Lung transplant

Question

I am 21 and suffer from CF. In September 2008 I had a transplant and since the transplant I continuously feel sick to my stomach. I am nauseous, especially after the evening meal. My doctor prescribed Domperidon but I don’t have the feeling that this helps sufficiently. Because I feel nauseous all the time, I eat less and less to avoid that problem. What else could I do to avoid being nauseous?

Answer

Dearest,
Ecorn is a medium to answer general questions on CF. The purpose is not to replace a consultation with your doctor. For your problem we do advise you to go see your doctor and talk to him about it.
So for your question, we can also give some general information about being nauseous. There are very many reasons for being nauseous. In case these complaints start soon after lung transplant, they can directly or indirectly have to do with this. But even then, there are several possibilities. It is therefore very important to list the symptoms that you have to your doctor and tell him about when you feel sick, how often, whether there is a relationship with food, whether it’s only with solid food or also with liquid food, how long the symptoms last, whether there’s other complaints such as pain in the gastric region, whether the stools are normal, … Depending on the severity of the nausea a doctor can check if further tests are necessary.
During the first period following a lung transplant, nausea can be a side-effect from some of the new medications the patient has to take such as immunosuppressive drugs and medicines to prevent infections. The doctor can change these medication around a bit, but of course there is not a lot of room to move because of the transplant. Most of the tablets are really very important to prevent rejection and infection.
Another cause of nausea can be reflux of gastric acid. Therefore treatment to reduce acid production is given post transplant. At times it is necessary to give higher doses or even a combination of medicines.
A more difficult to treat cause of nausea is delayed emptying of the stomach. Damage to the vagal nerve or immunosuppressive drugs given after transplant can be the cause of this. Symptoms that can point towards delayed gastric emptying are feeling sick, vomiting, feeling bloated and tolerating fluids but not solid food. Treatment that can be considered is:
- changing the diet
- limiting the fat intake
- limiting the amount of fiber intake
- decreasing alcohol and avoiding nicotine
- medicines that stimulate gastric emptying
- medicines that prevent nausea
- medication that decreases gastric emptying
- an optimal treatment of diabetes if the patient suffers from it

In some patients the treatment is really difficult. In the international literature there is some mention of electric stimulation of the stomach (gastric electric stimulation). This is a sort of pacemaker for the stomach. It speeds the gastric emptying so that there are less symptoms. Very little is known about this treatment modality in patients who underwent lung transplant.
But again to conclude, very many causes can result in nausea. Therefore your problem should be discussed with your doctor.
Kind regards
Dr. I. Bronsveld

04.01.2010