Management of Acute Gastrointestinal Symptoms
For immediate relief of your upset stomach with heartburn, nausea, vomiting, diarrhea, bloating, and cramps, start with an over-the-counter proton pump inhibitor (like omeprazole 20 mg once daily) for the heartburn, loperamide for diarrhea (if no fever or bloody stools), and an antispasmodic for cramps.
Heartburn Management
Proton pump inhibitors (PPIs) are superior to antacids and H2-receptor antagonists for controlling gastric acid and treating heartburn 1. Omeprazole 20 mg once daily provides early and sustained resolution of heartburn, with 74% of patients achieving complete heartburn resolution by day 27, compared to only 23% with placebo 2.
- Start with omeprazole 20 mg once daily - this dose is optimal for empiric treatment and provides significantly better symptom control than the 10 mg dose 2
- Antacids only transiently neutralize acid in the esophagus but do not prevent subsequent heartburn episodes 1
- H2-receptor antagonists rapidly develop tolerance with repeat dosing, making them less effective over time 1, 3
Critical warning: If heartburn persists despite frequent antacid use, this may indicate significant underlying pathology including Barrett's esophagus or even adenocarcinoma - 13 of 178 subjects (7%) in one study had serious conditions including Barrett's esophagus and adenocarcinoma despite only self-treating with antacids 4.
Nausea and Vomiting Management
Use around-the-clock antiemetic dosing rather than as-needed (PRN) administration to prevent breakthrough symptoms 5.
First-line antiemetic options:
- Ondansetron 8 mg orally 2-3 times daily 5
- Metoclopramide 10-20 mg orally 5
- Prochlorperazine 10 mg orally every 6 hours 5
For persistent nausea:
- Combine metoclopramide with ondansetron for synergistic relief 6
- Add lorazepam 0.5-2.0 mg every 4-6 hours to decrease anxiety and augment antiemetic effect 5
- Consider haloperidol 0.5-1 mg orally every 6-8 hours 5, 6
Important distinction: Patients sometimes have difficulty discriminating heartburn from nausea, so consider adding H2 blockers or proton pump inhibitors if dyspepsia is present 5.
Diarrhea Management
Loperamide is effective for treating diarrhea but must be titrated carefully 5.
- Start with low doses and increase gradually 5
- Common side effects include abdominal pain, bloating, nausea, and constipation 5
- Contraindications: Do NOT use if you have fever, bloody stools, or severe abdominal distention, as these may indicate infectious colitis or toxic megacolon 7
- Discontinue and seek medical attention if no improvement within 48 hours 7
Drug interaction warning: Loperamide exposure increases 3.8-fold with itraconazole and 12.6-fold when combined with both itraconazole and gemfibrozil, potentially causing cardiac arrhythmias including Torsades de Pointes 7.
Bloating and Cramps Management
Antispasmodics are effective for abdominal pain and cramping 5.
- Certain antispasmodics provide relief for global symptoms and abdominal pain 5
- Common side effects include dry mouth, visual disturbance, and dizziness 5
- Avoid insoluble fiber (wheat bran) as it may worsen bloating 5
If symptoms persist beyond 48 hours:
- Consider soluble fiber (ispaghula) starting at 3-4 g/day, building up gradually to avoid worsening bloating 5
- Regular exercise should be incorporated 5
Red Flags Requiring Immediate Medical Evaluation
Seek emergency care if you experience:
- Bloody stools or black tarry stools
- Fever with diarrhea
- Severe abdominal distention 7
- Fainting, rapid or irregular heartbeat, or becoming unresponsive 7
- Symptoms persisting beyond 48 hours without improvement 7
- Signs of dehydration (decreased urination, extreme thirst, dizziness)
Hydration and Supportive Care
- Ensure adequate fluid intake to prevent dehydration 5
- Assess and correct any electrolyte abnormalities if symptoms are severe 5
When Initial Treatment Fails
If symptoms persist after 48 hours of appropriate treatment, consider: