Mild Gastric Ulcers: When to Trust Your Doctor's Advice

The gastroscopy revealed a mild gastric ulcer, but the doctor assured that it is benign and does not require a biopsy?

Hello, Doctor.
I have been experiencing a loss of appetite for several weeks, and after undergoing an endoscopy, I was diagnosed with a mild gastric ulcer.
I have read a lot of information stating that biopsies are typically performed when gastric ulcers are found, but my attending physician assured me that it is benign and did not perform a biopsy.
I also came across articles online discussing misdiagnosis of gastric cancer as gastric ulcers, and I would like to ask if the likelihood of developing gastric cancer is high at my age.
Furthermore, my attending physician mentioned that a biopsy is unnecessary and does not want to perform another endoscopy.
Should I consider transferring to another hospital for a repeat endoscopy? Currently, I am taking antibiotics, but they do not seem to be having a significant effect (I have only been on them for three days).
Prior to this, I took medication to adjust my appetite for seven weeks, as the doctor mentioned that taking antibiotics might be uncomfortable, so I wanted to stabilize my condition first.
I tend to be easily anxious and worried, and this period has been really distressing for me.
I want to trust my doctor, but I am also afraid that a misdiagnosis could delay treatment and worsen my condition.
I am uncertain whether my appetite issues are due to psychological factors or if there is a genuine physical problem.
Please guide me and help clarify my concerns.

Mr. Hong, 20~29 year old female. Ask Date: 2022/06/12

Dr. Ke Fangxu reply Surgery

Smaller and smoother ulcers are generally less likely to require a biopsy for gastric cancer diagnosis, and there is a rationale for this.
Additionally, your young age is a factor that lowers the risk of cancer.
Since you are taking antibiotics, it is likely that you have a Helicobacter pylori infection.
Most patients experience symptom improvement within 1-2 weeks of medication.
However, if the discomfort in your stomach is caused by anxiety, that cannot be addressed with medication.
In any case, it is important to complete the oral medication course for the gastric ulcer first.

Reply Date: 2022/06/12

More Info

When dealing with mild gastric ulcers, it is essential to understand the nature of the condition, the importance of medical advice, and the potential risks involved. Your concerns about the diagnosis and treatment of your gastric ulcer are valid, especially given the anxiety that often accompanies health issues.
Firstly, it’s important to recognize that gastric ulcers can be caused by various factors, including Helicobacter pylori infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, and stress. Your doctor’s decision not to perform a biopsy may be based on their clinical judgment, which often considers the appearance of the ulcer during the endoscopy, your symptoms, and your medical history. In many cases, if the ulcer appears benign and there are no alarming features (such as significant weight loss, anemia, or family history of gastric cancer), a biopsy may not be deemed necessary.

However, your concerns about the risk of misdiagnosis are understandable. Gastric cancer can sometimes present with symptoms similar to those of benign ulcers, particularly in older adults or those with risk factors such as a family history of gastric cancer, smoking, or previous gastric surgery. The risk of gastric cancer increases with age, and while it is less common in younger individuals, it is not impossible. If you are feeling uncertain about your diagnosis, it is entirely reasonable to seek a second opinion or request further testing, such as another endoscopy or imaging studies.

Regarding your current treatment, it is common for doctors to prescribe antibiotics if H. pylori is detected, as eradicating this bacterium can lead to healing of the ulcer. It is also typical to experience some discomfort when starting antibiotics, as they can disrupt the balance of gut flora. It’s crucial to follow your doctor’s instructions regarding medication and to communicate any side effects you experience. If you have been on the antibiotics for only three days, it may be too early to assess their effectiveness fully.
If you continue to experience symptoms such as loss of appetite, pain, or discomfort, it is essential to keep your healthcare provider informed. They may consider adjusting your treatment plan or conducting further evaluations to ensure that your condition is being managed appropriately.
In addition to medical treatment, lifestyle modifications can also play a significant role in managing gastric ulcers. Avoiding irritants such as spicy foods, caffeine, and alcohol, along with practicing stress-reduction techniques, can help alleviate symptoms.
Lastly, it’s important to address the psychological aspect of your health. Anxiety and stress can exacerbate gastrointestinal symptoms, and it may be beneficial to speak with a mental health professional if you find that your worries are overwhelming. Cognitive-behavioral therapy (CBT) or mindfulness techniques can be effective in managing anxiety related to health concerns.

In summary, while trusting your doctor’s advice is essential, it is equally important to advocate for your health. If you feel uncertain about your diagnosis or treatment, do not hesitate to seek a second opinion or request further testing. Your health and peace of mind are paramount, and taking proactive steps can help ensure that you receive the best possible care.

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