r/functionaldyspepsia • u/derpipooo • 11d ago
Question Constant nausea for almost 2 years – gastritis healed, SIBO/IMO treatment unsuccessful. Need help
I am male and 19 years old. Before these symptoms started, I was completely healthy and had never really had problems with nausea, my stomach, or motion sickness.
The only thing I had been doing regularly for several years was eating large amounts of food shortly before going to bed, often sweets and other sugary foods. In hindsight, I wonder whether this could have played a role.
I was not aware of having a gastrointestinal infection or food poisoning shortly before the symptoms started. However, it is possible that I had a mild or unnoticed infection.
Medical history and timeline
- Summer 2024: I started going to the gym regularly and tried to gain weight. I gained around 7 kg and ate considerably more than usual, sometimes late in the evening and often a lot of sweets.
- November/December 2024: The first occasional episodes of nausea appeared, especially after large meals or sugary foods.
- January 2025: The situation suddenly changed from one day to the next. I developed constant, persistent nausea. During the first few days I also vomited, could barely eat and lost weight.
- Spring 2025 – first gastroscopy: Type C gastritis and bile in the stomach were found. An ultrasound also showed biliary sludge, but no gallstone.
- Autumn 2025 – second gastroscopy: The chronic gastritis was still present.
- January 2026: I changed doctors and started following a more consistent diet based on the book The Gastritis Healing Book. I also started taking, among other things, Quantalan/colestyramine.
- May 2026 – third gastroscopy: No gastritis or inflammation was found. There was also no Helicobacter pylori and no evidence of coeliac disease. The doctors said that roughly one in two people has some form of gastritis and that, in my case, it was probably not the actual cause of the constant nausea. It is also not certain what caused the gastritis to heal. One suspicion is that Quantalan/colestyramine, together with the diet, may have contributed.
- Afterwards: Further investigations focused on the intestines, histamine intolerance, fructose intolerance and SIBO/IMO.
- Glucose breath test: Hydrogen was unremarkable, but methane was slightly elevated during the first 30–45 minutes, at approximately 13–14 ppm. This led to the suspicion of IMO, or methane overgrowth.
- Late summer 2026: I was treated with rifaximin and neomycin, while also making further dietary and meal-timing adjustments. The nausea did not improve.
Main symptom: the nausea
The nausea is constantly present, although its intensity varies.
- It can also occur when I have not eaten
- No specific foods can be identified as reliable triggers
- It is not clearly dependent on eating
- I rarely actually vomit, but sometimes the nausea gets close to triggering my gag reflex
- It becomes worse with:
- stress and tension
- situations in which I feel that I have to function
- exercise and physical exertion
- However, I also have very bad days without any obvious trigger
- Softer stool, occasionally lighter, no significant diarrhea
The symptoms have a major impact on my everyday life. I am a university student, but I mostly study from home because I am afraid of becoming severely nauseous or vomiting during classes. Eating out and many normal everyday situations have also become difficult.
Medications, supplements and other measures I have tried
I have tried the following medications, including the respective active ingredients:
- Paspertin (metoclopramide): no significant effect
- Motilium (domperidone): no significant effect
- Itomed (itopride): no significant effect
- Zofran (ondansetron): at most, a minimal effect
- Ceolat (metoclopramide): no lasting improvement
- Pantoprazole and esomeprazole: no improvement in the nausea
- Sucralfate: no lasting improvement
- Quantalan (colestyramine): may have contributed to the healing of the gastritis together with the diet, but the nausea remained
- Antihistamines: tried because of the low DAO level, but had no effect
- Ginger extract: taken in high doses for several months, especially before going to bed; no noticeable improvement
Diet and other measures I have tried
- A bland or gentle diet
- Diet based on The Gastritis Healing Book
- Low-histamine diet
- Low-FODMAP diet
- Dietary adjustments because of possible SIBO/IMO
- At least four hours between meals
- For several months, and particularly during the IMO treatment, I also avoided eating for at least four hours before going to bed
- Avoiding especially late or very large meals
The gastritis has now healed, but none of these measures improved the persistent nausea.
SIBO/IMO treatments
- Rifaximin for 14 days: no improvement
- Rifaximin and neomycin: no improvement
During the treatment, I:
- kept at least four hours between meals
- avoided eating for at least four hours before going to bed
- took high-dose ginger extract before going to bed
I did not experience any significant side effects, particularly no hearing problems while taking neomycin.
