Stomach Ulcers: Symptoms, Treatment, and Follow-Up Care

Q: Stomach Ulcers: Symptoms, Treatment, and Follow-Up Care

Dear Mr. <br>Jason：<br>1. <br>In clinical practice, common diagnoses for upper abdominal pain or discomfort include gastric ulcers or inflammation, duodenal ulcers or inflammation, gastroesophageal reflux disease, gallbladder or biliary stones, gallbladder or biliary inflammation

Gastric ulcer and examination report issues?

Hello Doctor, I was diagnosed with a bleeding gastric ulcer during an endoscopy in early January of this year.
After taking PPI medication for several months, I still experience a burning sensation and bloating in my abdomen.
During a health check on September 17, I had another endoscopy, and the doctor said that I have fully recovered, with only mild superficial gastritis remaining.
However, I still feel discomfort in my abdomen every day.
The health check report indicated an elevated albumin-to-globulin ratio, a slight decrease in neutrophils, a copper urine test result that was inconclusive, and a slight increase in lymphocytes.
I am unsure if there are other issues causing my ongoing abdominal discomfort, and I don't know which specialty I should consult.
How should I explain this to the doctor? Thank you!

Jason, 20~29 year old female. Ask Date: 2021/10/07

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Jason:
1.
In clinical practice, common diagnoses for upper abdominal pain or discomfort include gastric ulcers or inflammation, duodenal ulcers or inflammation, gastroesophageal reflux disease, gallbladder or biliary stones, gallbladder or biliary inflammation, liver abscesses or tumors, pancreatitis or lesions, lung inflammation or tumors, colonic lesions, early shingles, early acute appendicitis, and spasms of the abdominal muscles or diaphragm, among others.
Of course, there are also many rare diseases, such as irritable bowel syndrome, intestinal tumors, vascular diseases, superior mesenteric artery occlusion, autoimmune diseases, anxiety disorders, etc.
2.
An "elevated albumin/globulin ratio" can have many causes; sometimes, the absolute values must also be considered for proper assessment.
The "urinary copper response may vary," and if blood glucose and urinary glucose levels are normal, it may be due to fasting, which is considered a normal variation.
The "slight decrease in neutrophils and slight increase in lymphocytes" in the blood may represent normal variation or mild abnormalities and cannot be used alone to determine a diagnosis.
3.
"There is still a burning sensation and bloating in the abdomen..." Essentially, the likelihood remains higher for gastrointestinal issues; I recommend discussing this with your family physician or visiting a gastroenterology clinic at a regional hospital or higher.
4.
Personally, I suggest that you avoid caffeinated beverages such as coffee, tea, and milk tea; also, limit alcohol consumption.
Additionally, please ensure to chew your food thoroughly and eat slowly, avoiding eating too quickly or too much.
After meals, do not sit down to work or watch TV immediately; try to walk around until your stomach settles before sitting down again.
If possible, have a small amount of fruit between meals.
Aim to drink warm water; avoid beverages, iced drinks, sugary drinks, and convenience store teas.
Regular exercise and walking are also recommended to avoid prolonged sitting.

Reply Date: 2021/10/07

More Info

Understanding stomach ulcers, their symptoms, treatment, and follow-up care is crucial for managing your health effectively. Stomach ulcers, also known as peptic ulcers, are sores that develop on the lining of the stomach or the first part of the small intestine (duodenum). They can cause a variety of symptoms, including abdominal pain, bloating, indigestion, and a burning sensation in the stomach.
From your description, it seems you have been diagnosed with a bleeding stomach ulcer and gastritis, and you have been on proton pump inhibitors (PPIs) for several months. PPIs are effective in reducing stomach acid, promoting healing of the ulcer, and alleviating symptoms. However, it is not uncommon for patients to continue experiencing discomfort even after the ulcer has healed. This could be due to several factors, including residual gastritis, dietary choices, or stress.

The fact that your recent endoscopy showed only superficial gastritis is a positive sign, indicating that the ulcer has healed. However, the ongoing symptoms of abdominal discomfort, burning sensation, and bloating suggest that there may be other underlying issues at play. The elevated white blood cell count and changes in your blood profile could indicate an inflammatory response or other conditions that may need further investigation.

Here are some recommendations for managing your symptoms and ensuring proper follow-up care:
1. Dietary Modifications: Pay attention to your diet. Avoid spicy, acidic, or fried foods that can irritate the stomach lining. Instead, focus on a bland diet that includes foods like bananas, rice, applesauce, and toast (the BRAT diet). Eating smaller, more frequent meals can also help reduce discomfort.

2. Stress Management: Since stress can exacerbate gastrointestinal symptoms, consider incorporating stress-reducing techniques into your routine. This could include mindfulness practices, yoga, or even talking to a mental health professional if you feel overwhelmed.

3. Follow-Up with Your Doctor: It’s essential to communicate your ongoing symptoms to your healthcare provider. You may want to ask for additional tests, such as an abdominal ultrasound or a CT scan, to rule out other potential issues. If your primary care physician is not able to provide answers, consider seeing a gastroenterologist for specialized care.

4. Medication Review: Discuss with your doctor whether your current medication regimen is appropriate. Sometimes, adjusting the dosage or switching to a different medication can help alleviate symptoms.

5. Monitor Symptoms: Keep a journal of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing and treating your condition.

6. Consider Other Conditions: If your symptoms persist despite treatment, it may be worth exploring other gastrointestinal conditions, such as irritable bowel syndrome (IBS) or food intolerances, which can mimic ulcer symptoms.

In summary, while your ulcer appears to have healed, the ongoing discomfort warrants further investigation. By maintaining open communication with your healthcare provider, making dietary and lifestyle adjustments, and possibly seeking a second opinion, you can work towards finding relief from your symptoms. Remember, managing a condition like this often requires a multifaceted approach, including medical treatment, lifestyle changes, and emotional support.

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