Duodenal Ulcer Treatment and Managing Symptoms - Gastroenterology and Hepatology

Treatment of Duodenal Ulcer

Hello Doctor, I recently underwent an upper gastrointestinal endoscopy due to discomfort in my stomach, and the doctor mentioned that I have a mild duodenal ulcer without Helicobacter pylori infection.
I was prescribed Pantoprazole for two months.
In the first few days of taking the medication, I noticed a significant reduction in stomach discomfort, but afterwards, I began to experience bloating after meals (my abdomen also becomes distended), along with persistent burping and flatulence.
I no longer have the sharp abdominal pain I experienced before, but the bloating is quite uncomfortable, and I feel a slight sharp pain in my abdomen before burping.
Additionally, as I am a student, sitting for long periods puts pressure on my abdomen, which is quite bothersome.
I am nearing the end of the second week of Pantoprazole; is this situation normal? I have been maintaining a very bland diet, completely avoiding spicy, sweet, fried foods, and beverages.
I also consume fruits and vegetables daily and maintain a regular routine.
Therefore, I would like to know if the bloating sensation is a side effect of the ulcer medication.
Should I schedule another appointment with my doctor for an examination, or is it acceptable as long as I do not experience severe abdominal pain? Additionally, I am taking Bifidobacterium lactis probiotics; will this interfere with the medication? Thank you.

yue, 20~29 year old female. Ask Date: 2012/01/10

Dr. Li Yongming reply Gastroenterology and Hepatology

Nexium (esomeprazole) belongs to the class of proton pump inhibitors and is currently the strongest antacid approved by the Taiwan Ministry of Health and Welfare.
Commonly used proton pump inhibitors include Pantoloc (pantoprazole), Nexium (esomeprazole), Pariet (rabeprazole), and Takeprone (omeprazole).
The Ministry of Health and Welfare has approved these medications for the treatment of gastroesophageal reflux disease (GERD) and upper gastrointestinal (GI) ulcers (stomach or duodenal ulcers).

Each medication has potential side effects, but not everyone will experience them.
According to the package insert, the reported side effects include peripheral edema, mild insomnia, headache, dizziness, abdominal pain, bloating, constipation, diarrhea, and nausea/vomiting, with an incidence of less than 10%.
Skin reactions such as dermatitis, pruritus, urticaria, dizziness, and dry mouth are less common, occurring in less than 1%.
These symptoms typically diminish over time.

Bloating is indeed a rare side effect associated with proton pump inhibitors; however, these medications are the standard treatment for peptic ulcers.
Many clinical trials have shown that Nexium significantly increases the pH level in the esophagus, leading some physicians to prescribe it preferentially.
If a patient experiences significant discomfort that disrupts daily life, they should inform their physician, who may consider prescribing a different proton pump inhibitor to see if the bloating side effect improves.
Bloating may also be caused by increased intestinal gas due to changes in gut microbiota, leading to an overgrowth of harmful bacteria that produce abnormal fermentation and foul gases.
Additionally, excessive intake of fiber and carbohydrates can increase gas production, especially with malabsorption or changes in gut flora.
Psychological factors, such as anxiety or stress, can lead to excessive air swallowing, sometimes resulting in aerophagia or autonomic dysfunction.
When gastrointestinal motility decreases, gas trapped in the intestines may not be expelled, leading to a sensation of bloating.
Conditions like constipation and irritable bowel syndrome (IBS) can also contribute to this state.

Therefore, it is possible that "psychogenic" bloating due to exam stress or related IBS may occur and is not necessarily a side effect of the medication.
Regardless, the following suggestions may help alleviate bloating:
1.
Regularly rest and practice deep breathing to relax.

2.
Limit foods that increase gas (such as legumes and nuts) and chew food thoroughly while eating.

3.
Avoid wearing tight belts or underwear.

4.
Probiotics containing lactobacilli and bifidobacteria can suppress the growth of harmful bacteria in the gut and reduce gas production.
Additionally, the lactic acid and acetic acid produced by probiotics can stimulate the intestines and enhance motility, aiding in gas expulsion.

