Chronic Gastritis or Ulcer? Seeking Answers After Months of Treatment

If gastritis has not improved after more than four months, could it be a chronic ulcer? Should I change clinics?

Hello Dr.
Chen, my questions are as follows: My illness history: On the evening of April 20, I ate a large bowl of beef noodles and drank iced asparagus juice, which led to gastric cramps.
I have been taking medication for over four months without improvement.
I usually experience mild gastric discomfort, especially after consuming greasy or hard-to-digest foods like instant noodles, tuna sandwiches, satay pork slices, or braised tilapia, as well as cookies with 20% fat content, which easily trigger gastric pain.
For most of these four months, my stomach has only felt slightly uncomfortable and bloated, and I can eat light buffet meals, but I often experience a recurrence of gastric pain after consuming greasy or hard-to-digest foods.
On July 4, I underwent an endoscopy, which revealed only mild to moderate gastritis (with remnants of Chinese food in the stomach), no other symptoms, and no Helicobacter pylori infection.
On July 7, I started taking the ulcer medication OMEZOL and have been taking it continuously with only three interruptions of 2, 4, and 2 days, meaning I have been almost continuously on medication but still unable to recover.
On August 22, I had another ultrasound on an empty stomach, which showed only mild fatty liver and small cysts on the kidneys.
My gallbladder was removed in 1997, and the common bile duct appears normal and not dilated.
Several times, I experienced gastric pain after taking gastric medication before dinner.
I have eaten egg porridge and steamed buns almost daily for a week at a time, with the longest being over a month, yet I still cannot recover.
In the past few years, I frequently took painkillers and muscle relaxants, but since the gastric pain on April 20, I have only taken painkillers seven times.
My questions are: 1.
Does the interruption of medication in the first two months, followed by over two months of continuous medication without improvement, indicate that the medication is ineffective? 2.
Does taking calcium carbonate after meals harm the stomach? Does drinking soy milk, aside from causing bloating, worsen gastritis? 3.
My condition is chronic gastritis; does this indicate a chronic ulcer? However, the endoscopy only showed mild to moderate inflammation.
4.
If I go to another clinic, will the medications prescribed be similar? After all, I have been taking ulcer medication for a long time.
5.
If I switch clinics and stop taking the gastrointestinal medications from the original gastroenterology clinic, will there be adverse reactions? 6.
Should I switch clinics and seek opinions from other doctors? Otherwise, I have been on the same medication for a long time without improvement.

Mr. Chen, 40~49 year old female. Ask Date: 2022/09/12

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is likely a case of impaired gastrointestinal motility, and there is no need to worry excessively.
I have no objections to changing doctors.

Reply Date: 2022/09/12

More Info

Chronic gastritis and ulcers can be complex conditions that require careful management and monitoring. Based on your description, it seems you have been experiencing persistent gastric discomfort despite ongoing treatment. Let's address your questions one by one, and I will provide additional insights into the management of chronic gastritis and ulcers.

1. Effectiveness of Medication: The fact that you have been on medication for over two months without significant improvement may suggest that the current treatment regimen is not adequately addressing your condition. However, it is essential to consider that healing from gastritis or ulcers can take time, and individual responses to medication can vary. If you have had interruptions in your medication, this could also impact your healing process. It may be beneficial to discuss with your physician the possibility of adjusting your medication or exploring alternative treatments.

2. Calcium Carbonate and Soy Milk: Taking calcium carbonate after meals is generally safe for most individuals, but it can cause gastric irritation in some cases, especially if taken in excess. As for soy milk, while it is nutritious, it can cause bloating in some people. If you notice that it exacerbates your symptoms, it may be wise to limit its intake. However, soy milk itself is not known to worsen gastritis significantly unless you have a specific intolerance.

3. Chronic Gastritis vs. Ulcer: Chronic gastritis refers to the inflammation of the stomach lining, while an ulcer is a sore that develops on the lining of the stomach or the first part of the small intestine (duodenum). Your endoscopy results showing mild to moderate gastritis without the presence of Helicobacter pylori suggest that you may not have an ulcer, but rather chronic gastritis. However, the symptoms you describe, particularly the pain after eating certain foods, could indicate that your gastritis is reactive to dietary choices.

4. Medication from Other Clinics: If you switch to another clinic and receive a different medication, it may or may not be similar to what you are currently taking. Different doctors may have varying approaches to treatment based on their clinical experience and the latest guidelines. It is essential to communicate your history and current treatment to any new physician to ensure continuity of care.

5. Discontinuing Medication: If you stop taking your current medications, you may experience a return of symptoms, especially if your gastritis is chronic. It is crucial to consult with your physician before making any changes to your medication regimen to avoid potential complications or worsening of your condition.

6. Seeking a Second Opinion: If you feel that your current treatment is not effective, seeking a second opinion can be a good idea. Different physicians may have different perspectives on your condition and may suggest alternative treatments or diagnostic tests that could provide further insight into your gastric issues.

In conclusion, managing chronic gastritis and ulcers requires a comprehensive approach that includes dietary modifications, medication management, and regular follow-up with your healthcare provider. It is essential to maintain open communication with your physician about your symptoms and treatment effectiveness. If necessary, do not hesitate to seek a second opinion to explore all available options for your health. Remember, lifestyle factors such as stress management, diet, and avoiding irritants (like NSAIDs) play a significant role in the management of gastric conditions.

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