Managing Chronic Stomach Issues: Ulcers, Acid Reflux, and Treatment Options

I have had a gastric ulcer for a long time, and it has not healed?

Hello, I experienced gastric bleeding and black stools in August of last year, which led to immediate hospitalization.
An endoscopy revealed that I had gastric ulcers and duodenal ulcers, along with Helicobacter pylori infection.
I was hospitalized for three days and took medication for two months, after which I improved.
However, the doctor advised that I still needed to take Tecta (pantoprazole).
As a result, whenever I skip breakfast, I experience stomach pain and slow digestion.
Sometimes the pain occurs, but I don't take medication every time.
Later, when the pain became severe, I underwent another endoscopy in December, and the ulcers had healed, but my stomach appeared very red and somewhat deformed.

In February of this year, I traveled abroad and frequently experienced slow digestion, so I occasionally took Tecta.
By the end of April, after consuming fried and sweet foods, my symptoms recurred.
I started taking a PPI (proton pump inhibitor) daily until the end of June, then stopped.
After stopping the medication, I experienced increased stomach acid when hungry, and I had some fasting pain in the morning, which subsided after eating, but I often felt bloated.

In August, I stopped taking traditional Chinese medicine and took Tecta for a week, which improved my stomach condition.
However, after a week, my symptoms recurred, and they were more severe than before, with nighttime acid reflux and persistent stomach acid pain.
I had to get up to take medication, and after a few days, I switched back to traditional Chinese medicine.
Since then, my symptoms have been fluctuating; I experience pain when hungry and at irregular times.

Now, in November, I consulted a doctor again, who prescribed Nexium (esomeprazole) 20 mg.
After taking it for six days, my stomach improved, but during the medication period, I still experienced intermittent pain.
Speaking loudly also triggered stomach acid pain, although the medication helped reduce the acid.

Now, a week has passed, and I wonder if I stopped the medication too early.
I am uncertain whether I have ulcers or chronic gastritis.
Should I continue taking Western medicine? It feels like my condition has not improved consistently this time.
What should I do? Even though my stomach feels better, it doesn't feel completely healed.

Cheng, 20~29 year old female. Ask Date: 2019/11/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is advisable to maintain a low dose of proton pump inhibitors for 1-3 months, and then switch to as needed.
Additionally, keep some antacids on hand for emergency use.

Reply Date: 2019/11/29

More Info

Managing chronic stomach issues such as ulcers and acid reflux can be quite challenging, especially when symptoms persist despite treatment. Based on your description, it seems you have a complex history of gastrointestinal problems, including gastric and duodenal ulcers, as well as symptoms of gastroesophageal reflux disease (GERD). Here’s a comprehensive overview of your situation and some recommendations.

Understanding Your Condition
1. Ulcers and Gastritis: You have experienced both gastric and duodenal ulcers, which are open sores on the lining of the stomach and the first part of the small intestine, respectively. These can cause significant pain and discomfort, especially when the stomach is empty or after eating certain foods. The presence of Helicobacter pylori (H. pylori) is a common cause of these ulcers, and it seems you have been treated for this infection.

2. Acid Reflux: Your symptoms of acid reflux, including nighttime regurgitation and discomfort when speaking loudly, suggest that the lower esophageal sphincter may not be functioning properly, allowing stomach acid to flow back into the esophagus. This can be exacerbated by certain foods, stress, and even the medications you are taking.

3. Medication Management: You mentioned taking proton pump inhibitors (PPIs) like Nexium (esomeprazole) and other medications to manage your symptoms. PPIs are effective in reducing stomach acid production, which can help heal ulcers and alleviate reflux symptoms. However, long-term use of PPIs can lead to rebound acid hypersecretion, where the stomach produces more acid once the medication is stopped, potentially leading to a cycle of dependency.

Recommendations for Management
1. Continue Medication as Prescribed: Given your history of ulcers and ongoing symptoms, it may be beneficial to continue taking the PPI as prescribed by your doctor. Stopping the medication prematurely can lead to a resurgence of symptoms. Discuss with your healthcare provider about the appropriate duration for PPI therapy in your case.

2. Dietary Modifications: Since you have noted that certain foods trigger your symptoms, it is crucial to identify and avoid these triggers. Common culprits include spicy foods, fried foods, caffeine, alcohol, and high-fat meals. Instead, focus on a diet rich in whole grains, lean proteins, fruits, and vegetables. Eating smaller, more frequent meals can also help manage symptoms.

3. Lifestyle Changes: Incorporate lifestyle modifications that can alleviate symptoms. This includes:
- Elevating the Head of Your Bed: This can help prevent nighttime reflux.

- Avoiding Late Meals: Try not to eat within three hours of bedtime.

- Managing Stress: Stress can exacerbate gastrointestinal symptoms. Consider relaxation techniques such as yoga, meditation, or deep breathing exercises.

4. Regular Follow-Up: Given the complexity of your symptoms, regular follow-up with your gastroenterologist is essential. They may recommend periodic endoscopies to monitor the healing of your ulcers and assess for any complications.

5. Consider Psychological Support: Since you mentioned experiencing emotional distress, it may be beneficial to seek support from a mental health professional. Stress and anxiety can significantly impact gastrointestinal health, and addressing these issues may improve your overall well-being.

Conclusion
In summary, managing chronic stomach issues requires a multifaceted approach that includes medication, dietary changes, lifestyle modifications, and regular medical follow-up. It is essential to communicate openly with your healthcare provider about your symptoms and treatment plan. By taking these steps, you can work towards achieving better control over your gastrointestinal health and improving your quality of life.

Similar Q&A

Understanding Persistent Abdominal Pain: Insights on Ulcers and Stress Factors

Dear Doctor, I have been experiencing mild pain in my abdomen and epigastric area for the past six months. Two gastroscopies have revealed the presence of a gastric ulcer and gastroesophageal reflux disease (GERD). The physicians have prescribed proton pump inhibitors (PPIs) for...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello Mr. Kevin: PPIs can treat gastric ulcers and reflux, but there may be a recurrence after discontinuation (which is different from the definition of ineffectiveness during treatment). A CT scan is used to examine organs other than the stomach, so the objectives are different...

Understanding Chronic Digestive Issues: Insights from a Gastroenterologist

I usually experience diarrhea due to stomach acid. I would like to consult a physician.

Dr. Cai Yaozhou reply Gastroenterology and Hepatology
Treatment can be discussed from three different perspectives: 1. Lifestyle modifications: 1. Dietary content and patterns: It is recommended to eat smaller, more frequent meals and avoid high-fat foods. The following foods should be avoided: chocolate, mint, coffee, onions,...

Managing GERD and Chronic Gastritis: Expert Insights and Treatment Options

Hello Doctor: I started experiencing gastroesophageal reflux symptoms last year. During this time, I have consulted three gastroenterologists and an ENT specialist for endoscopic examinations. All the doctors said that an upper endoscopy was not necessary and that I could take me...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello: Young individuals with acid reflux can initially manage it with medication and dietary adjustments, such as reducing coffee, sweets, acidic foods, and glutinous rice. Recurrences are common, so it's advisable to keep medication on hand and take it as needed.

Managing Chronic Gastrointestinal Issues: A Guide for Caregivers

My mother has had long-term gastrointestinal issues for several years, experiencing intermittent diarrhea, bloating, and gastroesophageal reflux disease (GERD). She has been taking over-the-counter antidiarrheal medications for diarrhea and applying mentholated oil to relieve blo...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, if you have already undergone surgery, it is recommended to discuss with your surgeon whether the symptoms are related to the postoperative period. Changhua Hospital cares about your health. Chen Shidian.