Gastric Ulcer not getting better

[nhagerty74]

I was recently diagnosed with a stomach ulcer via endoscopy.  I’ve been having the symptoms on and off for over a year.  I had been taking low dose aspirin everyday for a few years before this, and stopped taking it over 6 months ago.  I get a burning/gnawing pain in the center of my upper abdomen that is usually better after I eat a large meal.  I get bloating also.  It feels worse if I am upset or stressed and also if I do excersize that causes me to tense my ab muscles.

My primary care physician originally put me on Protonix for one month when I told him my symptoms.  I had some improvement but the symptoms came back after stopping, so I was then put back on Protonix for 3 months.  It did not get rid of the problem, so I had an endoscopy which revealed “erosion in the antrum compatible with gastritis”.  I was told it was a small ulcer and looked like it was already trying to heal.  Biopsies were taken also and everything was normal…no sign of cancer or infection.  Previous to this I had a blood test for h.pylori that was negative also.  I have now been prescribed Dexilant 60mg once a day.  I’ve been on it for 2 weeks so far and am still having the burning/gnawing pain almost daily. I've tried Zantac, Aloe Juice, as well as drinking raw cabbage juice everyday for 3 weeks.  I'm now taking DGL licorice everyday, but nothing seems to be helping.  I'm getting very depressed and I have no idea what to do.  I'm supposed to call my doctor back in a week and let them know how I am, but they made it sound like I should have symptom relief by now if this medicine is working, and I'm on the strongest PPI there is.

[Mariekimberia13]

I also have had this very same for 18 months.  And have tried all listed in these answers.  I'm becoming weaker, hurting more often and the doctors aren't doing anything... I'm scared.  Any other suggestions?

[Rgo27]

Hi- did you ever heal your ulcer? Same thing is happening to me and I've had it for 1.5 years.

[Heatmarpu]

I have the exact, consistent story. Did you ever find out any answers?

[nhagerty74]

I called the Dr. back and said the ppi's are doing nothing, so now I'm starting Carafate today to see how that works.  I requested the carafate because of your recommendation.  I'm wondering why it was never mentioned or offered to me in the first place.  I know doctors aren't miracle workers, but this is so frustrating.  I asked if I could have a possible food intolerance that I'm not aware of that could possibly be causing this and his answer was, you would need to talk to an allergist.  Maybe I should also talk to another gastro Dr. as well....

[Heatmarpu]

Did you end up doing the bowel emptying study?

I am very frustrated and sad; I had two "erosive gastropathies" diagnosed after egd in February; for which Zantac was prescribed. By June, the pain was unbearable and I had been on Zantac 75&150 since being prescribed. So I started dietary avoidances, stopped most medications and started DGL, cabbage juice and l glutamine. All helped, except when I started to wean off of them, within 48 hours, id spend days curled in fetal position from a burning band of pain in the middle abdomen area.

Like you, I am very physically fit and exercise. I am at my wits end...

[Rgo27]

Did you ever heal this? The same thing is happening to me.

[nhagerty74]

I also wanted to ask if you think it would be reasonable to ask for sucralfate before doing any further testing.  I told my Dr.'s medical assistant that dexilant wasn't working and asked if there was anything else to try, so he prescribed Nexium.  I don't even see the point...it's another ppi and I've already tried 2 of them.  I decided to try it just to see if it might help, and it's been a little over a week and still no improvement.  Seemed like eating used to help the pain and now sometimes it creates it...even eating plain oatmeal this morning caused it to start burning.

[nhagerty74]

I had a question regarding probiotics.  Every time I have tried to take probiotics, after a few days on them, I would start getting that same burning/gnawing pain in the upper center abdomen that I have now and it would get pretty bad, as well as diarrhea.  The pain would last for a week or two after I stopped taking them.  I've tried a few different ones and it happened every time.  Several months ago I started eating a couple of servings of greek yogurt everyday and it has live cultures in it.  Do you know if it's possible for probiotics/live cultures to cause an allergic reaction in someone and cause gastritis and erosions?  

[Christopher R Watters, MD]

It is also called bile reflux gastritis. The problem is that there is no reliable method for diagnosis. At one point we had hoped that you could do a HIDA scan and watch over the stomach to measure duodenogastric reflux but variations in liver anatomy made this unreliable. simply seeing bile in the stomach during upper endoscopy is also unreliable. this is frequently treated empirically with carafate +/- metaclopramide.

[nhagerty]

Is alkaline reflux gastritis dianosed with the gastric emptying study?  Is that the same thing as bile reflux?

[Christopher R Watters, MD]

The early morning misery is common with alkaline reflux gastritis. The distal erosions would also be common with this problem. I think the gastric emptying study would be a good idea.

[nhagerty]

Hida scan came back normal.  Had some gas pains during it, but not the burning/gnawing pain that started all of this.  Waiting to hear what the Dr. has to say.  I'm feeling a little better lately but still don't feel normal.  I think the Dexilant actually gives me a little stomach discomfort, which I also experienced with Protonix.  You mentioned a gastric emptying study....I was also wondering if maybe I should get checked for food allergies.  I don't notice anything I eat or drink bringing on the pain, but wondered if it could be a possibility of something like that.  The majority of the time I get it in the morning when my stomach is empty, or if I get very stressed out.  The last time I had a very stressful situation due to a family situation, the pain was really bad and lasted for a couple of weeks.

