PaJR Case Reports: 26M Acute Dyspepsia after a long motor cycle journey, Migrant worker Telangana PaJR

16-07-2025

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[16-07-2025 16.32] PPM 1: Migrant worker from WB, in Telangana since 8 years, working as a crane operator and pump operator for a private company

Complains of epigastric discomfort since last three days after having returned from a long drive at another crane operation site.

[17-09-2025 14:51] PPM 1: Reviewed

Was alright all these days and hence didn't update

Symptoms recurred since last 4 days and has mild Dyspepsia and mild headache.

Was free today and came for a check-up today also because he will be traveling home 2000 kms away from Telangana for the October fest

[17-09-2025 14:54] PPM 1: Adviced repeat previous medications

To meet Dr @PPM7 in MOPD now for a clinical examination of his abdomen and decide if he needs any further investigations.

Best for him would be to follow up regularly with his food plates and hourly activities here.

[17-09-2025 15:18] PPM 7: Sir no tenderness present, doesn't seem like he requires any investigations

[17-09-2025 15:18] PPM 1: Thanks

Ask him to share his stuff regularly here

[17-09-2025 15:19] PPM 7: Ok sir

[17-09-2025 21:25] PPM 6: Raw onion can sometimes cause dyspeptic symptoms

[18-09-2025 08:18] PPM 1: @Meta AI @PPM3 please share some data around how " raw onion can sometimes cause dyspeptic symptoms". Please support them with perplexity styled references

[18-09-2025 08:18] Meta AI: Raw onions are known to cause dyspeptic symptoms in some individuals due to their composition and digestive effects. Here’s a breakdown of the relevant data:

1. Trigger for Acid Reflux and Heartburn: Raw onions can relax the lower esophageal sphincter, which is the muscle that prevents stomach acid from flowing back into the esophagus. This can lead to acid reflux, heartburn, and a burning sensation in the chest or throat, especially if consumed before lying down or during the evening. The sulfur compounds and fructans in onions exacerbate this by increasing gastric acid production and fermentation in the gut.¹ ²

2. Gas, Bloating, and Abdominal Discomfort: Onions contain fructans, a type of carbohydrate that some individuals struggle to digest. When these fructans ferment in the gut, they produce gas, bloating, and abdominal cramps. For people with Irritable Bowel Syndrome (IBS), these symptoms tend to worsen significantly after consuming raw onions.³ ⁴

3. Nausea and Vomiting: Excessive consumption of raw onions can irritate the stomach lining, leading to symptoms such as nausea, vomiting, and even diarrhea. The high sulfur content in onions contributes to this irritation, making them problematic for individuals with sensitive digestive systems or pre-existing conditions like GERD.⁵

4. Specific Sensitivity and Allergies: Some people may have an intolerance or mild allergy to compounds found in onions, which can manifest as gastrointestinal distress, including stomach pain, cramping, or diarrhea. In rare cases, these reactions may indicate sensitivity to sulfur compounds or histamine-like effects.

5. Impact on IBS and High FODMAP Diets: Onions are categorized as high-FODMAP foods, meaning they contain fermentable carbohydrates that can aggravate IBS symptoms. For individuals following a low-FODMAP diet, even small amounts of raw onion can trigger significant discomfort.

These effects highlight the importance of moderation and awareness of individual tolerance levels when consuming raw onions. Cooking onions often reduces their sulfur and fructan content, making them easier to digest for sensitive individuals.

Have you experienced similar symptoms yourself, or are you exploring this for dietary adjustments?

[18-09-2025 08:18] Meta AI: https://timesofindia.indiatimes.com/life-style/food-news/7-side-effects-of-eating-raw-onions-you-must-know/articleshow/123565413.cms

[18-09-2025 08:18] Meta AI: https://www.natureword.com/11-side-effects-of-eating-onions/

[18-09-2025 08:18] Meta AI: https://krishijagran.com/health-lifestyle/side-effects-of-raw-onion/

[18-09-2025 08:18] Meta AI: https://eatforlonger.com/eating-raw-onions-side-effects/

[18-09-2025 08:18] Meta AI: https://www.findingasuitable.com/onion-toxicity-in-humans/

[18-09-2025 08:21] PPM 1: 👆@PPM3@PPM5 let's start prospectively structuring each PaJR AI use case separately as structured case reports vs the current PaJR conversational unstructured case reports @PPM4

[18-09-2025 09:28] PPM 3: Certainly! Here is a comprehensive analysis of how raw onions can cause dyspeptic symptoms, supported by scientific references and mechanisms:

# 🧅 How Raw Onions Can Cause Dyspeptic Symptoms: Mechanisms and Evidence

## 1. *FODMAP Content and Fermentation Effects*

- Raw onions are rich in *fructans, a type of fermentable oligosaccharide (FODMAP) that is poorly absorbed in the small intestine. When these carbohydrates reach the colon, they are fermented by gut bacteria, producing gas (hydrogen and methane) and drawing water into the intestinal lumen. This process can lead to **bloating, flatulence, abdominal pain, and altered bowel habits* in sensitive individuals, particularly those with irritable bowel syndrome (IBS) or functional dyspepsia .

- Studies indicate that onions are among the most common triggers for IBS symptoms due to their high FODMAP content. For example, a cross-sectional study of 384 functional dyspepsia patients identified onions as a significant aggravator of symptoms in 40.1% of participants .

## 2. *Sulfur Compounds and Gastrointestinal Irritation*

- Onions contain *sulfur compounds* (e.g., diallyl disulfide and allicin), which contribute to their pungency and potential to cause gastrointestinal distress. These compounds can:

- *Irritate the gastric mucosa*, leading to nausea, cramping, and indigestion .

