Addressing Duodenal Ulcer Treatment Challenges: A Patient's Journey

Duodenal ulcer treatment issues?

Hello Doctor, I went to the hospital in early March due to stomach pain and unexpectedly found out I have a duodenal ulcer after undergoing an endoscopy.
After a month of treatment with Tegoprazan, I experienced persistent anxiety, palpitations, insomnia, and frequent burping during the first month.
My stomach was gurgling, and I consistently needed to use the restroom around 6 AM, but my stools were often not well-formed.
When I returned for a follow-up after a month, the doctor switched my medication to Rabeprazole along with two other antibiotics.
However, upon consulting another gastroenterologist at the hospital, I discovered that they did not test for Helicobacter pylori infection during the initial endoscopy.
The hospital's approach was to directly administer antibiotic treatment.
Therefore, in the second month, they prescribed a triple therapy regimen, but I am unable to swallow the pills, as one of the antibiotics is a yellow tablet that cannot be crushed.
Currently, I am only taking Rabeprazole for treatment.
I am unsure if there are other treatment options available or if I should first go to a facility that offers Helicobacter pylori testing to confirm an infection before considering a change in my medication regimen.
Thank you for your time and response, Doctor.

mary, 30~39 year old female. Ask Date: 2010/04/15

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello,
1.
At least 90% of cases of duodenal ulcers are associated with Helicobacter pylori, which is why some physicians may initiate triple therapy without testing for the bacteria.
Simply taking amoxicillin is not sufficient; if the medication is inappropriate, other antibiotics can be substituted.
Generally, the efficacy of triple therapy is better.
Of course, testing can also be performed to confirm the diagnosis before initiating treatment.
2.
As for unformed stools, this may indicate gastrointestinal dysfunction and is not necessarily related to the stomach, duodenum, or Helicobacter pylori.
Wishing you good health,
Dr.
Chen Chih-Feng, Taoyuan Hospital, Department of Health

Reply Date: 2010/04/15

More Info

Addressing the challenges of treating a duodenal ulcer can be a complex journey, especially when compounded by factors such as anxiety and medication intolerance. Your experience highlights several critical aspects of managing this condition, and I appreciate your willingness to share your story.

Duodenal ulcers, which are a type of peptic ulcer, are often caused by an infection with Helicobacter pylori (H. pylori) bacteria, excessive use of nonsteroidal anti-inflammatory drugs (NSAIDs), or increased acid production in the stomach. The treatment typically involves a combination of medications aimed at reducing stomach acid, eradicating H. pylori if present, and promoting healing of the ulcer.

From your description, it seems that you initially received treatment with a medication called "泰克胃通" (likely a proton pump inhibitor or similar), which is intended to reduce stomach acid and promote healing. However, the anxiety and stress you experienced during this period can significantly impact gastrointestinal health, leading to symptoms such as increased gastric secretions, which may exacerbate your ulcer symptoms. It's not uncommon for patients with gastrointestinal issues to experience heightened anxiety, which can create a vicious cycle of discomfort.

After a month of treatment, it appears that your doctor switched your medication to "耐適恩" (likely referring to a different proton pump inhibitor or an alternative acid-reducing medication) along with two antibiotics to target H. pylori. However, the lack of initial testing for H. pylori is concerning, as this bacterium is a common cause of ulcers and should be addressed directly if present. The standard treatment for H. pylori typically involves a triple therapy regimen, which includes two antibiotics and a proton pump inhibitor.

Given your difficulty swallowing pills, it is essential to communicate this with your healthcare provider. There are alternative formulations available, such as liquid medications or dissolvable tablets, that can be easier to manage. Additionally, if you are unable to take one of the antibiotics due to its formulation, your doctor may be able to prescribe a different antibiotic that is more suitable for you.

Before proceeding with further treatment, it would be prudent to have a test for H. pylori if it has not been done already. This can typically be performed through a breath test, stool test, or endoscopy with biopsy. Identifying whether H. pylori is present will guide your treatment plan and help ensure that you receive the most effective therapy.

In the meantime, managing your anxiety and stress is crucial. Consider discussing your feelings with your healthcare provider, who may recommend counseling or stress management techniques. Lifestyle modifications, such as avoiding trigger foods, eating smaller meals, and practicing relaxation techniques, can also help alleviate some of your gastrointestinal symptoms.

In summary, it is vital to ensure that you are receiving the appropriate treatment for your duodenal ulcer, which may include confirming the presence of H. pylori and adjusting your medications accordingly. Open communication with your healthcare provider about your symptoms, medication tolerance, and any concerns you have will be key to finding a successful treatment path. Remember, you are not alone in this journey, and there are resources available to support you in managing both your physical and mental health.

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