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Management of Abdominal Pain, Bloating, Abdominal Discomfort, and Diarrhea in an OPD Setting Using Domperidone, Losec, Buscopan, Norfloxacin, Plasil, Senokot, Lactulose, Simethicone, Antacid

Writer: MaytaMayta

Updated: Feb 19

Table: Ready-to-Use Medication Orders

Medication

Dose and Administration

Domperidone (Motilium)

10 mg PO, three times daily (AC)


Take ~15–30 minutes before meals

Losec (Omeprazole)

20 mg PO, once daily


Ideally before breakfast

Buscopan (Hyoscine)

10 mg PO, three times daily (PRN for pain/spasm)

Norfloxacin

400 mg PO, twice daily (PC)


Use only if bacterial infection is confirmed/suspected

Plasil (Metoclopramide)

10 mg PO, three times daily (PRN for nausea/bloating)

Senokot (Senna)

2 tablets PO at bedtime (HS)

Lactulose

30 mL PO at bedtime


Discontinue if diarrhea ≥ 3 times

Simethicone

80 mg PO, four times daily (after meals and at bedtime)

Antacid (e.g., Aluminum hydroxide + Magnesium hydroxide)

10 mL PO, four times daily (1 hr after meals and at bedtime) or PRN

 

Introduction

Abdominal pain, bloating, abdominal discomfort, and diarrhea are common gastrointestinal (GI) complaints in the outpatient setting. A systematic approach to diagnosis and management is essential to identify potential causes—ranging from functional disorders (e.g., Irritable Bowel Syndrome, IBS) to infections, dietary factors, and medication-related issues.

This article presents a structured outpatient management plan, encompassing pharmacological therapies (e.g., proton pump inhibitors, prokinetics, antispasmodics, laxatives, and simethicone), supportive measures (dietary modifications, lifestyle interventions), and guidance on antibiotic use (including typical duration).


 

Initial Assessment and Diagnosis

1. Comprehensive History

  • Symptom Characterization: Onset, duration, severity, and triggers (meals, stress).

  • Bowel Habits: Constipation versus diarrhea, presence of nausea/vomiting, any red-flag symptoms (e.g., weight loss, GI bleeding).

  • Dietary Habits: Assess fiber intake, potential allergens or intolerances (e.g., lactose, gluten).

  • Medication Review: Current prescription and over-the-counter medications.

  • Travel History: Recent travel may raise suspicion for parasitic or bacterial infections.

2. Physical Examination

  • Inspection and Palpation: Assess for abdominal distension, tenderness, or palpable masses.

  • Auscultation: Evaluate bowel sounds to gauge motility (hyperactive, hypoactive, or normal).

3. Diagnostic Investigations (If Indicated)

  • Laboratory Tests:

    • Complete Blood Count (CBC), electrolytes, liver function tests, renal function tests.

  • Stool Analysis:

    • For persistent diarrhea, test for pathogens (bacteria, parasites), fecal occult blood, or inflammatory markers (e.g., fecal calprotectin).

  • Imaging (Ultrasound or X-ray):

    • If alarm features exist (e.g., suspected obstruction, severe unexplained pain, or red-flag signs).


 

Pharmacological Management

Treatment choices should align with the predominant symptom(s) and likely underlying cause.

1. Proton Pump Inhibitors (PPIs)

  • Example: Omeprazole (Losec) 20–40 mg PO once daily.

  • Indication: Reduces acid-related dyspepsia, gastroesophageal reflux disease (GERD), and peptic ulcer disease contributing to abdominal discomfort.

2. Antispasmodics

  • Example: Buscopan (Hyoscine) 10 mg PO three times daily or PRN.

  • Indication: Relieves GI smooth muscle spasms, particularly beneficial in IBS-type symptoms with cramping.

3. Prokinetics/Antiemetics

  • Domperidone 10 mg PO three times daily (before meals) to enhance gastric emptying and reduce bloating.

