Question

I have several gastric symptoms that are baffling my GP. They include feelings of nausea, feeling full quickly whilst eating a meal and bloating after a meal. My bowel movements are generally regular with no blood in the stools. However, I have had an occasional episode of diarrhoea during the night.

My GP thought I might have irritable bowel syndrome (IBS) – which I know is quite common in people with ME. But none of the IBS treatments have helped. Do you have any suggestions?

Answer

Doctors tend to divide gastric symptoms into the three anatomical areas that cover the gastrointestinal tract – the food tube that runs from your mouth to your bottom. Upper gastrointestinal (oesophageal) symptoms include nausea, problems with swallowing, and heartburn (pain in the chest caused by acid reflux). Abdominal (gastric) symptoms include pain, bloating, and feelings of fullness after food. Lower GI symptoms include pain, changes in bowel habit, or bleeding from the back passage.

As you say, irritable bowel symptoms – especially abdominal pain and changes in bowel habit – are quite common in people with ME/CFS but the symptoms you are describing suggest that the problem may be higher up the GI tract.

One possibility is what doctors call gastroparesis or delayed gastric emptying. In simple terms this means that the time for moving food and liquid through the stomach is slower than normal. This delay can then result in symptoms such as nausea, bloating and quickly feeling full during a meal.

So I suggest you mention this possibility to your doctor and diplomatically point out that there is also some published research to support the view that there are changes in gastric motility (i.e. movement) in people with ME/CFS.

The relevant medical reference here is: Burnet RB and Chatterton BE. Gastric emptying is slow in chronic fatigue syndrome. BMC Gastroenterology 2004, 4, 32.

If this explanation seems possible you could ask for a referral to a gastroenterologist, who may decide to carry out some hospital-based investigations including a gastroscopy (a look inside the stomach). Treatment of gastric motility problems can involve both drugs which improve gastric motility and diet – having 4 to 6 small meals per day and decreasing the amount of insoluble fibre. This will depend on individual circumstances.

The episodes of diarrhoea at night are also something that is occasionally reported by people with ME/CFS. This may be due to an abnormality in the way that a part of the (autonomic) nervous system can speed up or slow down bowel movements – resulting in either diarrhoea or constipation. A disturbance in nervous control of food movement may also help to explain the upper GI symptoms.

Always see your GP if you:

• often feel full quickly when eating
• often feel sick or vomit after eating
• have stomach pain that will not go away or keeps coming back
• have heartburn most days for 3 weeks or more
• have been feeling bloated for 3 weeks or more
• feel bloated regularly (more than 12 times a month)
• have a swelling or lump in your tummy

More Information

• NHS website information on gastroparesis and delayed gastric emptying
• Please let us know if you have been diagnosed with a gastric motility problem or gastroparesis. Has any treatment been particularly helpful or unhelpful? Please email feedback@meassociation.org.uk
• The MEA has an information leaflet on gastric and bowel symptoms. This mainly covers irritable bowel-type symptoms and the fact that coeliac disease should always be considered, and screened for, in anyone with ME/CFS who has IBS-type symptoms.