From the Guidelines
The patient's symptoms of frequent heartburn, constipation, diarrhea, and malaise are unlikely related to cardiac issues given the 95% ejection fraction on the HIDE scan, and therefore, a comprehensive gastrointestinal evaluation is warranted. The normal cardiac function, as indicated by the high ejection fraction, suggests that the patient's symptoms are more likely related to gastrointestinal issues rather than cardiac problems 1.
Given the patient's symptoms, it is essential to investigate potential gastrointestinal causes. A trial of a proton pump inhibitor such as omeprazole 20mg once daily before breakfast for the heartburn may be beneficial. Additionally, maintaining adequate hydration with 2-3 liters of water daily can help with constipation and diarrhea. A psyllium fiber supplement (1 tablespoon mixed in water once daily) can also help regulate bowel movements.
The combination of gastrointestinal symptoms and malaise raises concern for potential conditions such as irritable bowel syndrome, inflammatory bowel disease, celiac disease, or other gastrointestinal disorders. Laboratory tests including complete blood count, comprehensive metabolic panel, celiac antibodies, and inflammatory markers would be valuable to guide further management 1. A food diary may also help identify potential dietary triggers.
Key considerations for the patient's management include:
- Comprehensive gastrointestinal evaluation
- Immediate symptom management with proton pump inhibitors and fiber supplements
- Laboratory tests to guide further management
- Potential dietary triggers identification through a food diary
- Consideration of potential gastrointestinal disorders such as irritable bowel syndrome or celiac disease.
From the Research
Patient Symptoms
- The patient has frequent heartburn, constipation, and diarrhea bouts, as well as malaise.
- The patient has a 95% EF (ejection fraction), which is a measure of heart function.
Relevant Studies
- A study published in 1989 2 found that omeprazole was effective in treating duodenal ulcers, gastric ulcers, and reflux oesophagitis, with healing rates of 58-83% after 2 weeks and 84-100% after 4 weeks.
- A study published in 2000 3 compared the efficacy and tolerability of rabeprazole with omeprazole in the healing of erosive gastrooesophageal reflux disease, and found that rabeprazole 20 mg once daily was equivalent to omeprazole 20 mg once daily.
- A study published in 2018 4 found that 8 weeks of omeprazole 20 mg significantly reduced both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms.
- A study published in 1996 5 found that pantoprazole was superior to ranitidine and equivalent to omeprazole in the short-term treatment of peptic ulcer and reflux oesophagitis.
- A study published in 2019 6 found that optimizing omeprazole dosing regimens improved symptom control in patients with persistent GERD symptoms, and estimated cost savings of $159.60 per treated patient.
Potential Treatments
- Omeprazole 20 mg once daily may be effective in reducing heartburn and other symptoms of GERD, as shown in studies 2, 4, 6.
- Rabeprazole 20 mg once daily may be an alternative to omeprazole, as shown in study 3.
- Pantoprazole 40 mg once daily may be another option for treating peptic ulcer and reflux oesophagitis, as shown in study 5.