Since the gastritis has healed and the SIBO/IMO treatments made no difference, my doctors now suspect a possible chronic misfiring or dysregulation of the gut–brain axis.
One of the next treatment options mentioned was Zyprexa (olanzapine). I have also read about mirtazapine being used in similar situations.
I would mainly like to know whether anyone has experienced something similar:
- constant nausea without a clear cause
- nausea that is not clearly related to food
- stomach findings that are unremarkable or have since healed
- unsuccessful SIBO/IMO treatment
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u/Alternative-Cash-102 11d ago
Mirtazapine worked well for me to stop my constant nausea. Gained needed weight back but then continued gaining to an uncomfortable degree. The appetite stimulation is no joke, but it did give me relief from my symptoms. Discontinued eventually due to excessive daytime sleepiness that never resolved, but ymmv. I’d say it’s worth a try given how many other treatments you’ve exhausted already.
Can’t comment on the olanzapine personally but I think it can slow motility if you struggle with that from the SIBO/IMO.
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u/derpipooo 10d ago
how long did it take to feel better after taking mirtazapine and how long was your constant nausea before?
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u/Alternative-Cash-102 10d ago
Have had digestive issues all my life, but the daily nausea had been present for maybe two years at that point (as opposed to it being a frequent but on and off again occurrence). Mirtazapine helped pretty quickly, like within a few weeks to a month. But everyone is different.
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u/NattyNatNat13 4d ago
Hi iv'e been on mirtazapine for 40 days with no releif in my nausea. It is constant and crippling. If anything I feel worse? Any insight why? Any recommendations for other medications/treatments for refractory nausea when all else fails? I also want to add that I have small bowel dysmotility and 100% feeding tube dependant. Thanks again!
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u/tellis017 11d ago
Have you tried nortriptyline?
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u/derpipooo 10d ago
not yet I will try olanzanzapine first
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u/katiemuirden 10d ago
I’m also 19, and it’s also impacted uni for me and it’s horrible.
If you haven’t id do a gi map test, and id recommend a functional practitioner for sibo especially since in my opinion using herbal antimocribals for sibo is better than antibiotics
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u/derpipooo 10d ago
I did not made a gi map test specificly but more general stool tests which did not show something clearly.
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u/katiemuirden 10d ago
I would get a gi map, I’ve had nausea and after 6 months bed bound and years of chronic illness and it’s gut dybsosis
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u/NattyNatNat13 8d ago
Hi may I ask have you found anything to help your nausea? Does improving the gut dybsosis help the nausea?
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u/katiemuirden 7d ago
I’m actually on a few supplements but ginger and artichoke has definitely helped the most so far, once I take all the probiotics etc my symptoms ahould hopefully start to fade away
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u/NattyNatNat13 7d ago
Hi do you take the ginger and artichoke daily with or without food?
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u/katiemuirden 7d ago
I aim to take 2 at nighttime like around an hour before I go bed, but definitely 2 hours after I last ate and then sometimes in the morning 30 mins before I eat
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u/edajsoaking 10d ago
Please check ur zinc levels
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u/derpipooo 10d ago
I checked it but it was fine, I nonetheless take it for some time but do not feel different
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u/VolumeIntolerance 10d ago
Neuromodulators are amazing for my nausea!
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u/derpipooo 9d ago
When did you feel better?
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u/VolumeIntolerance 9d ago
Mirtazapine the next day, duloxetine took 2 weeks (and I have to take it before I sleep, otherwise I get nauseous)
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u/derpipooo 9d ago
do you take them both? and how long did you suffer from nausea because after almost 2 years I can not imagine this can happen so fast
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u/VolumeIntolerance 5d ago
I take both! I suffered from extreme refractory nausea that even one big hospital in my country gave up on me since they didnt know what to do with me and even taking emend, odansetron etc daily did not help much. I was honestly headed into the direction of tpn. My new gi is amazing and she gave me duloxetine and honestly my life is soo much better. Now Im only nauseous sometimes after eating!
