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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have gilbert's syndrome, recurring ulcer problem and elevated SGOT and SGPT. Treatment?

Answered by
Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5770 Questions

Posted on Fri, 28 Dec 2012 in Digestion and Bowels
Question: Hi, Iam a 39 year old male. Iam taking pantaprazol 40 (morning)and rantac (morning and evening) for my ulcer problem.It is recurring every 6 months for the last 2 years and it stays for 2 months.It starts with burning,pain and nausea in the stomach.Later the hunger pangs start 2-3 hrs after food and after taking food I get relief.After taking a PPI blocker and H3 blocker and some home remedies and a bland diet for 2 months,it usually just goes away .But the burning and hunger pangs after 2-3 hrs after food doesn't go away this time.Now Iam planning to add sucrafil syrup also along with the acid blockers.Does it have any known side effects?How effective is it? Can you suggest any other drug apart from this for my ulcer?
I dont have any allergies or other ailment or history of illness other than this but I have gilberts syndrome and my SGOT and SGPT is slightly elevated
I dont want to go to do endoscopy as I have a history of gastritis. Iam parallelly taking health supplements like vit E and home remedies like cabbage juice which is giving good relief.
Answered by Dr. Grzegorz Stanko 36 minutes later

Thank you for the query.

First of all you need to know that symptoms of peptic ulcer and stomach cancer can be the same. Upper GI endoscopy is usually performed not to diagnose peptic ulcer but for ruling out stomach cancer. It should be performed especially when regular treatment does not bring any relief or the symptoms are recurrent. Moreover, during the endoscopy Helicobacter Pylori test is performed. Without this bacteria eradication any treatment wont be effective.
It is also possible that your symptoms are caused by gall stones. The symptoms might be similar to peptic ulcer. So abdominal ultrasound is also advisable in your case.
So if you do treat yourself with PPIs and H2 blockers (which should not be taken together)without any diagnostics, you may only obscure the symptoms of the diseases. And the same is with Sucrafil.

Hope this will help. Feel free to ask further questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Grzegorz Stanko 17 hours later
Hi Doctor,
As i said i have a history of gastritis and had taken triple therapy under a physicians supervision to eradicate H.pylori in 2001.Afterwards there were no episodes of gastric discomfort till 2011 when it was triggered as a result of an extensive dieting and recurred in 2012 after a 10 day course of extensive antibiotics for throat infection and cold prescribed by an ENT doctor.Had it been H.Pylori, wouldn't the antibiotic have fixed it instead of resulting in symptoms of duodenal ulcer?

Also on bland diet days the symptoms are minimal or negligible.But on a spicy/greasy and diet with more condiments from hotels it gets upset.Does gall stone have the same characteristics?your reply is greatly appreciated. Thanks
Answered by Dr. Grzegorz Stanko 4 hours later

I do not assume that you have peptic ulcer for 100%. It is only one of possibilities according to your medical history and symptoms. Peptic ulcer gives pain after 1-2 hours of the meal, nausea caused by increased acid secretion and chest burning. The symptoms are eased by PPIs or H2 blockers. It sounds very similar to mentioned by you symptoms, that is why I`m keep talking about ulcers.
History of Helicobacter Pylori eradication does not rule another infection out. This bacteria needs two antibiotics with high dosages (as you can see, we do not treat it with one antibiotic - in other words this bacteria is hard to eradicate) and in some cases the treatment might not be effective so it needs another course of different antibiotics.
Throat infection is usually treated with one antibiotic what usually is not sufficient for H.Pylori eradication. Moreover, when you do treat the bacteria shorter than necessary or with low dosage, you do teach bacteria how to prevent this antibiotic instead of killing them. Such bacterias do become resistant for antibiotics. That is why we cannot treat throat antibiotics therapy as effective for H.Pylori.
If it is about gall stones, it gives symptoms after a 1-2 hours of the meal (similar to the peptic ulcer), nausea appears, the pain usually is under right rib cage (bot not necessary) and radiates to the back. The symptoms do get worse after fatty or spicy foods (such foods do stimulate bile secretion and gallbladder contraction).

Hope this answers your questions. Feel free to ask further questions (especially if I have missed something).
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Grzegorz Stanko 53 minutes later
In the last 2 weeks Dr.Garnett Cheney's cabbage therapy brought a lot of relief(a quart of cabbage juice mixed with carrot and celery a day)It erased the symptoms from 60% to 90%.As of now the level of symptoms are very minimal.Mornings are okay.Later in the evening at 5pm have a light burning feel.A banana and a veg juice(sugar free) will fix it.Then later at night around 9 pm similar burn(minor) starts which is eased by dinner.That's why I was asking you about continuing with sucrafil for a couple of weeks.
Another info regarding me is that i had taken psychiatric treatment for anxiety in 2008.Does stress and anxiety play a role in gastro disorders?

I have an unpleasant experience and memory of endoscopy last time in 2001.Thats why iam reluctant of it(totally had 3 endoscopy so far.1999,2000,2001)Do you think it is absolutely necessary to have GI endoscopy or is there any other alternate medicine which can be tried before going for it? .Is it still done orally without anasthesia?

your reply is awaited
Answered by Dr. Grzegorz Stanko 5 hours later

You have the right to be afraid of endoscopy as this is very unpleasant test. But this test can be done with kind of smooth anesthesia where there is no need of intubation (usually they use Propofol with Fentanyl). You need to ask your doctor about it.
I can not tell you that endoscopy is not necessary. This is huge responsibility at this point. For 99% you do not have cancer and peptic ulcer. But still it needs to be clearly explained.
Specific diet can help with acid reflux and similar diseases. That is why some foods do help you with symptoms. But this is not permanent solution as you still do not know what are you really curing.
Stress and anxiety plays very important role in whole body including digestive tract. You have an ability to stimulate stomach acid and bile secretion. It happens when you are hungry and start thinking about the food. And stress can work same way. It is known that stress stimulates stomach acid secretion and makes your symptoms worst.
If you are really unable to have endoscopy you can try this:
- perform Helicobacter Pylori Quick Test (no endoscopy necessary)
- if H.Pylori infection is present you should have antibiotics treatment (Amoxicillinum 1000 mg once a day + Metronidazole 500 mg twice a day during 10 days)
- without regard to H.Pylori quick test result, try Omeprasole 40 mg once a day in the morning before a meal during 30 days (pantoprasole and rantac should be not taken with it)
- avoid coffee, fruit juices, soft drinks, fatty foods
- drink more mineral water
- start Magnesium 400 mg once a day supplementation
- last meal should be two hours before sleeping
- while sleeping put your head little bit higher

If such treatment wont bring any relief after a month, endoscopy should be performed.

Hope this will help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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