5.
Antifoaming agents like dimethylpolysiloxane (simethicone) can help alleviate abdominal symptoms caused by intestinal gas.
They act directly on gas in the digestive tract, promoting absorption and expulsion.

Patients may also consult their physician during follow-up visits for appropriate medications to address these issues after a thorough history and physical examination.

Reply Date: 2012/01/10

More Info

Duodenal ulcers are a common gastrointestinal condition that can cause significant discomfort and require careful management. Based on your description, it seems you have been diagnosed with a duodenal ulcer and have been prescribed a medication called "耐適恩" (likely referring to a proton pump inhibitor or similar medication) for treatment. It is encouraging that you have experienced some relief from your symptoms initially, but the persistence of abdominal bloating, belching, and flatulence is understandably concerning.

Understanding Duodenal Ulcers
Duodenal ulcers are open sores that develop on the lining of the duodenum, which is the first part of the small intestine. They can be caused by several factors, including:
1. Helicobacter pylori infection: Although you mentioned that your tests did not show this bacterium, it is a common cause of ulcers.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs): Regular use of NSAIDs can irritate the stomach lining and lead to ulcer formation.

3. Excessive alcohol consumption and smoking: Both can exacerbate ulcer symptoms and delay healing.

4. Stress: While not a direct cause, stress can worsen symptoms and affect healing.

Treatment Overview
The primary goals of treatment for duodenal ulcers include reducing stomach acid, promoting healing of the ulcer, and preventing recurrence. Medications like proton pump inhibitors (PPIs) or H2-receptor antagonists are commonly prescribed to reduce acid production. In your case, "耐適恩" is likely a PPI, which is effective in managing ulcer symptoms.

Addressing Your Symptoms
The symptoms you are experiencing, such as bloating and discomfort after meals, can be attributed to several factors:
1. Medication Side Effects: While PPIs are generally well-tolerated, some individuals may experience gastrointestinal side effects, including bloating and gas. These symptoms can occur as your digestive system adjusts to the medication.

2. Dietary Factors: Even with a healthy diet, certain foods can cause bloating. Foods high in fiber, while beneficial for overall health, can lead to gas production, especially if introduced suddenly or in large quantities.
3. Eating Habits: Eating too quickly or consuming large meals can also contribute to bloating. It may help to eat smaller, more frequent meals and chew your food thoroughly.

4. Stress and Posture: As a student, prolonged sitting can compress the abdomen, leading to discomfort. Incorporating short breaks to stand and stretch may alleviate some of this pressure.

Recommendations
1. Monitor Symptoms: Keep track of your symptoms, noting any patterns related to your diet or activities. If the bloating persists or worsens, it would be wise to consult your healthcare provider.

2. Consult Your Doctor: Given that you are nearing the end of your medication course, it would be prudent to follow up with your doctor. They can assess whether your symptoms are a normal part of the healing process or if further intervention is needed.

3. Probiotics: The use of probiotics, such as the "白蘭氏木寡醣乳酸菌" you mentioned, can be beneficial for gut health and may help alleviate some gastrointestinal symptoms. However, it is always best to discuss any supplements with your healthcare provider to ensure they do not interfere with your medications.

4. Lifestyle Modifications: Continue maintaining a balanced diet, stay hydrated, and consider stress-reduction techniques such as mindfulness or gentle exercise.

Conclusion
In summary, while some bloating and discomfort can be expected during the treatment of a duodenal ulcer, persistent or worsening symptoms should not be ignored. Regular follow-up with your healthcare provider is essential to ensure proper healing and management of your condition. By monitoring your symptoms, adjusting your diet, and maintaining open communication with your doctor, you can effectively manage your ulcer and improve your overall well-being.

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