Duodenal Ulcers: When to Consult a Gastroenterologist

Q: Duodenal Ulcers: When to Consult a Gastroenterologist

Hello： It is recommended to visit a gastroenterologist after two weeks of taking Nexium to continue the prescription. <br>Additionally, after the wound stabilizes, approximately 3 to 4 months into the medication, a follow-up endoscopy should be performed. <br>If ulcers are still

Duodenal ulcer

On May 2nd, I was taken to the emergency department of a major hospital due to abdominal pain, where I was diagnosed with acute peritonitis and a gastrointestinal perforation (approximately the size of a fingertip).
I underwent surgery performed by a general surgeon to repair the perforation.
After the surgery, I asked the doctor about the cause of my peptic ulcer, specifically whether it was related to Helicobacter pylori and if I needed treatment for it.
The doctor responded that Helicobacter pylori is present in everyone and that even after treatment, it can regenerate, so there is no need to treat the duodenal ulcer.
He mentioned that it depends on individual dietary habits whether it will recur.
He only prescribed me with a two-week course of antibiotics and scheduled a follow-up appointment in two weeks.
I am concerned that the doctor's response differs significantly from what I found online.
Should I consider a referral to a gastroenterologist, even though I am still under the care of the general surgeon?

Mr. Hsieh, 40~49 year old female. Ask Date: 2016/05/21

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: It is recommended to visit a gastroenterologist after two weeks of taking Nexium to continue the prescription.
Additionally, after the wound stabilizes, approximately 3 to 4 months into the medication, a follow-up endoscopy should be performed.
If ulcers are still present, a biopsy can be conducted, and if Helicobacter pylori is detected, eradication therapy should be initiated.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun

Reply Date: 2016/05/21

More Info

Understanding duodenal ulcers and their management is crucial, especially after experiencing complications such as perforation and acute peritonitis. Your situation highlights the importance of a comprehensive approach to treatment and follow-up care.
Duodenal ulcers are a type of peptic ulcer that occurs in the first part of the small intestine (the duodenum). They can be caused by several factors, including infection with Helicobacter pylori (H. pylori), excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs), and lifestyle factors such as smoking and alcohol consumption. The symptoms can include abdominal pain, bloating, and indigestion, and in severe cases, complications like perforation can occur, leading to acute abdominal conditions requiring surgical intervention.

In your case, after undergoing surgery for a perforated duodenal ulcer, it is essential to monitor your recovery closely. The fact that your surgeon indicated that H. pylori is present in many individuals and may not necessarily require treatment in every case can be somewhat misleading. While it is true that H. pylori is common, it is also a significant contributor to the development of peptic ulcers. Therefore, if you have a history of ulcers, it is generally advisable to test for H. pylori and, if positive, to undergo eradication therapy. This typically involves a combination of antibiotics and acid-reducing medications.

Your surgeon's recommendation to focus on dietary habits is also valid, as lifestyle modifications can significantly impact ulcer healing and recurrence. A diet low in irritants (such as spicy foods, caffeine, and alcohol) and high in fiber can promote better digestive health. However, this should not replace medical treatment, especially if there is an underlying infection.

Regarding your question about whether to consult a gastroenterologist, it is highly advisable. Gastroenterologists specialize in digestive disorders and can provide a more comprehensive evaluation of your condition. They can perform necessary tests, such as endoscopy or H. pylori testing, and offer tailored treatment plans that may include medication management, dietary recommendations, and regular follow-up care.
In summary, while your surgeon has provided some guidance, a gastroenterologist can offer a more specialized perspective on managing your duodenal ulcer and preventing future complications. It is essential to address any lingering symptoms, such as abdominal pain or changes in bowel habits, and to ensure that you are on the appropriate treatment regimen. Do not hesitate to seek a second opinion or further evaluation from a gastroenterologist, especially if you have concerns about your recovery or the potential for recurrence of your ulcer. Your health and well-being should always be the top priority, and having a specialist involved in your care can provide peace of mind and a clearer path to recovery.

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