Advice on recurring nausea, vomiting and diarrhoea in my adult daughter

[Nightmare2022]

i need some advice on where to go to get help for my dd (20). I am looking for suggested diagnosis or recommendations for specialists in London who could help her.

She is suffering from recurring episodes of nausea, vomitting and diarrhoea. She feels worse in the morning and belches a lot and brings up a little bit of sick but doesn’t empty her stomach. She has a lot of loose stools passing just a small amount multiple times a day. No blood in stools. She has had 3 episodes in the past year and they last 1-2 weeks. Two of the episodes seemed linked to stress as it was deadline time for uni coursework. The other episode was when we were on holiday so no stress although she was very excited about the holiday and then ended up missing out a lot because she was ill. She complains of unpleasant taste in mouth during these episodes and all food tastes terrible. Then she becomes fixated on how horrible food is and can’t eat and then panics about this and gets very distressed.

She has had blood tests and not Crohn’s or a thyroid issue.

She is autistic and her diet is terrible and not very varied. She seems to live off bagels, filled pasta and home made smoothies.

When younger (about 12) she complained frequently of nausea and GP said it was because she wasn’t eating breakfast and she did start to eat something and seemed to improve. She lives away from home now when at uni so I don’t see what she is eating.

She also suffers from depression and anxiety. Takes sertraline but still has depressive episodes.

Any advice gratefully received. Thank you.

Sounds very similar to a friend of mine who has recently been diagnosed with Cyclical Vomiting Syndrome. Hers is very affected by stress/anxiety, and also triggered by travel. The episodes are really debilitating, especially in the mornings. I think she ended up seeing someone privately to get it diagnosed as she was largely being dismissed by her GP. I'm pretty sure are saw someone in London but not sure who.

Thank you. I did wonder if it could be this. I was diagnosed with cyclical vomitting syndrome as a child but I was fortunate to grow out of it.

I’m so sorry to hear about your daughter @Nightmare2022 Sadly, Crohn’s Disease isn’t diagnosed via a blood test so I’m not sure who told you this. Inflammatory Bowel Disease is diagnosed via multiple tests - gastroscopy, colonoscopy, Pill Cam to look at the digestive system & take biopsies. This is how you get a definitive diagnosis.
Stress does seem to be a major trigger for her, so I’d definitely be going back to your GP & asking for a referral for further testing, & really push for it. The symptoms you describe are absolutely debilitating, although the bad taste in her mouth points to a stomach issue. I had this when my Crohn’s flared although there could be more logical explanations. Your GP needs to be your first port of call again.

I forgot to include - in London, St Marks is the absolute place for referral. It is actually one of the UKs leading bowel centres of excellence.

Sertraline did that to me. It didn’t resolve until I switched to a different medication.

Other possibilities include water borne infections like giardia, cytosporidium..has she been tested for any of these?

My dd has this too. It seems related to anxiety but we're not sure. IBS has been suggested.

This can be:

side effects of various medications
food intolerance - mine was dairy
various inflammatory bowel conditions - colonoscopy needed to rule most out.

Get her tested for coeliac disease.

question - when you say she belches, is it proper burping or more like a persistent gurgling that eventually leads to retching?

I’ve suffered with a problem for years which I’ve now come to realised is Retrograde Cricopharyngeus Dysfunction, commonly known as ‘no burp syndrome’. It’s when you can’t successfully clear gas out of my upper digestive tract, which causes bloating high up under my rib cage, acid reflux with a horrible taste in my mouth and then when it’s bad, a kind of retching where it’s like I’m vomiting gas (sorry, disgusting I know). I have this alongside IBS so also get a cycle of bowel issues.

I’ve had to manage it with diet and also thinking carefully about clothing - tight bra straps or high waistbands make it much more likely to escalate.

This might not be relevant but wanted to share because I had all sorts of tests and no one could answer me, only for me to read about it in a news article and see my symptoms described perfectly.

Thank you for sharing @DC555 . It is proper burping so I don’t think it is this.