Apparently a treatment involving antibiotics has a reported 70-90% cure rate pf peptic ulcers (cite)(cite).
However when when I when to the hospital with severe stomach pains and vomiting up my own bile they prescribed Maalox, and then on a return trip, omeprazole telling me I’d have t take it for life. Well the omeprazole worked for awhile, but not so much anymore.
As I set here, my insides aflame, a tired irrational whimpering ball that just wants the pain to end so I can sleep, I’m reading up on peptic ulcers, and I just need to know why?
Why would two separate doctors not prescribe a treatment that chances are would work to end a painful condition for good?
Now I’ve gotta spend money I don’t have to go in again. If this is too close to medical advice I understand, but I’m not seeking medical advice. I’m going to go to a doctor, maybe an er doc if the pain don’t end soon.
I just really wanna know what those other two doctors were thinking?
Personally, I tested negative for the bacteria responsible for ulcers. Antibiotics would have been a waste for me. If they didn’t test you, then I have no idea.
hmm they did draw blood but they didn’t tell me what they did with it. So maybe it’s something else.
Well they were ER docs and it’s 3 am when I had the question so if I were to ask probably “who are? How’s you get my number? Why’d you call so late? go to the ER”
which is advice I may end up taking yet. Last time it was $1,000, so it’s just a matter of when pain over comes financial inhibition
The bacteria that can be wiped out with antibiotics
Excessive use of anti-inflammatory drugs that agitate the stomach lining.
I begged my GP for the antibiotics but he refused without an endoscopy. Had that, and turns out he was right, I didn’t have it. My partner played a similar trick on her GP, having seen me go through the endoscopy which she Did Not Want. He relented, she took the antibitoics without the tests, it cured her. Turns out she Did have an ulcer caused by the bacteria.
Now, this is the British NHS so I’m sure practices vary, but my understanding here is that they don’t like dishing out antibiotics willy nilly – for medical, not cost, reasons, I might add. Clearly, it would’ve been cheaper to give me the drugs than send me for various tests including the endoscopy.
It might be worth noting that my GP was a young, enthusiastic thing. Her GP was an old, world weary man who couldn’t be bothered to argue.
I am not a doctor, but I do know that not all stomach pain, and acid reflux are ulcers … you may simply have serious gastric reflux that will respond just fine to omeprazole. I take omeprazole becaue I take meds that essentially require it, it protects me from probably getting an ulcer thanks to the other meds rather than GERD.
They told me I did. The doctor told me they’re just something you get as you get older.
I did end up going to the hospital. turned out the ulcer flare up was caused by some nasty stomach flu. Somehow it set them off singing a terrible song. The doctor said vomiting can stress the lining or something, but I think it was the nasty its self. I was feeling burning long before I had nausea.
That said the gastroenterologist looks like a really good idea. Get this thing nipped in the bud for good.
To answer the Q about the previous hospital visit, yes I asked him all sorts of questions about dosage. I did not mention the antibiotic treatment because at the time I had went in thinking the pain was a kidney infection, and I was not very familiar with the antibiotic treatment. Further I assumed as the doctor he’d know more about these things than me so I wasn’t going to try arguing my way from a position of sleep depravity, and ignorance. SanVito, thanks for the information!
There is an algorithm for treatment of dyspepsia, if you’re interested. The vast majority of indigestion and epigastric pain is non-ulcer dyspepsia.
If the patient has symptoms to suggest stomach or oesophageal cancer, or active bleeding from an ulcer you scope them ASAP.
If not, the first step is diet and lifestyle advice (less alcohol, less tobacco, less spicy food, propping up the head of the bed etc).
If that doesn’t work you move on to PPIs like omeprazole.
If that doesn’t work you check antibodies for H.Pylori- the ulcer causing bacteria. If it is positive- you treat with 2 antibiotics and high dose PPI.
If it is negative, you scope.
If the treatment for H.Pylori fails, you scope.
Treating everyone for H.Pylori without appropriate testing and a trial of PPI is neither cost effective (as the majority won’t have ulcers) nor a good idea in terms of antibiotics resistance and side effects from treatment.
The ER docs did what ER docs do- they provided emergency symptomatic treatment. It sounds like they diagnosed you with acute gastritis and gave you treatment for that, assuming if it didn’t work you would see your own doc for the next step.
The ER doc’s job is to make sure you aren’t dying from a bleeding ulcer, and getting you out of the department ASAP. Testing you for H.Pylori antibodies and treating you, or arranging a non urgent scope…not really their job. That’s what GPs are for.
