PHGG, prucalopride, psyllium, and capers helped more than anything so far — but I’m still piecing it together

I’ve had digestive problems for several years that began after a severe illness around late 2023/early 2024. My main symptoms are methane-predominant constipation (bowel movements every 3–4 days before treatment), bloating, excessive gas, globus sensation, LPR/reflux without much heartburn, regurgitation, thick mucus in my throat, occasional difficulty swallowing, brain fog, fatigue and a feeling that food sits in my stomach for too long. Fatty meals and large meals make symptoms worse. Stress also makes my digestion noticeably worse.

I had a methane breath test which was positive (peak methane around 24 ppm). Upper endoscopy showed a normal oesophagus, stomach and duodenum apart from very mild chronic inflammation in the mid oesophagus. H. pylori was negative. A previous barium swallow was also normal.

Treatments I’ve tried:

Omeprazole: Reduced some reflux symptoms and for a period changed my LPR from thick globus to more of a vapour sensation. It allowed me to tolerate foods like tomato sauce and chocolate better, but I developed significant constipation, bloating and hair loss, so I stopped it. I have recently restarted it because symptoms became severe again. Famotidine (Pepcid): Some benefit for reflux/LPR but did not resolve the globus. Digestive enzymes: Minimal benefit. Zinc L-carnosine: Unsure if it helped. Sauerkraut: Tolerated. Oregano tea and berberine: Tried previously with no dramatic improvement. Prucalopride: Currently taking. Appears to help bowel motility. PHGG (partially hydrolysed guar gum): One of the most helpful things so far. My stools are now much larger, softer and easier to pass, and I feel like I empty more completely. Psyllium husk: Helpful when combined with PHGG, although it initially caused bloating. L-glutamine (5 g/day) and glycine: Started recently. Since starting, together with PHGG and other changes, I’ve noticed less brain fog, improved bowel function and my rosacea seems calmer, although I can’t be sure which treatment is responsible. Capers (around one tablespoon daily): Since adding these I’ve noticed a surprisingly large improvement in brain fog and my ability to follow conversations, although I don’t know if this is due to quercetin or coincidence. Neck, chest and fascia stretching: This has significantly reduced my globus sensation on some days, suggesting there may also be a musculoskeletal or breathing component alongside reflux.

Current diet is high in lean protein and vegetables with moderate healthy carbohydrates. I avoid overeating, stop eating at around 70–80% full, chew food thoroughly until it is almost a paste, eat slowly, avoid large drinks with meals and avoid eating close to bedtime.

Current status: I still have reflux/LPR and globus, but recently I’ve had some of the best days I’ve had in years with clearer thinking, improved energy, much better bowel movements and significantly reduced globus. I’m trying to work out which combination of treatments is responsible.