Stomach Ulcers and Acid Reflux: Causes and Management

Q: Stomach Ulcers and Acid Reflux: Causes and Management

Hello： (1) Discomfort in the lower abdomen may warrant consideration of issues such as constipation or fecal impaction. <br>Additionally, gynecological conditions and urinary tract diseases should also be taken into account. <br>(2) Your medications primarily aim to reduce gastri

Gastric ulcer and gastroesophageal reflux disease (GERD)

Hello Dr.
Tsai,
In July, I experienced significant anxiety and stress due to my mother's brain aneurysm surgery.
Following that, I developed gastrointestinal symptoms, and a gastroscopy in October revealed mild gastric ulcers and rectal ulcers.
The rectal ulcer has since healed (I underwent a colonoscopy).
I would like to ask you:
1.
I still occasionally experience sharp pain in my lower abdomen (not necessarily during meals).
What could be the possible causes?
2.
I take Nizatidine (40 mg) and Gascon tablets in the morning, and half a packet of Lomotil (500 cc of water).
In the evening, I take Esomeprazole and half a packet of Lomotil (500 cc of water).
After about two months of taking Lyrica, I developed gastroesophageal reflux symptoms, despite not consuming coffee, tea, alcohol, or sweets.
My weight is 49 kg, and I do not engage in binge eating.
I am unsure if this is related to the medications (rebound acid secretion?).
Last week, I underwent a second gastroscopy, and the doctor noted that my stomach still shows inflammation and erosion (but no longer ulcers).
He advised me to manage my emotions, but I have been on medication for three and a half months, and I still experience discomfort during meals.
I have also had some sharp pain near my right upper abdomen under the rib cage for nearly a week, along with a sensation of a foreign body in my throat, a persistent sour and bitter taste in my mouth throughout the day, a tingling sensation on my tongue, and pain in the xiphoid process (cardiology consultation showed no issues).
I find this very distressing and would appreciate your advice.
Thank you very much!

chelle, 30~39 year old female. Ask Date: 2013/01/23

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: (1) Discomfort in the lower abdomen may warrant consideration of issues such as constipation or fecal impaction.
Additionally, gynecological conditions and urinary tract diseases should also be taken into account.
(2) Your medications primarily aim to reduce gastric acidity, alleviate bloating, soften stools, and relieve emotional stress, and they are unlikely to cause what you refer to as rebound gastric acid (a term rarely used in medical literature).
The only suggestion is that functional gastrointestinal issues, such as rapid or slow motility, should be further evaluated by a physician.
(3) Furthermore, mild hiatal hernia can lead to gastroesophageal reflux, which is commonly seen in young, underweight women.
It is recommended to improve this condition through dietary changes, proper sitting posture, exercise, and moderate weight gain.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun

Reply Date: 2013/01/23

More Info

Understanding stomach ulcers and acid reflux involves recognizing their causes, symptoms, and management strategies. Stomach ulcers, also known as gastric ulcers, are open sores that develop on the lining of the stomach. They can be caused by a variety of factors, including infection with Helicobacter pylori bacteria, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption, and high levels of stress. Acid reflux, or gastroesophageal reflux disease (GERD), occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort.

In your case, the anxiety and stress related to your mother's surgery may have contributed to the development of your gastrointestinal symptoms. Stress can exacerbate conditions like ulcers and acid reflux by increasing stomach acid production and affecting gut motility. The presence of a mild gastric ulcer and rectal ulcer, as noted in your endoscopy, indicates that your gastrointestinal tract is under some distress.

1. Regarding the occasional stabbing pain in your lower abdomen, this could be attributed to several factors. It may be related to gastrointestinal motility issues, such as constipation or gas buildup, which can cause discomfort. Additionally, gynecological or urinary tract issues should also be considered, especially if the pain is not directly linked to meals. It is essential to monitor the pain and discuss it with your healthcare provider if it persists or worsens.

2. As for the medications you are taking, it is important to understand their roles. The medications you mentioned, such as pantoprazole (耐適恩), are proton pump inhibitors (PPIs) that reduce stomach acid production. While these medications are effective for treating ulcers and GERD, they can sometimes lead to a phenomenon known as "rebound acid hypersecretion" when discontinued, but this is less common with long-term use. Your symptoms of acid reflux, despite not consuming common triggers like coffee, tea, or alcohol, may suggest that your stomach is still producing excess acid or that there may be other underlying issues, such as a hiatal hernia, which can exacerbate reflux symptoms.

The ongoing inflammation and irritation in your stomach lining, as noted in your recent endoscopy, may also contribute to your discomfort. It is not unusual for patients with ulcers or gastritis to experience persistent symptoms even while on medication, especially if the underlying causes are not fully addressed.
In terms of management, here are some recommendations:
- Dietary Modifications: Focus on a bland diet that is low in irritants. Avoid spicy foods, acidic foods, and large meals. Eating smaller, more frequent meals can help reduce the burden on your stomach.

- Lifestyle Changes: Elevate the head of your bed to reduce nighttime reflux, and avoid lying down immediately after eating. Maintaining a healthy weight can also alleviate pressure on the stomach and esophagus.

- Stress Management: Since stress can exacerbate gastrointestinal symptoms, consider incorporating relaxation techniques such as mindfulness, yoga, or gentle exercise into your routine.

- Follow-Up Care: Regular follow-ups with your healthcare provider are crucial. If your symptoms persist despite medication, further evaluation may be necessary to rule out other conditions or to adjust your treatment plan.

In conclusion, while your current treatment regimen is aimed at managing your ulcers and reflux, it is essential to address lifestyle factors and monitor your symptoms closely. If your discomfort continues or worsens, further investigation may be warranted to ensure that there are no additional underlying issues contributing to your symptoms. Always consult with your healthcare provider before making any changes to your treatment plan.

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