Post-Treatment Care for Mild Stomach and Duodenal Ulcers: Is It Necessary?

Helicobacter pylori, mild gastric ulcer, mild duodenal ulcer, issues after 16 weeks of medication?

Hello Doctor, in July of this year, I went to a gastroenterology clinic for a self-paid gastroscopy.
The doctor mentioned that I have mild gastric ulcers and mild duodenal ulcers, and a polyp was removed for biopsy.
After a week, I returned to review the report, and the polyp was benign, but I tested positive for Helicobacter pylori.
The doctor prescribed medication to eradicate the bacteria for two weeks (for Helicobacter pylori), followed by a 16-week treatment regimen.
I am now nearing the end of the 16-week treatment, but during my last visit to pick up medication, the clinic informed me that after the 16 weeks, I would need to return for a follow-up appointment to receive maintenance medication for my stomach.
Is it really necessary to take maintenance medication after the 16-week treatment for gastric ulcers? The cost of bi-weekly follow-up visits can be a financial burden over several months.

My gastrointestinal issues began in August of last year, when I started experiencing heartburn shortly after consuming food and then drinking latte coffee.
This discomfort would extend from my stomach to my throat, and I would need to vomit to feel better.
I then consulted the current clinic, where the doctor initially performed an ultrasound and diagnosed me with gastritis.
I was advised to avoid coffee, spicy foods, and similar items.
My symptoms have been intermittent, and I have been picking up medication intermittently from August to around December of last year, stopping the medication until February of this year when I went to a major hospital for another gastroscopy.
The doctor stated that I only had gastritis and did not test for Helicobacter pylori (I had been tested for it two years prior, but it was negative).
However, my symptoms have persisted.

Recently, I have been experiencing discomfort after consuming milk tea, red tea lattes, and cream puffs, which was not an issue before.
My family suggested that I might have a Helicobacter pylori problem, so in July, I informed the clinic that I wanted to self-pay for a gastroscopy, which led to the findings mentioned at the beginning.
Additionally, my family experienced significant stress due to a major car accident in September of last year, which may also be a contributing factor.

Currently, I occasionally experience mild discomfort after consuming milk tea, red tea lattes, and spicy foods, but it resolves the next day as long as I avoid these items.
I do not have any other discomfort or abdominal pain.
I would like to ask the doctor a few questions:
1.
After the two-week treatment for Helicobacter pylori and the 16-week treatment for gastric ulcers, is it necessary to have a follow-up gastroscopy? I have seen mixed opinions online; some say to wait for symptoms to reappear before having a gastroscopy, while others recommend having a follow-up gastroscopy after the treatment ends.

2.
The clinic mentioned that after the 16-week treatment, I should return for maintenance medication.
Is this necessary, or can I wait until I experience abnormalities before returning for a follow-up?

Mr. Lan, 30~39 year old female. Ask Date: 2023/10/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

After sterilization, a confirmation of successful sterilization is performed (often using the blow test).
It may be considered to discontinue medication or to keep maintenance medication to be taken only when symptoms arise.

Reply Date: 2023/10/26

More Info

Post-treatment care for mild stomach and duodenal ulcers is indeed a significant aspect of managing your gastrointestinal health, especially after a treatment regimen that includes antibiotics for Helicobacter pylori (H. pylori) and medications for ulcers. Here’s a comprehensive overview addressing your concerns.

1. Need for Follow-Up Endoscopy Post-Treatment
After completing a 16-week treatment for ulcers and H. pylori, the necessity of follow-up endoscopy can depend on several factors:
- Symptom Resolution: If your symptoms have significantly improved and you are not experiencing any discomfort, some healthcare providers may suggest monitoring your condition without immediate endoscopy. However, if you continue to experience symptoms such as heartburn, nausea, or vomiting, it may be prudent to have a follow-up endoscopy to assess the healing of the ulcers and rule out any complications.

- Initial Severity: If your ulcers were diagnosed as severe or if there were any complications noted during your initial diagnosis, a follow-up endoscopy might be recommended to ensure proper healing.

- H. pylori Status: If there is any suspicion that H. pylori may still be present, a follow-up test (which could be a breath, stool, or endoscopic biopsy test) may be warranted to confirm eradication.

In summary, while some patients may not require an endoscopy if they are asymptomatic after treatment, others may benefit from it, especially if symptoms persist or there were initial concerns about the severity of the ulcers.

2. Need for Maintenance Medication
Regarding the need for maintenance medication after completing the ulcer treatment, this is a common practice in gastroenterology:
- Prevention of Recurrence: Maintenance therapy with proton pump inhibitors (PPIs) or other medications may be recommended to prevent the recurrence of ulcers, especially in individuals with a history of recurrent ulcers or those who have risk factors such as ongoing use of NSAIDs (non-steroidal anti-inflammatory drugs), smoking, or excessive alcohol consumption.

- Symptom Management: If you continue to experience symptoms like heartburn or discomfort after meals, maintenance medication can help manage these symptoms and improve your quality of life.

- Individualized Approach: The decision to continue with maintenance therapy should be individualized based on your specific symptoms, history of ulcer disease, and overall gastrointestinal health. If you are experiencing occasional discomfort but can manage it by avoiding certain foods (like spicy foods or caffeine), you may discuss with your doctor the possibility of tapering off maintenance medications.

3. Economic Considerations
You mentioned concerns about the financial burden of frequent visits and medication. It’s essential to communicate this with your healthcare provider. They may be able to adjust your treatment plan, suggest alternative medications that are more cost-effective, or provide a more extended prescription to reduce the frequency of visits.

4. Lifestyle and Dietary Modifications
In addition to medication, lifestyle and dietary changes play a crucial role in managing ulcer symptoms:
- Dietary Adjustments: Avoiding trigger foods (like spicy foods, caffeine, and acidic foods) can help minimize symptoms. Keeping a food diary may help identify specific triggers.

- Stress Management: Given the stress from personal circumstances, incorporating stress-reduction techniques such as mindfulness, yoga, or counseling may also be beneficial.

- Regular Follow-Up: Even if you feel better, regular follow-ups with your healthcare provider are essential to monitor your condition and adjust treatment as necessary.

Conclusion
In conclusion, while follow-up endoscopy and maintenance medication can be beneficial in managing your condition, the necessity of these interventions should be tailored to your specific situation. Open communication with your healthcare provider about your symptoms, concerns, and financial considerations will help in creating an effective management plan. Always prioritize your health and well-being, and don't hesitate to seek further clarification from your doctor regarding your treatment and follow-up care.

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