Suggest treatment for duodenal ulcers

Posted on Thu, 14 May 2015

Question: I am experiencing severe upper stomach discomfort usually right under the breast. Most times it happens a couple of hours after eating, and can last up to a half hour, but sometimes it doesn't happen all day until after the evening meal, when it can last for an hour or hour and a half. It is very severe and can come up into the chest and my back. In January, I had an ultrasound which showed that my gall bladder, pancreas, liver, and spleen were all fine. Last year I had an endoscopy which showed everything to be fine. It doesn't matter what food I eat. I could eat a meal today and have no problem. I could eat the same meal the next day and have the problem. I have had acid reflux for several years, and it is under control with a Prilosec every day. Can you shed some light on what my problem might be? Thank you very much.

Answered by Dr. Panagiotis Zografakis (1 hour later)

Brief Answer:
Gallbladder, duodenal, acid reflux, vascular problems may cause it

Detailed Answer:
Hello,

the fact that you've had a normal ultrasound scan is very much against the diagnosis of a gallbladder problem. Duodenal ulcers may cause pain but the negative endoscopy (although it was last year) is also against it. Since you have acid reflux disease, a repeat endoscopy wouldn't go amiss.

Vascular problems may cause pain to the abdomen and chest. Occluded coronary arteries may cause chest pain that radiates to the abdomen and may indeed start after meals. Abdominal blood vessels can also be affected and cause ischemia to parts of the gastrointestinal system. Ischemia can present with pain and perhaps other symptoms or signs like gastrointestinal bleeding, diarrhea etc.

Untreated acid reflux may cause esophagitis, which may present with chest pain that may radiate to the abdomen. Acid reflux is more likely to cause symptoms immediately after a heavy meal, rather than two hours later.

Finally, nervous system problems may delay gastric emptying (gastroparesis). Such problems are usually caused by diabetes, abdominal surgery, drugs etc

So in conclusion, there are various possibilities. The main ones have to be excluded with a new ultrasound scan, endoscopy and cardiovascular assessment.
Contact me again, if you'd like more information about this condition.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (1 hour later)

The discomfort always starts at the upper stomach and after awhile, it sometimes goes to my back, and just a couple of times it went to my chest. It did not last long on my chest. I thought perhaps it did that because I was very nervous. I should have mentioned that when I get the symptoms, I lay on my stomach and there is a little relief, but not a lot of relief. When these symptoms happen, I sometimes feel cold and sometimes feel hot, but not every time I get them. Also, some times the symptoms happen while I am in the beginning or middle of eating a meal. I don't understand why it is more severe in the evening. For my meal this evening, I made a XXXXXXX spinach, and fruit smoothie because I was afraid to eat a regular meal. All my meals are healthy, nothing fried, and contain either fish or chicken breast, with steamed vegetables, and usually followed by jello or a fresh fruit cup. I drink water and no coffee or tea. This morning for breakfast, I had dry multigrain toast and a banana. I am losing weight (which I need to shed a few pounds) because I do not have large meals any more.

Answered by Dr. Panagiotis Zografakis (6 hours later)

Brief Answer:
I still believe you should carry on with the assessment I've suggested

Detailed Answer:
Hi,

thanks for the input!
Your diet seems to be as healthy as it can be, so I suppose it shouldn't be part of your problem. The aforementioned tests are important to exclude the most common causes. You haven't mentioned anything about your pancreas but I should ask this: have you even had pancreatitis? Chronic pancreatitis may sometimes present with intermittent pain. A CT scan of the abdomen should be sufficient to exclude that, although the sensitivity of this test for chronic pancreatitis is not perfect. I would suggest proceeding to the first tests I've mentioned before doing the CT.

If the tests are negative (or perhaps even before doing the tests) you can try a practical approach with metoclopramide administration (if you can find it in the USA) or any similar prokinetic drug. This drug speeds up stomach emptying and may cause some relief in cases of gastroparesis.

I hope you find my advices helpful!
If you have more questions, please contact me again.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar