Stomach Ulcers: Questions About Treatment and Diagnosis

Q: Stomach Ulcers: Questions About Treatment and Diagnosis

Hello： <br>1. <br>Other medications similar to rabeprazole include omeprazole (Prilosec), pantoprazole, esomeprazole (Nexium), and lansoprazole (Prevacid). <br>These are all proton pump inhibitors that block gastric acid secretion, preventing stomach ulcers from being exposed to

Gastric ulcer -- It's me again, sorry..?

Dr.
Tsai, I apologize for bothering you again.
I have a few more questions, and I hope you can forgive me.

1.
Is there a better medication for gastric ulcers than "Bai Yi Kui"? I've been taking one pill a day for a week, but my symptoms are still fluctuating (bloating and discomfort).

2.
If the ulcer is caused by Helicobacter pylori, is taking only Bai Yi Kui effective? I've been wondering why the doctor didn't send a sample for testing.
Are they really that confident that it’s not an ulcer caused by Helicobacter pylori or other reasons? Since I already had an endoscopy, shouldn't a sample have been collected as well?
3.
Recently, when I wake up in the morning on an empty stomach, I experience very foul belching (it smells like blood), but there is no blood in my stool or dark stools.
Could this also be caused by a gastric ulcer?
I've read many of your responses, and I truly appreciate your kindness.
Thank you for being such a great doctor, and keep up the good work!

Xiao Ke, 30~39 year old female. Ask Date: 2012/11/02

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello:
1.
Other medications similar to rabeprazole include omeprazole (Prilosec), pantoprazole, esomeprazole (Nexium), and lansoprazole (Prevacid).
These are all proton pump inhibitors that block gastric acid secretion, preventing stomach ulcers from being exposed to acidic environments, thereby promoting self-healing of the wounds.
The efficacy and side effects of these medications can vary among individuals and depend on the severity of the ulcer.
It is recommended to discuss your symptom recovery status with your physician during follow-up visits to determine whether a medication change is necessary.
Additionally, bloating and discomfort may intermittently occur during the initial treatment of ulcers and may take about 2-3 weeks to stabilize.
However, if bloating and discomfort persist despite medication use, it is advisable to investigate other potential causes.
If your BMI exceeds 24, it is essential to lose weight to reduce abdominal circumference, and to minimize the intake of irritant foods (such as tea, coffee, fried foods, spicy foods, sweets, smoking, alcohol, betel nut, etc.).
2.
Regarding the lack of biopsy, you should clarify your physician's considerations.
Based on experience, if an endoscopic evaluation suggests that a biopsy may trigger rebleeding from an ulcer, I would recommend treating the ulcer first before performing a biopsy.
The timing for a follow-up endoscopy for biopsy can range from a few days to several weeks later.
Additionally, the carbon-13 isotope breath test is another method to determine if there is a Helicobacter pylori infection.
3.
It is not necessarily caused by a gastric ulcer; oral/gum diseases, respiratory issues, and dietary factors should also be considered.
Changhua Hospital cares about your health.

Dr.
Tsai An-Shun

Reply Date: 2012/11/02

More Info

Understanding stomach ulcers, particularly in the context of your questions, involves a comprehensive approach to diagnosis and treatment. Stomach ulcers, also known as peptic ulcers, can be caused by various factors, including Helicobacter pylori (H. pylori) infection, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, and stress.
1. Medication Alternatives to "Bai Yi Kui" (百抑潰): If you are currently taking a proton pump inhibitor (PPI) like "Bai Yi Kui" (which is likely a brand name for a PPI), and your symptoms persist, it is essential to consult your healthcare provider. There are other PPIs available, such as omeprazole, lansoprazole, or rabeprazole, which may be more effective for you. Additionally, H2 receptor antagonists like ranitidine or famotidine can be considered, although they are generally less potent than PPIs. Your doctor may also evaluate the dosage or duration of your current medication, as sometimes a higher dose or a combination of medications may be necessary for symptom relief.

2. Testing for H. pylori: If your ulcer is suspected to be caused by H. pylori, it is crucial to confirm this through testing. Common methods include a urea breath test, stool antigen test, or endoscopic biopsy during your gastroscopy. If your physician did not perform a biopsy during the endoscopy, it may be due to the clinical judgment that your symptoms and history did not strongly indicate an H. pylori infection. However, if you have concerns, it is reasonable to request further testing. Treating H. pylori typically involves a combination of antibiotics and PPIs, known as triple therapy, which is essential for healing the ulcer and preventing recurrence.

3. Foul-smelling belching: The symptom of foul-smelling belching, especially if it has a metallic or "bloody" odor, can be concerning. While it may be related to gastric issues, including ulcers, it is essential to consider other potential causes, such as gastroesophageal reflux disease (GERD) or even more serious conditions. The absence of blood in your stool is a positive sign, but it does not rule out the possibility of an ulcer or other gastrointestinal issues. It is advisable to discuss this symptom with your healthcare provider, as they may recommend further evaluation, such as imaging studies or additional endoscopy, to rule out complications.

In summary, managing stomach ulcers requires a tailored approach based on individual symptoms and underlying causes. If your current treatment is not effective, do not hesitate to reach out to your healthcare provider for a reassessment. They may suggest alternative medications, conduct necessary tests for H. pylori, and evaluate any concerning symptoms like foul-smelling belching. Regular follow-up is crucial to monitor your condition and adjust treatment as needed. Remember, effective communication with your healthcare provider is key to achieving the best outcomes for your health.

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