Persistent Stomach Burning: When Medication Fails to Relieve Symptoms

The condition of gastric burning is not improving significantly with medication?

Hello, doctor.
I have been suffering from gastroesophageal reflux disease (GERD) for many years.
I started treatment two years ago and have undergone several endoscopies.
The results showed only slight redness and some burn-like conditions.
My attending physician at Mackay Memorial Hospital prescribed me Tegoprazan, which initially worked well and gave me peace of mind regarding my condition.

In mid-December last year, I experienced hematuria and began taking antibiotics for about two weeks.
I had to stop taking Tegoprazan (the prescription indicated to avoid taking it with stomach medications).
During that time, I started experiencing unusual symptoms, including a burning sensation in my stomach (it feels both hot and prickly), sometimes radiating to lower areas of the stomach, and sometimes localized in the stomach.
During these episodes of burning, I also experience belching, followed by a feeling of hunger, which is very strange.
Initially, these episodes were infrequent, but they have become more frequent recently.

I had no choice but to consult my attending physician again, and I underwent another endoscopy.
The results were similar to before, and I was advised to continue taking Tegoprazan.
However, since the onset of the unexplained burning sensation, Tegoprazan seems to have limited effectiveness in alleviating it.
Recently, I even visited the emergency room due to the discomfort from the burning sensation and underwent an abdominal CT scan to rule out issues with other organs, which also came back normal.

This situation has become quite embarrassing, and my attending physician is unsure of what is happening, as the functions and imaging reports of the pancreas and other organs are normal.
It seems to have turned into a psychological issue, severely impacting my quality of life.
I would like to ask the doctor what I should do.
If I want to completely rule out gastric issues, what additional tests would you recommend? Additionally, since I previously had an infection with Helicobacter pylori and underwent treatment, could the long-term use of Tegoprazan, which creates a less acidic environment in the stomach, allow for a recurrence of Helicobacter pylori that might cause this burning discomfort? Please help me, doctor.
I am really suffering.
Thank you.

kaguramaki, 30~39 year old female. Ask Date: 2021/01/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

It may be advisable to continue medication (possibly increasing the dosage at your own expense) and monitor the situation, while maintaining a normal diet.
If necessary, a 24-hour esophageal pH monitoring can be performed (the test may cause some discomfort).

Reply Date: 2021/01/28

More Info

Persistent stomach burning can be a distressing symptom, especially for individuals with a history of gastroesophageal reflux disease (GERD) and other gastrointestinal issues. Your situation, where you have experienced a resurgence of burning sensations in your stomach after stopping your medication, raises several important considerations.

Firstly, it’s crucial to recognize that the symptoms you describe—burning sensations, discomfort, and increased belching—can be associated with several gastrointestinal conditions, including GERD, gastritis, or even peptic ulcers. The fact that you have a history of GERD and have undergone multiple endoscopies suggests that your esophagus and stomach lining have been monitored for any significant damage or abnormalities. However, the persistence of your symptoms despite treatment indicates that there may be underlying factors that need to be addressed.

One potential factor is the interruption of your medication regimen. You mentioned that you had to stop taking your medication (泰克胃通) due to a course of antibiotics. This is significant because certain antibiotics can disrupt the balance of gut flora, potentially leading to gastrointestinal symptoms, including increased acid production or altered digestion. The burning sensation you are experiencing could be a rebound effect from stopping the medication, which may have been controlling your acid levels and protecting your stomach lining.

Moreover, you raised a valid concern about the possibility of a Helicobacter pylori (H. pylori) infection. If the initial treatment for H. pylori was not completely effective, it could lead to a resurgence of symptoms. H. pylori is known to cause chronic gastritis and can contribute to the development of ulcers, which could explain the burning sensation. It would be prudent to discuss with your physician the possibility of retesting for H. pylori, especially if your symptoms have not improved.

In terms of further evaluation, if you have not already done so, consider discussing the following options with your healthcare provider:
1. Repeat Endoscopy: If your symptoms persist, a repeat endoscopy may be warranted to assess for any new developments, such as ulcers or significant inflammation that might not have been present during your last examination.

2. pH Monitoring: This test can help determine if acid reflux is occurring and whether it correlates with your symptoms. It can provide insight into whether your GERD is adequately controlled.

3. Gastric Emptying Study: If you are experiencing symptoms of fullness or discomfort after eating, this test can evaluate how well your stomach empties its contents.

4. Dietary Review: Sometimes, dietary factors can exacerbate GERD symptoms. Keeping a food diary to identify any potential triggers can be beneficial. Foods that are spicy, acidic, or high in fat can worsen symptoms.

5. Psychological Evaluation: Given that your symptoms have been described as potentially having a psychological component, it may be helpful to explore stress management techniques or cognitive behavioral therapy (CBT) to address any anxiety or stress that may be contributing to your symptoms.

In conclusion, while your symptoms may have a physiological basis, psychological factors can also play a significant role in gastrointestinal disorders. It’s essential to maintain open communication with your healthcare provider to explore all possible avenues for treatment and management. If your current medication is not providing relief, do not hesitate to discuss alternative treatments or adjustments to your regimen. Your quality of life is paramount, and finding a solution that works for you is the ultimate goal.

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