  • Metoclopramide (Plasil) 10 mg PO three times daily/PRN can be used as an alternative, but monitor for side effects (e.g., extrapyramidal symptoms).

4. Antacids

  • Aluminum hydroxide + Magnesium hydroxide 10–20 mL or 1–2 tablets, taken 1–3 hours after meals or PRN.

  • Indication: Neutralizes excess gastric acid, providing quick relief from mild dyspepsia.

5. Simethicone

  • Dosage: 80–125 mg PO four times daily, after meals and at bedtime.

  • Indication: Reduces gas bubble formation, alleviating bloating and discomfort.

6. Antibiotics (If Infection is Suspected or Confirmed)

  • Norfloxacin 400 mg PO twice daily (after meals) is an example often used for bacterial gastroenteritis (e.g., certain strains of E. coli).

  • Duration:

    • Acute Bacterial Diarrhea/Traveler’s Diarrhea: Typically 3–5 days if clinical improvement is observed.

    • More Severe or Complicated Infections: May require up to 7–10 days, guided by culture results and clinical response.

  • Important: Use antibiotics judiciously to prevent resistance; confirm bacterial etiology whenever possible.

7. Laxatives

  • Senokot (Senna) 2 tablets PO at bedtime to stimulate bowel movements, helpful if constipation contributes to bloating.

  • Lactulose 30 mL PO once daily (usually at bedtime). Discontinue if diarrhea ≥3 times/day or if bloating worsens significantly.


 

Supportive Measures

1. Dietary Modifications

  • Low FODMAP Diet: Temporarily reduce fermentable oligosaccharides, disaccharides, monosaccharides, and polyols to reduce bloating.

  • Smaller, Frequent Meals: Avoid large meals that can exacerbate abdominal distension.

2. Lifestyle Recommendations

  • Light Exercise and Ambulation: Helps promote GI motility.

  • Avoid Carbonated Beverages: Minimizes excess gas formation.

  • Adequate Hydration: Particularly critical if diarrhea is present to prevent dehydration.


 

Monitoring and Follow-Up

1. Symptom Tracking

Advise patients to keep a record of bowel habits, pain intensity, and potential triggers. This information can guide treatment adjustments.

2. Medication Response

Adjust dosages or switch medications if symptoms persist or if side effects develop. Reassess the need for antibiotics if initial stool cultures are negative or if symptoms resolve.

3. Red-Flag Symptoms

Promptly investigate or refer for further evaluation if the patient experiences:

  • GI bleeding (hematemesis, melena)

  • Unexplained or severe weight loss

  • Persistent vomiting

  • Signs of obstruction (severe distension, vomiting, no passage of stool or gas)


 

Conclusion

Effective management of abdominal pain, bloating, discomfort, and diarrhea in the outpatient setting involves:

  1. Targeted Pharmacotherapy

    • PPIs for acid-related issues (e.g., omeprazole).

    • Prokinetics (domperidone, metoclopramide) for motility enhancement.

    • Antispasmodics (hyoscine) for cramping.

    • Laxatives (senna, lactulose) if constipation is contributing to bloating.

    • Simethicone and antacids for symptomatic relief of bloating and acid-related dyspepsia.

    • Antibiotics (e.g., norfloxacin) only when an infection is confirmed or strongly suspected, typically for 3–5 days in straightforward cases, or longer (7–10 days) if clinically indicated.

  2. Supportive Measures

    • Dietary modifications (low FODMAP, smaller meals).

    • Lifestyle adjustments (mild exercise, hydration).

  3. Regular Monitoring & Patient Education

    • Monitor symptom improvement, medication response, and potential side effects.

    • Reinforce the importance of follow-up and alert patients to seek immediate care if red-flag symptoms arise.

By integrating a methodical approach to diagnosis, evidence-based treatments, and close follow-up, clinicians can optimize symptom relief, prevent complications, and ensure timely referral for further evaluation if necessary.

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Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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