Re: EGD results

Posted By HFHSM.D.-rf on July 31, 1998 at 16:45:50:

In Reply to: EGD results posted by Dee on July 31, 1998 at 11:08:14:






: I am a 41 yr. old female with a long history of recurrent stomach problems.  I had a cholecystectomy in '91.  I don't drink, smoke, or use any drugs.  Two years ago I had a positive blood test for H. Pylori and was treated with two antibiotics.  Pain went away after awhile, but slowly came back months later.  Last week I had an EGD which, in my physician's words, revealed numerous ulcers, erosion and inflammation.  He pointed out some superficial ulcers and prescribed Prevacid 30 mg., twice a day and to return in one week for a followup.  I know he took about 3-4 biopsies for H. Pylori.  I do not have those results yet.  I was given a copy of the pictures and, quite frankly, I was sickened by what I saw (good thing I'm not a doctor).  The one thing he repeatedly said during the procedure was, "I did not expect this."  Okay, so now I'm worried, right?  The one thing on the pictures that has my curiosity going is a long, dark (coffee ground like), somewhat straight, line going around the stomach.  He took several pictures of that.  I thougt ulcers would be rather circular, but this looks a little deep in areas and is a line, wider in some areas, but straight and long.  It stands out, to say the least.  Also, the pictures shows many, many areas where it looks like  coffee grounds are embedded, not in a collectively large area, but scattered all over.  Last of all, since taking the Prevacid I have noticed pain AFTER taking it and feeling rather lethargic.  Is it my imagination or could it be the medication?  I've been searching the Internet for pictures similar to mine, but, thank God, none of them look like mine.  I just still wanna understand what's going on and what I can do to have a healthy stomach.



: : Dear Dee,
Ulcer disease of the stomach and small bowel is not as uncommon as you might think.  Approximately 5-10% of people will develop ulcers in their lifetime. This number is much higher for people infected with H. pylori.  Treatment to eradicate H. pylori infection is far from perfect.  Depending on the regimen, only 80-85 % of people will eliminate the bacteria.  Allow me to elaborate.
H. pylori is a bug that can infect the stomach and cause ulcer disease. This bug is present more often in older people. It is not clear how it is transmitted but experts think it may be related to poor sanitation.  Infection usually occurs in childhood.  Almost all duodenal ulcers and about 85-90% of gastric ulcers are due to H, pylori infection. Drug regimens are available for treatment. Most of the two drug regimens have cure rates in the range of 75-85%.
Another major cause of ulcer disease is nonsteroidal anit-inflammatory agents like aspirin, motrin, bufferin, excedrin, advil, naproxen, anacin etcetra. Tylenol does not cause ulcers.
Since I cannot see the pictures I am unable to offer you a diagnosis. From what you have described it seems that you have ulcers and erosions. It is essential to exclude H. pylori infection (either due to failure to eradicate with your previous treatment or recurrent infection).  If you practice life style factors that can cause ulcers, you should stop.  Smoking, drinking alcohol or taking non-steroidal agents can cause your symptoms.  Rarely, certain tumors can cause increased acid production and ulcers.
Prevacid belongs to a class of drugs called proton pump inhibitors. These are very effective in the treatment of ulcer disease. I do not think that the pain you feel after taking Prevacid is related to the drug. The pain may be a manifestation of the ulcer disease or something else. Lethargy can occur with Prevacid though it is not common. You need to discuss these symptoms with your doctor and make sure that there is no other cause. If the lethargy is felt to be due to the Prevacid your doctor can prescribe an alternative medication.
I hope we have been able to answer some of your questions.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-sg
*keywords: ulcers, H. pylori
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Dear Doctor:
Thank you for your response.  I wanted to let you know about my follow-up visit.  The results came back that I still have H. Pylori.  I was previously treated with Flagyl and Biaxin, both 500 mg., twice a day.  I am now being treated with Helidac Therapy and Zantac 150 mg.  Since one of the drugs in this therapy is Flagyl, but in a combination with Tetracycline, do I stand a good chance of eradicating this bacteria?  Also, since my doctor seemed to be in a hurry I did not get the chance to ask any questions, but I would like to know what is the current recommendation on determining if the bacteria is gone after treatment?  Is it another blood test or EGD or just "come back if you have any problems?"
One last question - to anyone's knowledge, does this bacteria seem to cause other symptoms other than gastroentestinal?  In particular, I have had for a few years a feeling of "hot spots" on the lower part of my legs with a feeling sometimes that something is crawling on them.  Right now, the feeling of sudden, but brief heat seems to be concentrated on the bottom of my heel on my left foot.  I used to think it was because I was overweight, but I have lost 36 pounds and now weigh 124, but am still having these funny sensations.  So, I am curious to know if this could be related in any way to this bacteria.
Thank You.
_
Dear Dee,
H. pylori infection is the subject of much research.  If your organism is resistant to Flagyl, then your chances are reduced of successful eradication of the infection.  After you have completed therapy, and been 'off' medications for for 28 days, then you can have a c14- urea breath test which is a noninvasive way to confirm whether you have eradicated the H. pylori.  The bug produces an enzyme called urease that digests urea releasing radioactive CO2 that is detected by a special counter.  People with H. pylori infection produce more CO2 than those who have had the infection eradicated.  A serology blood test (measures antibodies to H. pylori) will not allow for the differentiation between current active infection and a successfully treated infection in the past.
At present, we belive that H. pylori only causes gastrointestinal disease (ulcers, gastric cancer, a form of gastric lymphoma).  There have been reports suggesting that H. pylori may be involved in other conditions but these suggestions are not widely accepted.
This information is presented for educational purposes only.  Always consult your personal physician for specific medical questions.
HFHSM.D.-rf
*keywords: H. pylori, ulcers
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