Could Duodenal Ulcers Be the Cause of My Persistent Stomach Acid?

Could a duodenal ulcer be the main cause of my long-term discomfort from excessive stomach acidity?

Hello Doctor, I have been experiencing a very sour sensation in my stomach every night around 11 PM for the past two months, which continues until midnight.
Eventually, it worsened to the point where I feel this sourness during the day as well, coming in waves and causing significant discomfort.
However, the symptoms mainly consist of acidity and burning, without much stomach pain.
Due to my concerns, I underwent an endoscopy a week ago, and the doctor diagnosed me with mild gastritis, a duodenal ulcer, and Helicobacter pylori infection, and prescribed Pantoprazole for me.
However, Pantoprazole is to be taken once daily, and after taking it for a week, I still feel the sour sensation in my stomach by evening, suggesting that my stomach acid is not well-controlled (the doctor mentioned I could take an additional dose at night if uncomfortable).
I would like to ask if my symptoms, primarily characterized by acidity and burning, could be caused by the duodenal ulcer or Helicobacter pylori? Most people seem to report pain, but my symptoms are more related to acidity.
I am concerned whether Pantoprazole will completely resolve my acid issues or if I need to take it for a while before the condition improves.
Thank you, Doctor, for patiently reading my question.
😊

Miss Huang, 20~29 year old female. Ask Date: 2017/11/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, your symptoms may also be associated with gastroesophageal reflux disease (GERD).
Taking strong antacids can simultaneously treat both GERD and gastric ulcers as well as duodenal ulcers.
Therefore, please be patient and cooperate with your physician regarding the medication.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2017/11/19

More Info

Duodenal ulcers can indeed be a significant factor contributing to your persistent stomach acid symptoms. The symptoms you describe—intense acid sensations and burning in your stomach—are commonly associated with both duodenal ulcers and conditions like gastroesophageal reflux disease (GERD). The presence of Helicobacter pylori (H. pylori) infection, which you mentioned was diagnosed during your endoscopy, is also a critical factor. H. pylori is known to cause inflammation of the stomach lining (gastritis) and is a common cause of peptic ulcers, including duodenal ulcers.

When you have a duodenal ulcer, the protective lining of the duodenum is compromised, which can lead to increased acid secretion and a sensation of burning or discomfort. This is particularly noticeable at night or when your stomach is empty, which aligns with your experience of increased acidity around 11 PM. The fact that you feel better after taking medication like Pantoloc (a proton pump inhibitor) suggests that your symptoms are indeed related to acid secretion.

Regarding your concern about whether Pantoloc alone is sufficient to manage your symptoms, it’s important to understand that while proton pump inhibitors (PPIs) like Pantoloc are effective in reducing stomach acid production, they may not address the underlying causes of your symptoms, such as H. pylori infection. Treatment for H. pylori typically involves a combination of antibiotics and PPIs, known as triple therapy, which aims to eradicate the bacteria and promote healing of the ulcer.

Your experience of feeling better initially but then experiencing a resurgence of symptoms later in the day could indicate that the single dose of Pantoloc is not providing adequate acid suppression throughout the day. It’s not uncommon for patients to require adjustments in their medication regimen, including the possibility of taking a second dose later in the day or exploring other medications that can provide additional relief.

In terms of the healing process, it’s essential to give your body time to recover from the ulcer. While some patients may experience rapid relief from symptoms, others may take longer, especially if there are complicating factors like H. pylori infection. It’s crucial to follow your doctor’s recommendations closely, including completing any prescribed course of antibiotics if you are being treated for H. pylori.

Additionally, lifestyle modifications can play a significant role in managing your symptoms. These include avoiding trigger foods (such as spicy, fatty, or acidic foods), eating smaller meals more frequently, and avoiding lying down immediately after eating. Stress management techniques can also be beneficial, as stress can exacerbate symptoms of acid reflux and ulcer discomfort.

In summary, your symptoms of persistent stomach acid are likely related to your duodenal ulcer and H. pylori infection. While Pantoloc is an effective treatment for reducing stomach acid, it may not be sufficient on its own, especially if H. pylori is present. It’s essential to discuss your ongoing symptoms with your healthcare provider, who may recommend additional treatments or adjustments to your current medication regimen. With appropriate treatment and lifestyle modifications, you should see improvement over time.

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