gastrophy , esophagitis and gastritis ..oh my

[ohmeowzer RN, RN]

i have a pt who is 48 years old.. she has all the above with a history of h pylori... she tells me that she has a hard time eating and the GI doc told her to watch her protein intake and that she may develop cancer from the gastrophy.. she of course freaked out,,, she is being treated for her h pylori , all this info was found from a EGD and colonscopy.. and lots of biospy's taken.. does anyone have any idea how i can calm her nerves and help her with her diet? i am not a gastro nuse and know little about gastrophy and it's indications .. any ideas would be so helpful.. she has trouble swallowing from the esophagitis.. and seems to always have stomach pain.. which i don't blame her... does anyone have any of these and what do you do to calm your painful stomach and what do you eat? ty so much !!poor lady just hurts from throat to bum.. thank you all in advance !!

[7student7]

I have eosinophillic esophagitis and gastroenteritis and the bacterial overgrowth that usually comes with it. The things that helped me in the long term were probiotics- I took the pills, ate Greek yogurt, drank kefir, the works. I cut out almost all grains, especially wheat. I also stopped consuming most milk products (some, like Greek yogurt and kefir aren't so bad). Milk and wheat proteins are murder on the stomach. (look up leaky gut if you're curious). I also cut out most sugar bc of the bacterial overgrowth. Honestly, what I tried to follow was the paleo diet from marksdailyapple.com, but I know people on this board tend to dislike "fad diets". Even if you dislike the diet, you can't argue with the science behind probiotics or avoiding gluten at least!

I don't know if it's official medical advice and I certaintly am not trying to give medical advice, but this is what worked for me personally. I went from horrible pains and many vitamin deficiencies to perfectly fine and off all meds in about 6 months. Antiacids don't work, and steroids just trade one type of pain for another. You've got to eat right to get healthy.

[netglow, ASN, RN]

Well, this might be a case where there has to be a lot of experimentation on her part. Generally she needs to find what type of foods upset the cart. She needs to keep a document on what food she trys and if it disagrees, what the side effects were. Then maybe some sort of plan can be put together. I think that there is so much muddling around with people like this that they go along for years without any headway. She probably already has some idea of the offending foods. Foods that cause gas build up, cause reflux, constipation or diarrhea etc. are the big symptom makers. Thing is everybody is different in what foods they do not tolerate well.

This takes a lot of time and commitment from the patient. I wonder if she can get a dietician referral to help her? Most MDs will frustrate quickly when it gets to this point, because they have no training for this and also do not want to have anything to do with this part of the game so, she needs a dietician.

She needs to change her sleep environs if she is refluxing... I believe (correct me if I'm wrong) that you are to try and sleep on your left side, and with HOB elevated (use phone books under bed legs, and wedge pillow etc.)

Also her doc needs to keep changing her acid inhibitor to one that works for her. There are a few out there and they should be changed if she does not experience some relief. Maybe anxiety relief is in order too - but that can be a catch 22 as some of those longer term medications do cause nausea.

She also needs to get somewhere and walk for exercise, nothing fast and furious, but I have read that this does help for all the old fashioned reasons.

[7student7]

I agree with the dietician suggestion. Docs do not have the patience for this sort of thing.

[rn undisclosed name]

One other thing that may be beneficial to try is sucralfate. It coats the gi tract and may provide some relief if taken prior to meals. I don't know if that's been tried but it does work for some condition so it may be an option for her.

[ohmeowzer RN, RN]

thank you so much for all your help.. i am going to get a dietary consult today and have her write down foods that upset her stomach.. i think she did say milk .. i have been a nurse for 25 years and really haven't had many pt's who are inflamed from their esophagus to their orifice.. poor woman.. i guess she said she has been complaining for a year .. and finally she came in .. she has really pain and i think she hurts alot .. i feel for her ,, i can see she has real pain and i saw her colonscopy and egd pictures and she is very inflamed .. and yet she finally is put on protonix and pain medicine... off nsaids.. .. thank you all so much for your help.. thats why i love this forum.. we care about our patients and want the best for them.. it's good to have you all here to help !!

[rnbob]

I know this sounds off the wall, but a probiotic called : Jarro-Dophilus EPS, has been extremely helpful for both upper and lower GI problems for a lot of people (read the reviews on Amazon.com). It worked wonders for my own wife.