June 6, 2022. 18yo patient lost a total of 26 lb. Vommiting progressed to 6-7 times per day. She eventually underwent an endoscopy and was told she had reflux and eosinophilic esophagitis. She continues to have vomiting on a fairly regular basis. She also has heartburn. She is constipated. I get a hint of rumination.
August 16,2022. She had several other complaints today. She does feel bloating at times. She has also developed constipation. She has a good bit of difficulty having a bowel movement unless she takes a laxative. She does eosinophilic esophagitis although I am not sure it is producing a lot of symptoms. I still wonder if there might be a degree of rumination here. Constipation predominant IBS: I think she has this. I think she would do well with Linzess so will give that a try.
August 2022 Endoscopy showed (pay attention to this one). Upper endoscopy showed normal esophageal motility. Barium swallow showed some reflux but no stenosis.
June 15,2023. 19 y.o. female who presents to the GI Clinic today for a follow-up appointment regarding dysphagia and constipation. She also had concerns for constipation today. She still has reflux, that seems to be worsening. she would like to identify what the cause of her problem(s). She also noted that she had a bout of constipation alternating w/diarrhea. She also has other symptoms to include the migraines, joint/knee discomfort, and body aches. She is a consideration for rumination.
June 18,2023 Endoscopy results (look at 2022, compared to 2023).
LES/EGJ: low resting pressure
ESOPHAGEAL BODY: very weak. Only a few transmitted contractions
UES: normal pressure and normal relaxation
RESPONSE TO 5 RAPID SWALLOWS: very weak
SUMMARY: Ineffective esophageal motility
Esophageal body: Ineffective swallows, Not all swallows have failed peristalsis
90% of her swallows are ineffective
This study is positive for pathologic acid reflux with positive symptom correlation for cough, heartburn, and regurgitation.
June 3,2023. She presents reporting heartburn and bowel concerns. She continues to have heartburn even while on a regimen pantoprazole, and lots of tums. She also complains of bowel issues as she is not have a bowel movements on a daily basis if she does not take the Linzess.
August 24,2023. Her constipation continues, even when on Linzess and MiraLax. We discussed trying a different treatment since Linzess is not effective, I put her on amitizia.
September 14,2023. Patient advises of not having a BM in 3 weeks, so she tried amitizia and had a severe reaction. She saw an urgent care provider, who recommended she stop the medication, which I agree w/. She was on Linzess for the weeks prior and still didn't have adequate response.