Case

Age (yrs)

Race

Sex (M/F)

Case History

Gastrointestinal Symptoms

Attempted Treatments without Resolution of Symptoms

1

71

C

F

History of ischemic colitis, IBS-D esophageal spasms/hypersensitivity, Schatzki’s ring, anxiety, and chronic atypical chest pains, complaints of hemorrhoids and irritation, rare rectal bleeding from hemorrhoids, rheumatoid arthritis

Worsening epigastric pain, general abdominal pain, bloating/distension, diarrhea

Pantoprazole, omeprazole, sildenafil, atropine/ hyoscyamine/scopolamine/

phenobarbital, pantoprazole, hyoscyamine, ondansetron, promethazine, topical hydrocortisone acetate (2.5%)

2

53

C

F

History of IBS-U, nausea, acid indigestion, foul smelling flatus, anemia, multiple somatic complaints

Chronic abdominal pain, bloating/distention, flatus, epigastric pain, nausea

Dicyclomine, omeprazole

3

37

H

F

Lactose intolerance, small intestinal bacterial overgrowth, IBS-U symptoms

Chronic abdominal pain, bloating/distention, diarrhea, positive H2 breath test

Pantoprazole, hyoscyamine, polyethylene glycol 3350 NF, probiotic, flaxseed, subsequent monthly courses of rifaximin followed by dicyclomine

4

62

C

F

History lactose intolerance, IBS-U, dyspesia/tachygastria, GERD, reflux esophagitis, recurrent polycythemia vera

Chronic and severe abdominal pain, bloating/distention, with occasional dyspepsia

Aluminum hydroxide, magnesium hydroxide and simethicone, milk supplemented with lactase, dicyclomine (discontinued due to blurred vision)

5

59

B

F

History of IBS-D, GERD, insomnia, sleep apnea

Watery BMs with urgency, abdominal pain and distention relieved by defecation, “bubbling” followed by nausea/ vomiting

Escitalopram, amitriptyline, alosetron caused nausea

6

63

C

M

Long history of IBS-D, GERD, dyspesia/tachgastria, gastritis, gastroparesis, anal fissure, hiatal hernia, renal cell carcinoma

Abdominal pain, bloating/distention, diarrhea

Omeprazole (discontinued), diphenoxylate/atropine, dicyclomine (discontinued), tamsulosin, simvastatin, losartan, simethicone

7

54

H

F

History of IBS-U, gastritis, GERD, reflux esophagitis, hemorrhoids

Chronic abdominal pain, bloating/ distention, nonulcer dyspepsia, moderate epigastric pain after meals

Dicyclomine, hyoscyamine, omeprazole, bisacodyl, phenobarbital, PEG-3350

8

52

C

F

History of gastroparesis and IBS-D multiple somatic and joint complaints

Generalized abdominal pain, bloating, early satiety, chronic diarrhea, foul smelling gas and flatulence, bloating/distention, nausea, vomiting

Pantoprazole, ondansetron, propranolol, chlordiazepoxide/clidinium, topiramate, quetiapine, lamotrigine, sumatriptan, trazodone

9

66

H

F

Long history of IBS-D, GERD, gastritis, fundic gland gastric polyps, avoids dairy

Quit her part time job due to symptoms, urgent exploding diarrhea mainly in morning with abdominal cramping, fecal incontinence

Citalopram, bismuth subsalicylate

10

63

H

F

Long history of IBS-D, GERD, gastritis

Chronic watery, non-bloody diarrhea with urgency occurring 2 - 3 times a day

Mesalamine (resulted in rash), sulfasalazine, metronidazole, methylprednisolone