Somewhat related, there are 4 main tests for H pylori.
The gold standard is a biopsy - this is time consuming and uncomfortable. The other 3 ways are:
-Serum antibody test
-Urea breath test
-Stool antigen test.
The serum antibody test has terrible specificity and sensitivity and does not differentiate between current and past infection. It is a terrible test and should not be used by anyone.
The urea breath tests and stool antigen tests are the tests to get; the only problem with these is that PPIs and bismuth (pepto-bismol) interfere with the test, so you need to be off them for two weeks before doing the test.
For the urea breath test, you blow into an empty vial and then drink a drink that has some isotope-labeled urea in it. 1/2 an hour later, you blow in another empty vial. The idea is that if you have the bug, it will metabolize the isotope-labeled carbon in the drink into special CO2 and by measuring the delta between the pre- and post- samples you can tell if the bug is there or not.
The stool test is just an immunoassay in a little test card, much like a pregnancy test. It has very similar sens/specificty to the urea breath test and results come back much faster.
So, if you didn’t blow into two different tubes, have your poo collected, or have some dude stick a long thing into your stomach to take a sample, they did not confirm a diagnosis of H. pylori.
Im curious if anyone can explain why a Chinese doctor would not prescribe antibiotics in the following scenario:
Patient has a long history of ulcer pain
Endoscopy is performed and diagnosis the following:
a) Superficial Atrophic Gastritis
b) Duodenal Ulcer
c) Duodenal Diverticula
A breath test is performed for H. Pylori and confirmed it is high (reading of 5.8 where below 4 is normal)
Doctor prescribes the following Western medicines:
Omeprazole 500mg (PPI) - being given intravenously
Hydrotalcite tablets (Antacid)
And two TCM (Traditional Chinese Medicines):
荆花胃康胶丸 - (Genkwa flower) - general TCM medication for gastritis
康复新液 - (Kangfuxin Ye) - Periplaneta americana or its ethanol extract, has healing powers for cell regeneration
The question is this: Why did the Doctor NOT prescribe any antibiotics? This seems completely wrong given the diagnosis of H. Pylori … any plausible explanations that I am missing?
They think it’s an antibiotic resistant strain, they fear promoting antibiotic resistance or other side effects? IIRC there are worries about making people sick by killing off harmless or beneficial bacteria along with H.Pylori with the antibiotics.
Or they have a traditional medicine fetish and prefer that over the real thing.
Oh, and something unrelated to the question but interesting; checking out the Wiki page on H.Pylori I came across this:
Something of a mad scientist moment there. “Fools! I’ll show you* all!!*” <glug glug>
Yes thanks, those are good reasons. I don’t know much about how they classify the strain, but based on the time from diagnosis to prescription I don’t think there was much analysis of the strain.
My plan, is to have her ask the doctor why he didn’t prescribe, and then if there is no good answer, to have her get the prescriptions herself (which are easily obtainable in China pharmacies)
california_dreamer: There’s no urgency to treat the H. pylori. In fact, since the breath test isn’t totally reliable, it’s reasonable to wait for a confirmatory test (if one was done, or is to be done, of course) before starting antibiotics. Given the use of IV PPI, it sounds like the patient is in hospital, so it’s still extremely early in the course of the illness.
It also pays to keep in mind, that eradicating the H. pylori prevents ulcer recurrence and has no significant effect on the initial healing of the ulcer, i.e. yet again, providing no reason for early antibiotic therapy. In fact, we usually wait 2 to 4 weeks to start the antibiotic regimen (IIRC), i.e. until they come back for follow-up with the gastroenterologist (for those who underwent endoscopy).
KarlGauss : Thanks, and I understand there is no urgency. She has possibly had HP for years; maybe since childhood. My understanding is that although the ulcer may be healed by the Omeprazole, the HP will continue to irritate the tissues and a new or additional ulcers will occur.
She is not in the hospital. An IV is the standard way to administer drugs to in China and is done as an outpatient. There was not any request for a followup to see retest for HP in 4 weeks which I believe is also standard - in addition, I am not aware of any biopsy of tissue taken from the endoscopy.
She has had the same ulcer, or recurring ulcers, for more than 5 years.
I don’t understand this. You say that gastric reflux is an ulcer but you take medicine protecting you from getting an ulcer. Acid reflux is not caused by an ulcer, but a relaxed valve which allows the gastric contents to back up into the esophagus.
Acid reflux is not caused by an ulcer, but a relaxed valve which allows the gastric contents to back up into the esophagus.