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Question about pain and gastritis

The various unpleasant manifestations of Helicobacter can be described here. Remember however that the great majority of persons with Hp have no symptoms that they are aware of and consider themselves normal.

Moderators: Toni, barjammar

Helico_expert
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Re: Question about pain and gastritis

Post by Helico_expert »

it's limited to what endoscopy can see. And it's impossible to get histology of every part of your stomach. As long as the visual examination from endoscopy shows no abnormality, no H. pylori, histology is good, then the risk of cancer is low and that's what most of us care most.

The persistent symptoms, especially the reflux, we can only hope that they can be controlled by PPI, in order to reduce risk of throat cancer and teeth corrosion.

NoxArcana
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Re: Question about pain and gastritis

Post by NoxArcana »

Helico_expert wrote:
Tue Dec 03, 2019 10:57 pm
it's limited to what endoscopy can see. And it's impossible to get histology of every part of your stomach. As long as the visual examination from endoscopy shows no abnormality, no H. pylori, histology is good, then the risk of cancer is low and that's what most of us care most.

The persistent symptoms, especially the reflux, we can only hope that they can be controlled by PPI, in order to reduce risk of throat cancer and teeth corrosion.
The problem is that the PPI doesnt seems to help, my last endoscopy showed minimum inflamation and no other issue, the symptoms were still strong, then doctor told me to take 40mg daily, one month has passed and the reflux and upper abdominal pain persist, i go back and then he ask me do take 40mg 2x for 2 weeks to see if it helps, but then again there were no improvement, so if i take 20mg or 80mg per day the result is the same, he asked about stress/anxiety, since i was a child i suffer from anxiety, i read some papers who correlates functional dyspepsia after h pylori erradication with anxiety or depression, and my epigastric symptoms started after some panic attacks that i had in 2018, do you think that the persistent symptoms may be caused by anxiety?
Plus, i'am still young, 27yrs male with no other health problem.

Helico_expert
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Re: Question about pain and gastritis

Post by Helico_expert »

are you taking omeprazole? have you tried other brand? eg. rabeprazole or pantoprazole or esomeprazole.

some people are more sensitive to PPI choice that others. Perhaps you should give each of them a trial.

27 yo is still very young.

so exactly what is the symptoms other than just pain? or can you explain the pain? i assume you had done ultrasound to rule out gall stones.

NoxArcana
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Re: Question about pain and gastritis

Post by NoxArcana »

Helico_expert wrote:
Wed Dec 04, 2019 4:30 pm
are you taking omeprazole? have you tried other brand? eg. rabeprazole or pantoprazole or esomeprazole.

some people are more sensitive to PPI choice that others. Perhaps you should give each of them a trial.

27 yo is still very young.

so exactly what is the symptoms other than just pain? or can you explain the pain? i assume you had done ultrasound to rule out gall stones.
i'm taking nexium, i tried lansoprazole, pantoprazole, pantoprazole magnesium, dexilant and pariet, lansoprazole is the only one which doesnt help at all, the others have basically the same effect.
The symptoms are a burn sensation right before the esophagus, probably it comes from the fundus, and reflux, the doctor also told me to take gaviscon before i go to sleep, which help a little at night.
I did 2 ultrasounds, the only abnormality was an intense intestinal meteorism, but all the organs were fine.

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barjammar
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Re: Question about pain and gastritis

Post by barjammar »

Hi after a normal work up the main strategy for this kind of symptom is to exclude anything serious or easily treatable and then expect symptoms to gradually improve, especially in a young person.
I don’t encourage the diagnosis of stress as a cause of organic disease because it is pretty much a “dead end” which means that the patient thinks he or she has a diagnosis when in fact no diagnosis has been made and the stress diagnosis encourages a do nothing attitude so that further thought into the diagnosis is not required.
Consider motility studies related to the oesophagus plus all the necessary investigations needed to rule out anything serious for example ECG and a cardiac opinion, ENT, motility studies, ultrasound, CT scan.
Consider dietary changes. I try to keep the stomach empty by asking the patient to avoid roughage or hard to digest food also to do the usual things which might help reflux symptoms such as elevating the head of bed slightly, and making sure that the evening meal is taken several hours before bedtime.
Check the link below for information on hard-to-treat cases. Then search the forums for questions and answers similar to yours.
docs/200808%20stenstrom%20Hp%20Treatment.pdf

NoxArcana
Posts: 34
Joined: Thu Feb 07, 2019 12:05 am

Re: Question about pain and gastritis

Post by NoxArcana »

barjammar wrote:
Fri Jan 03, 2020 8:31 am
Hi after a normal work up the main strategy for this kind of symptom is to exclude anything serious or easily treatable and then expect symptoms to gradually improve, especially in a young person.
I don’t encourage the diagnosis of stress as a cause of organic disease because it is pretty much a “dead end” which means that the patient thinks he or she has a diagnosis when in fact no diagnosis has been made and the stress diagnosis encourages a do nothing attitude so that further thought into the diagnosis is not required.
Consider motility studies related to the oesophagus plus all the necessary investigations needed to rule out anything serious for example ECG and a cardiac opinion, ENT, motility studies, ultrasound, CT scan.
Consider dietary changes. I try to keep the stomach empty by asking the patient to avoid roughage or hard to digest food also to do the usual things which might help reflux symptoms such as elevating the head of bed slightly, and making sure that the evening meal is taken several hours before bedtime.
Thanks for your answer, I did an ECG, the doctor told my heart is fine, i also follow the diet, my last meal is 2h before bedtime and elevate the bed as well, but i never did motility studies, if there is a motility issue this can be fixed taking medication or only with surgery?

Helico_expert
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Re: Question about pain and gastritis

Post by Helico_expert »

you can probably try Mosapride or Domperidone to improve motility problem.

NoxArcana
Posts: 34
Joined: Thu Feb 07, 2019 12:05 am

Re: Question about pain and gastritis

Post by NoxArcana »

Helico_expert wrote:
Sun Jan 05, 2020 9:48 am
you can probably try Mosapride or Domperidone to improve motility problem.
Domperidone didnt help, my doctor told me to stop because of the side effects, i dont know if there is Mosapride here, i'll ask my doctor about it. Last time he tried to increase the PPI dose, and if the symptoms persist he would ask for a CT scan. I dont feel any other issue, my exams are fine, i hope to find some medication like mosapride. Thanks for your help, like always. :D

mitul_108
Posts: 22
Joined: Mon Sep 30, 2019 5:34 pm

Re: Question about pain and gastritis

Post by mitul_108 »

Why CT Scan?? Endoscopy not???

Helico_expert
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Re: Question about pain and gastritis

Post by Helico_expert »

CT scan is to rule out other problems such as gall stones and condition of other organs. For stomach problem, the primary diagnosis is still endoscopy.

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