[Christopher R Watters, MD]

As to healing rates, I am unaware of any data to answer the question. As a generality, things that aggravate an already inflammed site would be expected to slow the healing process.

[nhagerty]

I asked if excersize would be harmful...I already know it aggravates it.  I was asking if working out would somehow stop or slow the healing process.  I can stop poking myself in the epigastrium, but excersize is really important to me.  I'll call my Dr. tomorrow and see what he says I should do...I just like to get more than one, hopefully non-sarcastic, opinion on things.

Just to add for anyone reading this that might be afraid to ask questions to the Doctors/Nurses that you are employing:  By asking questions and researching on my own, and not caring how I might hurt a physician's ego, I saved myself 6 months of chemotherapy and a lifetime of side effects, that was going to be done to me just for the sake of doing it when I didn't need it.  And then again a couple years later when I was "told" to take a drug that "might" prevent cancer.  I said no because they couldn't show me any information on it.  Of course, the Dr. treated me horribly over it for disagreeing with her, and then 6 months later a study was released that said that drug didn't help.  That's when I learned about being my own advocate.  I don't come on here thinking I'm going to get an actual diagnosis over the computer, but at least I can learn questions to ask my Dr. or other tests that I may need to have performed.  It's always good to have more than one opinion when it comes to your health.

[Christopher R Watters, MD]

If younsat and poked a finger into your epigastrium for an hour the pain would probably be aggravated also. Why would you not expect that constant flexing of your rectus abdominus would do the same? As for endometriosis, it can pop up anywhere in the abdomen and cause misery. I would consider it a long shot but I suppose it could land on the stomach and show up as inflammation inside. With the cancer history have you had a CT scan? I think it would also be unlikely given the time that has passed but abdominal imaging would be appropriate. Breast cancer frequently metastasizes to the omentum or liver. But, as I said, this would be unlikely given the early stages and the time that has passed.

[nhagerty]

Also wanted to ask in my previous comment:  I normally lift weights 3 to 4 times a week, and have noticed that tensing up my abs, which happens with almost any weight training excersize, seems to make my ulcer symptoms start up after I've been working out for about 20 minutes. It's usually very mild, but I've stopped working out because I'm scared I'm making things worse.  Will that make an ulcer worse or stop it from healing?

I also have endometriosis and was wondering if there could be any connection between the two?  I get alot of bloating and constipation from the endometriosos, so between that and the ulcer situation I'm miserable :(    

I also had stage 1 breast cancer when I was 31 and stage 0 melanoma when I was 33.  I'm turning 38 this month and have been doing good other than this stomach situation.  The Dr. doesn't think this ulcer is related to either of those, but of course I'm scared.  They said all the biopsies were normal that were taken during the endoscopy.  I had an abdominal ultrasound last year that was normal also.

I know I'm asking alot of questions...my doctors love that about me! lol!  Thanks for talking to me...I hope you're having a nice holiday weekend.

[nhagerty]

I'm scheduled for a HIDA scan next week to find out if I have any problems with my gallbladder.  I'm still having symptoms on and off and still taking Dexilant 60mg (it's been 30 days now).  I'll have a few good days where I think I'm getting better and then a day where it bothers me again (like today).  I'm starting to get scared and depressed and feel like it's ruining my life.  I'm starting to think that this situation is never going to get better.  After the endoscopy the Dr. said this was "very easy to treat".  Apparently he was wrong.  I'm worried they won't find anything that could be causing this and I'll have to live with it and risk ending up with stomach cancer.  Have you seen many cases where there is no explanation for something like this and it won't go away?

[Christopher R Watters, MD]

One can think of erosions as very shallow ulcerations.

[nhagerty]

Does "Erosion in the antrum compatible with gastritis" mean I have an ulcer, or something that can lead to an ulcer?  

[Christopher R Watters, MD]

Please see my prior comment.

[nhagerty74]

Also, what happens if we don't find another problem (gallbladder, etc) and the ulcer doesn't heal from the dexilant?  Are there any other options?  I already took Protonix for 3 months before having the endoscopy.

[nhagerty74]

I was taking a low dose aspirin (80mg) everyday for a few years before this started.  Could that have caused it?

[Christopher R Watters, MD]

One question is whether they have the right diagnosis. What was shown on the EGD was antral erosions. Typically stomach ulcers don't come from too much acid like duodenal ulcers. Typically it is a problem that comes from a breakdown in the stomach's ability to protect itself. This can be due to infectious things like H. Pylori, medications like steroids or non-steroidal anti-inflammatories, or direct irritation from things like bile refluxing backwards into the stomach. The latter could actually be made worse by administering acid suppressants because the acid was neutralizing the alkaline stuff refluxing into the stomach. If this were the case medicines that protect the stomach like sucralfate would be better than the acid suppressing agents.  It would also be reasonable to assess gastric emptying since the irritation can be aggravated by stasis of noxious things in the stomach.

[nhagerty74]

If my gallbladder is fine and the ulcer doesn't heal after using Dexilant 60mg for 6-8 weeks, what would be the next step?

[Christopher R Watters, MD]

Although it is possible to have both an ulcer and gallbladder disease one generally does not cause the other.

[nhagerty74]

Can gallbladder problems cause stomach ulcers and gastritis?