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.

[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.