A 69-year-old female presents with nausea and vomiting, abdominal pain, heart palpitations. She describes herself as high strung and anxious. Even the gut pain gives her anxiety leading her to worry about underlying cancers and other possible health issues. When gut pain increases anxiety gets worse and anxiety remits as gut symptoms improve. It is obvious the gut/brain axis is heavily involved in this case. It is discussed with the patient how the gut has more nerve endings than any other organ in the system and this is likely to be a key reason for the anxiety. As we know, only 20-30% of the signal along the vagal nerve which connects brain to gut, comes from the brain. Most of the signal is input coming from the gut. This is part of a major channel of the gut-brain axis.
The patient is on a PPI, which gives symptomatic relief, but can create certain long-term side effects. Some potential side effects noted in the literature include decreased absorption of nutrients, increased risk of food sensitivities and allergies secondary to not fully degrading protein structures, and atrophy of the lining as PPIs increase ADMA that blocks local production of nitric oxide, decreasing blood flow.
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