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.

[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?