter. Caffeine should be avoided. In addition, the pH of most soda is in the 3 to 4 range, which is especially difficult for those who suffer from the LPR form of reflux. This is because it will reactivate pepsin and cause symptoms. And finally there is the carbonation which is in and of itself acidic, but also increases the volume in the stomach and therefore the yield pressure and promotes additional reflux. The double whammy that occurs with carbonation is not only does it cause reflux but the gaseous form of pepsin is expelled when the gas is expelled, particularly worsening the LPR form of reflux.

There can be many reasons for bloating and nausea. Considering that you were recently jaundiced it is likely that the reason for the bloating and nausea is related. As an example, if the jaundice was due to the passage of gallbladder stones or sludge, gallbladder disease alone can't present as bloating and nausea following meals. In addition, if your liver is swollen due to other causes that led to the jaundice, just the enlargement alone can make you feel bloated and potentially even nauseated. Finally, there are a host of other conditions that may not be related to the jaundice, and that could include gastroparesis or gastric motility disturbance, constipation, small bowel bacterial overgrowth, to name really just a few.



Mark Noar
mdnoar@verizon.net

In your question, you mentioned two distinctly different symptoms: one of esophageal burning consistent with reflux, and the other nausea, which is indicative of either a stomach inflammatory condition or ulceration, or the possibility of stomach motility disturbance. Both these conditions require further investigation for proper recommendation of medication. If you wanted to try something simple, you could try some over-the-counter Zantac or Pepcid to see if it gave you the desired effect. If the medication does not work, or you find that you require the medication for constant use, you really should be seen by a gastroenterologist for further diagnosis.

Mark Noar

There are a number of different reasons that could be causing the symptoms. The differential diagnosis includes gallbladder disease, gastritis or ulcer disease, and especially gastroparesis or other gastric motility disturbance related to the diabetes.

Mark Noar

With specific regard to your question of how can celiac disease be diagnosed, in particular because of your son's reaction to when he eats bread, there are a number of ways this can be done. There are some blood tests that can be performed initially and if positive, then you have the diagnosis. If the blood tests are negative, then it may be necessary to consider an endoscopy with a biopsy of the small bowel and intestinal lining to confirm the diagnosis.

Mark Noar

The symptoms that you are describing are most consistent with gastroesophageal reflux disease, especially the subtype known as LPR, or laryngopharyngeal reflux. While this is typically a benign condition, it could be a signal of more serious underlying conditions such as ulceration of the esophagus, or even early malignancy. Other possibilities include infectious agents such as yeast, inflammatory changes caused by the use of other medication or other inflammatory conditions such as the development of a stricture or a condition known as eosinophilic esophagitis. With these type symptoms, it is advisable to see a gastroenterologist and to undergo an upper endoscopy to diagnose the actual condition and therefore allow more personalized therapy.


Mark Noar

It is not always necessary to undergo surgery in order to correct a gallbladder problem such as gallstones. Another approach is to consider gallstone dissolution therapy, which is oral medication designed to slowly dissolve stones over time. However, before considering this option, you will need to have a functioning gallbladder. In this case, an HIDA scan would need to be performed showing in ejection fraction of 20% or greater. If ejection fraction is low, then gallstone dissolution therapy is often not effective. When the ejection fraction is greater than 20%, I have found a better than 50% success rate in dissolving gallbladder stones and sludge over a one-year period of time.


Mark Noar

There are number of potential diagnoses that come to mind. My short list differential regardless of the creatinine clearance issue includes: gallbladder disease, gastritis, or gastric ulcer, gastroparesis or other gastric motility disorders. Many with renal failure issues may especially be subject to gastritis or duodenitis or ulcer disease as well as gastric motility issues. Immediate diagnostic evaluation should include upper endoscopy as well as gastric emptying Electrogastrography. Gallbladder studies will also need to be done.

Mark Noar