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    Can duodenitis cause acid reflux?

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Posted on Wed, 2 Aug 2017 in Abdominal Pain
Question: Is it acid reflux? Can duodenitis cause reflux? Will I ever feel normal?

I'm 26 years old and 5 months ago I was out drinking and got punched in the stomach. The next day I took some ibuprofen and coffee on an empty stomach. Eventually ate some food and went for a run later in the day. On my run I felt a burning pain under my ribs. Ever since that day I have had daily issues with burning pain under my ribs into my chest, bloating, burping and just general epigastric pain about 2 hours after most meals. Especially made worse after drinking water with a meal, eating a meal that has meat, eating spicy food or too much. I can only eat very small meals and if I eat too much, I pay. Definitely worse If I lay down or lean forward. I have seen my pcp, gastroenterologist and a chiropractor. I have tried many PPIs and have not had much relief, I also feel that they have sensitized me more to stomach acid as every time I try to come off (because I don't feel good while on ppis - bloating/nausea/chest pressure) my stomach burns terribly. I am currently taking 15mg lansoprazole BID with a probiotic and feel... okay. I have been on some form of a PPI for a 3-4 months now (omeprazole, dexlansoprazole, rabeprazole). I can eat a little more with this regimen, but I still don't feel normal by any means. This makes me very frustrated because I was running 50 miles a week and now I can't run because I reflux when I do. I've lost 10 pounds even with quitting running. Everyone I talk to seem to not be too concerned because it's not like I'm gravely ill, but I feel like this has taken a lot of XXXXXXX from my life. I am unable to run, drink coffee, alcohol, eat meat/spicy food or drink too much water without paying a large price (bloating/burning/difficulty taking deep breaths because it feels like my stomach is in my chest. In general it is sort of hard to take a deep breath in because my stomach just feels sort of tight. Could this be duodenitis causing reflux? or is it just GERD and I'm doomed? I'd rather have something that I could heal versus my XXXXXXX just spontaneously opening or not closing properly. Below are the diagnostic tests that I have received and their results.

CT abdomen/pelvis - no acute inflammatory process. benign exam.
Ultrasound of gallbladder, pancreas, kidneys, liver - showed tiny polyp in my gallbladder - they were not worried about it.
EGD - no esophagitis. no hiatal hernia. no gastritis. very mild duodenitis. No ulcers. No other significant findings. I am frustrated that they did not biopsy for H. pylori.
H. Pylori Ab - negative - twice.

I started to have panic attacks due to chest pressure/pain every once in awhile. So, my PCP felt that anxiety was causing all of my gastro issues. I now have alprazolam and citalopram, but I assure you that my reflux/stomach issues have caused my anxiety in the first place. Also, I have been anxiety free for 2 weeks and have still been having significant pain and discomfort. This problem makes it hard for me to sit down as I hunch making it hard to just watch tv. I know that I am not dying, but I'm also not living life to it's fullest.

I am planning to get a second opinion from a gastroenterologist as I felt that my first one was a very nice guy, but was short and not thorough enough.

Also, my brother had similar stomach issues when he was in law school and was treated with ppis and antibiotics for h. pylori and got better.

My Questions:
- could duodenitis cause my reflux?
- Could it take >5 months for my duodenitis to heal?
- What is the sensitivity of h. pylori antibody immunoassay? - Like could it still be caused by h. pylori?
- Could it be SIBO? - I am more constipated and have not had diarrhea, but I burp like crazy. I get an amazing build up of pressure in my epigastric region (which is when I get anxiety). When I burp the anxiety and discomfort ease pretty significantly.
- Could it be Bile Reflux Disease?
- I have not had a stomach problem-free day for the past 5 months. What's my outlook here?

doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Dyspepsia with duodenutis and Acid reflux'

Detailed Answer:
Hello and thank you for choosing HealthcareMagic for your query,

I've gone through all your details and appreciate your concern.

Most likely, the problem you are having is called Dyspepsia overlapped with duodenitis and acid reflux.


Ans1- Yes it can cause all your symptoms.Duodenitis is inflammation of the duodenum (the first part of the small intestine), which is located just below your stomach. Both gastritis and duodenitis have the same causes and treatments.The stomachs lining gets inflamed, irritated, or eroded in gastritis. It may either happen gradually or suddenly. Excess alcohol consumption, chronic vomiting, anxiety, stress, certain medicines like aspirin can all cause gastritis.So in short inflammation leads to irritation which causes acid to reflux back in food pipe.

2-With proper medication(Agressive therapy) it may take almost 3 months for you to feel better.

3-Almost 99% sensitive.

4-If endoscopy is normal then no it cant be H.Pylori infection.

5-Bloating and acid can be caused by any kind of food. In most of the cases, it's fatty foods which cause these symptoms. Any food whether it's fat or protein or complex carbohydrate when can not be properly digested, releases large amount of gases like hydrogen, methane, carbon dioxide which causes burping.Take a good quality probiotic and external digestive enzymes.
Small Intestinal Bacterial Overgrowth can be a reason of severe flatulence .
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine, and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestines causing improper and disturbed food digestion.


Tests suggested-
Small bowel imaging and a gastric-emptying scan.



Take a proton pump inhibitor like Esomeprazole 40 mg twice daily along with a prokinetic drug (eg.Domperidone) for 5 days. This will provide you symptomatic relief from symptoms
of dyspepsia (you may need to obtain prescription for this from your local physician).

Antacid like Pepto bismol can be taken for few days along with it.
Any over counter probiotic should be taken for few days to provide relief in symptoms of indigestion.

Apart from this, some dietary restrictions are to be followed-

- Avoid alcohol or smoking.
- No aerated beverages.
- Take light non spicy easily digestible food for few days.
- No Fast food like pizza or burger should be taken.
- Drink a cup of cold milk daily.
- Avoid fatty foods.
-Eat simple and natural home cooked food.
If possible try detox diet (Raw vegans) for at least 3 month. Take normal food in lunch while in supper take uncooked raw (low fiber) natural form of food. This can play wonders.
Avoid taking excessive fibres. A total fiber intake of about 20-25 gram per day would be good for you.

You are a typical case of Gastroenterology.So take opinion in speciality query section.A general practioner can't provide you with relevant details.


Hope i was helpful.

Thanks
Dr XXXXXXX
Gastroenterology.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
Answered by
Dr.
Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2428 Questions

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