Brief Answer: Need some more information before treating you Detailed Answer: Hello and welcome to HCM! I have read your query carefully and can understand your problem. I want to tell you that - I agree with the dignosis of IBS in your case compared to dumping syndrome ( however, it may that you have symptoms of both together) and that - though it is troublesome illness but I want to assure you that with right treatment you will definitely get better! I have had several patients in my clinic who either have IBS alone or comorbid with other psychiatric illnesses. And almost always there is significant improvement in their IBS symptoms. I want to know few things before I can provide a management plan-- 1. do you ever have episodes of constipation for days together, may be 10-15 days alternating with diarrhoea? 2. how do you feel usually , do you have some anxiety or sadness on off? 3. why are you on prestiq and stilnox, as they are given in psychiatric illnesses. I have had very good results with a drug called ulrax in cases like yours, but for coming to a conclusion in your case I would like to have answers to the above questions. Hope the reply helps you please provide the necessary details

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Brief Answer: Please read below Detailed Answer: Hello, So, you take prestiq for anxiety and stilnox for sleep. You still need drug to sleep -- which means the anxiety is not well controlled -- which is one of the factor that you have so many abdominal symptoms. I have seen in my clinical practice that once the anxiety is well controlled, the sleep medicines are not required and stomach also settles down to a great extent. A) For such cases where there is anxiety comorbid with IBS, it is worthwhile to try out venalafaxine 37.5 mg and then increase upto 300 mg, after monitoring the response. Prestiq is a good molecule , it is a sub part of Venlafaxine , but mild...so, usually doesn't give desired response in severe cases. moreover the maximum dosage is low, so one can't move it up so much when needed. You should try to talk to your doctor about this point. B) Along with this, it is good if we add the combination - Ulrax : pantoperazole ( this will also take care of some dumping if it is there), clidnium , chlordiaxepoxide, given at night. It helps in handling the anxiety, sleep, cramps, gurgling and loose stools. I usually stop this after the anxiety and other symptoms are well conttrolled. C) On and off people require etizolam 0.24 mg on SOS basis, to curb anxiety and upsetting bowels. So, please talk about - Venlafaxine ( change prestiq) , adding etizolam and the combination of pantoperazole, clinidium, and chlordiaxepoxide. #### I'm almost sure that the main diagnosis is IBS for your bowel complaints, with may be component of dumping. The dumping can be handled by: 1. not eating very spicy and oily food,espically as a meal itself 2. donot take much of caffeine and tea 3. avoid staying hungry for more than 2 hrs. Take small frequent meals. 4. if possible, start walking/ jogging for at least half an hour a day The above steps are very very effective in handling post gall bladder dumping in almost every case. Do try them out. Hope the reply is useful Please feel free to ask more queries for clarification If you are satisfied, please rate the answer and close the query Dr. Manisha Gopal MD Psychiatry

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