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

Liver, gallbladder, and gastrointestinal tract?

Hello Doctor: In January, I underwent an endoscopy due to stomach pain, discomfort, and bloating.
The doctor diagnosed me with a mild gastric ulcer.
After taking medication for two weeks, I returned for a follow-up and was found to have a Helicobacter pylori infection.
I then took antibiotics and ulcer medication for another two weeks.
During the course of the antibiotic treatment, my stomach felt normal without any discomfort.
However, after finishing the antibiotics and continuing with the ulcer medication, I started experiencing discomfort and pain again.
Does this indicate that the eradication was unsuccessful, or could there be other underlying issues? Should I undergo another endoscopy? What are the implications of having two endoscopies in a short period?

Ms. Chen, 40~49 year old female. Ask Date: 2024/02/23

Dr. Hu Guozheng reply Gastroenterology and Hepatology

Recommendation for follow-up evaluation.

Reply Date: 2024/02/23

More Info

Understanding stomach ulcers, also known as peptic ulcers, involves recognizing their symptoms, treatment options, and the importance of follow-up care. Stomach ulcers are open sores that develop on the lining of the stomach or the upper part of the small intestine, primarily caused by an infection with Helicobacter pylori (H. pylori) bacteria, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, or stress.

Symptoms of Stomach Ulcers
Common symptoms of stomach ulcers include:
1. Abdominal Pain: This is often described as a burning sensation in the stomach area, which may improve or worsen with eating.

2. Bloating: Many patients report a feeling of fullness or bloating, especially after meals.

3. Nausea and Vomiting: Some individuals may experience nausea, and in severe cases, vomiting may occur.

4. Loss of Appetite: Due to pain or discomfort, individuals may avoid eating, leading to weight loss.

5. Heartburn: A burning sensation in the chest can also accompany stomach ulcers.

6. Dark or Tarry Stools: This can indicate bleeding in the stomach, which requires immediate medical attention.

Treatment Options
The treatment for stomach ulcers typically involves a combination of medications and lifestyle changes:
1. Proton Pump Inhibitors (PPIs): Medications like omeprazole (Prilosec) or lansoprazole (Prevacid) reduce stomach acid production, promoting healing.

2. Antibiotics: If H. pylori infection is present, antibiotics such as amoxicillin or clarithromycin are prescribed to eradicate the bacteria.

3. Antacids and H2-receptor antagonists: These can help neutralize stomach acid and provide symptomatic relief.

4. Avoiding NSAIDs: If possible, patients should avoid medications like ibuprofen or aspirin, which can exacerbate ulcer symptoms.

5. Dietary Modifications: A bland diet that avoids spicy, acidic, or irritating foods can help manage symptoms.

Follow-Up Care
Follow-up care is crucial for individuals diagnosed with stomach ulcers. If symptoms persist after treatment, further evaluation is necessary. This may include:
1. Repeat Endoscopy: If symptoms continue despite treatment, a repeat endoscopy may be warranted to assess the healing of the ulcer and check for any complications.

2. Testing for H. pylori: After completing antibiotic therapy, testing for H. pylori is essential to confirm eradication. This can be done through breath, stool, or endoscopic biopsy tests.

3. Monitoring Symptoms: Patients should keep track of their symptoms and report any worsening or new symptoms to their healthcare provider.

Addressing Your Concerns
In your case, it appears that after completing the antibiotic course, you have resumed experiencing symptoms. This could indicate that the H. pylori infection was not fully eradicated, or it may suggest that the ulcer has not healed adequately. It is not uncommon for patients to require additional treatment or a different antibiotic regimen if the initial treatment fails.

Regarding your question about undergoing two endoscopies in a short period, while it is generally safe, it is essential to discuss this with your healthcare provider. They can provide guidance based on your specific situation and the need for further evaluation.

In conclusion, managing stomach ulcers involves a comprehensive approach that includes medication, lifestyle changes, and regular follow-up care. If you continue to experience symptoms, it is vital to communicate with your healthcare provider to explore further diagnostic options and treatment adjustments.

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