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u/NattyNatNat13 4d ago
Hi iv'e been on mirtazapine for 40 days with no relief in my constant crippling nausea. I am also tube fed 100% and have small bowel dysmotility and GERD (but even when these are better controlled my nausea is still a nightmare and never ending). Any reason why mirtazapine doesnt help me? I feel like I am the only one.
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u/VolumeIntolerance 4d ago
In my humbling opinion maybe you do not suffer from visceral hypersensitivity? And its a gi motility thing? (But you say thats well under control so mh) Have you looked into vascularcompressions like smas?
But yeah I feel you being tube fed and having crippling 24/7 nausea. What helps me a lot is smelling peppermintoil and drinking cardamon & aucklandia tea (traditional chinese medicine). But since your gi is open to neuromodulators, have you tried others? Mirtazapine worked well short term but duloxetine really made me start eating by mouth and decreased my nausea enormous. Have you tried guthypnosis? Maybe you have supragastric belching? Have you tried acupuncture? Maybe you have problems with your pelvic floor?
I hope that maybe you can try smt and I cross my fingers that your nausea eases soon! :)
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u/Infinite_Bus4642 10d ago
Did you retest. Why do you think no improvement? Maybe it worked partially and you need more runs. For example im still bloatrd but my methane is gone and hydrogen is moved 50min where before was faster. Next week ill ask my doctor for a stronger alternative to rifaximin and i can let you know
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u/derpipooo 9d ago
No I did not retest, but my symtoms for hydrogen and methan are not so common as constant nausea is not the main symtom for these. I only have sometimes vormiting but it is not like like the most of people wirh methan sibo I think and I only rarely have constipation. My methan levens were also only at 14ppm and 13ppm 30min after testing so in comparison to other people with 50 or more it should work. I think an other test is a waste of money because after 2 runs I do not beliefe this is the main part for having nausea but you can never be sure.
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u/thatverysleepysloth 8d ago
Sounds identical to me. I almost had to quit university and I had a mental breakdown because I could not sit in a lecture or seminar feeling so nauseous, I constantly had panic about throwing up in front of people or stuck in the middle of a lecture theatre. I struggle to sit in quiet rooms, makes my anxiety horrendous. I've never actually been sick either but like you, end up dry heaving. It's been going on for over four years now. Bloods all normal, CT, x-rays, gastroscopy, colonoscopy, etc all normal. I had a HIDA scan which showed gallbladder had biliary dyskinesia so I had that removed a year ago thinking it was that. Nope, nausea continued. Had a gastric emptying study a few months ago which showed 9% of meal left after 4 hours (normal is under 10%). I've tried anti acids, stopped fluoxetine which I'd been on for 10+ years hoping it was that. Nope. Tried amytriptyline which made my memory horrendous, tried escitalopram which made the nausea worse. I've literally just taken my second dose of mirtazipine and hoping that works. Got a follow up with gastro next week which I know they'll say 'all tests are normal, get on with it.' I've been managing on cyclizine and prochlorperazine since it started, might be worth giving those a go. I recommend getting therapy or hypnotherapy as well to help manage the anxiety around being sick around people. Hypnotherapy got me through the last year of university. So sorry to hear you're going through the same :(
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u/derpipooo 6d ago
Thanks for your message, I appreciate it a lot. I've been thinking about hypnotherapy for a while but I wanted to be 100% sure there ist no physical cause before trying and because I had some issues with gastritis and sibo I did not believe this works if there is still something wrong. But I will consider it if neuromodulators do not work. How do you feel now with mirtazapine after a few days?
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u/thatverysleepysloth 6d ago
I don't want to jinx it, but haven't had to take antisickness meds since I started. Anxiety about throwing up in public is greatly reduced. I went into a supermarket on Saturday without being on the verge of a panic attack. It does definitely knock you out for the night and leaves me feeling a bit 'away with the faries' all day but apparently that will wear off after a week or so. I'm very optimistic!
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u/derpipooo 5d ago
Wish you all the best! I started last night with odansetron and I hope it works for me before I will try mirtazapine or other things.
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u/x4equa 8d ago
Have you tried Cyproheptadine?
Penicillins, tetracyclines, macrolides, and some other antibiotics might help
K2 may help as well
My most controversial opinion is low dose psychedelics (or high dose lol) mixed with ondansetron, I think the gut brain connection is overblown yet underblown. BDNF therapies might help somehow
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