- *Relax the lower esophageal sphincter (LES)*, facilitating acid reflux and heartburn. A 1990 study demonstrated that raw onions significantly increased heartburn episodes and acid reflux in individuals with frequent heartburn compared to controls .

- In rare cases, sulfur sensitivity may manifest as allergic reactions (e.g., itching, hives, or breathing difficulties) .

## 3. *Impact on Acid Reflux and Esophageal Sensitivity*

- Raw onions are a *potent refluxogenic agent*. They reduce LES pressure and stimulate gastric acid production, which can exacerbate gastroesophageal reflux disease (GERD) symptoms. This effect is attributed to their high concentration of volatile compounds and fermentable fibers .

- Clinical observations note that raw onions cause longer-lasting and more severe reflux compared to cooked onions, as cooking partially breaks down these irritants .

## 4. *Individual Variability and Comorbid Conditions*

- *Functional dyspepsia patients* often report heightened sensitivity to raw onions. A study found that 40.1% of dyspepsia patients experienced symptom aggravation from onions, likely due to visceral hypersensitivity and disrupted gut-brain axis signaling .

- *Cross-reactivity* in individuals allergic to other Liliaceae plants (e.g., garlic, leeks) or grass pollens may worsen symptoms .

## 5. *Comparison with Cooked Onions and Alternatives*

- *Cooking onions* reduces their FODMAP content and volatile sulfur compounds, diminishing their potential to cause dyspepsia. Sautéing or boiling onions can make them tolerable for some individuals .

- Alternatives like *chives, ginger, or infused oils* may provide flavor without triggering symptoms .

## 6. *Management Strategies for Onion-Induced Dyspepsia*

- *Low-FODMAP diet*: Temporarily eliminating high-FODMAP foods, including raw onions, under dietitian guidance .

- *Enzyme supplements*: Alpha-galactosidase enzymes (e.g., Beano) may help break down fructans but are not universally effective .

- *Portion control*: Small quantities of raw onions may be tolerated if symptoms are mild .

## 💡 Key Takeaways:

- Raw onions are a common trigger for dyspeptic symptoms due to their *fructan content, sulfur compounds, and refluxogenic effects*.

- Symptoms include *bloating, heartburn, nausea, and abdominal pain*, particularly in individuals with IBS, functional dyspepsia, or GERD.

- *Cooking onions* and using alternatives can mitigate risks, while *dietary modification* remains the primary management approach.

### 📊 Table: Onion-Related Symptom Triggers in Functional Dyspepsia Studies

| :--- | :--- | :--- | :--- |

For individuals experiencing persistent symptoms, consultation with a gastroenterologist or dietitian is recommended to tailor dietary strategies and rule out underlying conditions.

[18-09-2025 09:34] PPM 3: Introduction

Dyspepsia is a common gastrointestinal disorder characterized by symptoms such as heartburn, bloating, and discomfort, which significantly affect the quality of life. Various dietary factors may influence the onset and severity of dyspeptic symptoms. Notably, onions, specifically Allium cepa, are often cited as a potential irritant for individuals experiencing these symptoms. This literature review explores the relationship between onion consumption and dyspepsia while evaluating relevant findings from recent studies.

Key Insights

Effect of Capsaicin on Dyspeptic Symptoms: A study evaluated the effects of capsaicin, a compound found in chili peppers but not in onions, on heartburn and dyspepsia. The results indicated that while capsaicin did not significantly change the overall scores for heartburn and dyspepsia, it notably reduced the time required to reach peak heartburn after meals. This suggests that some food components may exacerbate dyspeptic symptoms by sensitizing gastroesophageal tissues 1. Although this study does not directly involve onions, it highlights how dietary substances can impact dyspeptic experiences.

Dietary Linoleic Acid Levels: Research on the dietary intake and adipose tissue levels of linoleic acid among patients with non-ulcer dyspepsia and peptic ulcer disease revealed that both patient groups had significantly lower amounts of linoleic acid compared to healthy controls. This study offered insights into dietary habits that may relate to gastrointestinal health. While onions are not explicitly studied, the findings suggest dietary composition may play a critical role in dyspeptic symptomatology, accentuating the need for a better understanding of food sensitivities and dietary impacts 2.

Symptom Triggers Identified by Patients: Patients with dyspepsia pointed to various foods that exacerbated their symptoms, including onions, fried foods, and alcohol. This aligns with anecdotal reports that specific foods may lead to increased dyspeptic symptoms for some individuals. Therefore, onions, as components of a diverse diet, can provoke symptoms and should be considered in dietary assessments for dyspeptic patients 2.

Conclusion

The connection between onion consumption and dyspeptic symptoms underscores the complexity of dietary influences on gastrointestinal health. While direct studies on onions and dyspepsia are limited, existing research shows that certain food components may exacerbate symptoms and that individual responses to dietary intake can vary. It becomes critical for those experiencing dyspeptic symptoms to identify potential triggers within their diets, including onions. Overall, a comprehensive understanding of dietary impacts, along with targeted dietary assessments, may lead to better management of dyspepsia. Further research specifically focusing on onions and dyspeptic symptoms would greatly enhance our understanding of this relationship.

Reference

[1] The effects of capsaicin on reflux, gastric emptying and dyspepsia.

[2] Dietary intakes and adipose tissue levels of linoleic acid in peptic ulcer disease.[PubMed. ai]

https://1drv.ms/x/c/83fd19b3363f46cd/EcoG5YX267xFrch37zLMjF8BxeydqJipc5rmbqGjRb_Bmw

[18-09-2025 10.05] PA: