Suggest treatment for gastritis, back pain and abdominal pain

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Posted on Sat, 25 Apr 2015 in Medicines and Side Effects
Question: For the past four months my wife is suffering from sever gastritis, back pain and stomach pain. We had consulted gastroetnrioloist, orthopedic and physician . The orthopedic said nothing wrong as far as he is concerned. The gastroetnrioloist asked us to take Ultasonic Abdomin Scanning and found nothing wrong. However, he prescibed some medication for gastritis. But her pain continued and we did consult a physician who asked us to undergo blood test and found nothing adverse. She was taking Olmesartan medoxomil hydrochlorothiazide 40mg prescribed by a physician since last week of XXXXXXX 2014 when he found her BP high and changed the drug from Losar H. Now this second physician found BP high and prescribed Cilaheart 5 along with Olmesartan medoxomil hydrochlorothiazide 40mg. We consulted AQsian Institute of Gastroentiology in XXXXXXX and they prescribed some drugs for gastriti. When she is continuously suffering from back pain, abdomin pain and gastritis, we approaced XXXXXXX Asia Referral Hospital Yeshwathpur XXXXXXX which was referred by Asian Institute of Gastroentriology as we are reseding in XXXXXXX When we attended the XXXXXXX Asia Referral Hospital Yeshwathpur XXXXXXX they did endo scopy, colonoscopy and byopsi for abdomin pain and OMESARTAN as it was written on all reports. Then the doctors after seeing reports said that she does not require any medicnes for gastritis or for pains as the tests are normal. They suggested to do YOGA and change of life style(?). When asked about OLMESARTAN writen on the reports they prescribed to continue the drug. Now, hewr problem is continuing and the doctors at XXXXXXX Asia Referral Hospital Yeshwathpur XXXXXXX did not explained why they did test for OLMESARTAN and after that why they have asked us to continue the same. Her problem is continuing. When checked on net the indications of my wife are tallying with the OLMESARTAN as side effect one in 100. Please enlighten us on this aspect.
Additional Information: I forgot to intimate that when my wife said of severe backache the doctor of XXXXXXX Asia prescribed "TRYPTOMER 10mg" for 3 weeks one tab per night which is being started today.
Please note that all the medicines prescribed for Blood Pressure ARE NOT BY XXXXXXX Asia doctors but other physicians. We approached XXXXXXX Asia for the gastroenteritis specialists for the problem of gastritis, back pain and abdomen pain. This clarification is given as the statement typed at visited a doctor may mislead. It is meant that the patient went to XXXXXXX Asia Hospital to consult on the problem of gastritis, back pain and abdomen pain and not for Blood Pressure.
doctor
Answered by Dr. Divakara 18 hours later
Brief Answer:
It could be a Metabolic disease.

Detailed Answer:
HI

Greetings from Dr.Divakara.P
Thanks for posting your query.

First of all let me clarify that Olmesartan is for her high blood pressure and not for her gastritis, back pain and abdomen pain, also her problems are not due to side effect of Olmesartan.

Well a normal endoscopy rules out the possibility of Gastritis so there has to be some other disease which is causing her problem.

The problems could be in Liver , Pancreas , Back bone or some metaboic diseases. I need to know few more details.

1. What exactly you mean by gastritis? Is it the burning sensation in abdomen/ chest? or it is bloating sensation or something else?

2. Where exactly she feels the back pain ? Does the back pain increases on doing physical activities like bending forward or turning to sides ?

3. Where exactly is the stomach pain? What is the character of stomach pain? Is it continuous or intermittent ? Is the pain burning or pricking or squeezing ?
Does the pain increases after having food ? If so any particular food or all food ?

She would require some additional tests but before advising for the tests I need to go through the tests ( apart from what you have uploaded ) done on her by her physician. Kindly upload those reports also.

Also in one of the report upload by you it was written that she is having Chronic diarrhea but you have not mentioned anything about that . Kindly clarify.

Will be looking forward for your reply.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Divakara 1 hour later
Dear Dr XXXXXXX
Greetings!
First of all, I must thank you for your reply in detail.
Olmesartan 40mg was prescribed by a physician for my wife for high blood pressure in the last week of XXXXXXX 2014. When she was having severe belches and back pain, first we approached a gastroenterologist who treated for IBS and prescribed some medicines after asking us to under go Ultrasonic Scanning of abdomen which was normal. She got temporary relief. We could not go to him for follow up as he changed the location of his practice and not known to us. When the back pain increased we went to a physician who added Cilaheart 5mg for BP in addition to Olmesar 40mg as he found her high after seeing the diagnostic reports he prescribed. When I went to XXXXXXX my doctor friend when he heard the problem of my wife took us to Asian Institute of Gastroenterology where one of the XXXXXXX doctors is known to him well. When he learnt he suuggested us to go to Clumbia Asia XXXXXXX after prescribing some medicines. As desired by you all diagnostic reports are being uploaded.
Now, the answers for your specific questions:

What exactly you mean by gastritis? Is it the burning sensation in abdomen/ chest? or it is bloating sensation or something else?
It is meant by ‘bloating sometimes’ and ‘belches’ as gas was coming out. When any ointment or pain oil is applied on the back and massaged belches come out.

Where exactly she feels the back pain ?
Middle of the back at bottom when bending while performing XXXXXXX and top to bottom in the centre while standing for some time. She gets piercing pain in the back.

Does the back pain increases on doing physical activities like bending forward or turning to sides ?
No.

Where exactly is the stomach pain?
Both sides of the stomach
What is the character of stomach pain?
Pain when pressed.

Is it continuous or intermittent ?
Only when pressed

Is the pain burning or pricking or squeezing ?
No.

Does the pain increases after having food ?
No

If so any particular food or all food ?
Not Applicable

Also in one of the report upload by you it was written that she is having Chronic diarrhea but you have not mentioned anything about that . Kindly clarify.

"Chronic diarrhea" was never told by us . In fact some laxative was prescribed for constipation.

Some more information if useful:

She underwent hysterectomy in the month of October 2010 at Apollo Hospital XXXXXXX as a cyst was found in the ovaries. Both uterus and ovaries were removed. There was no complication prior to surgery but during a routine ultra sonic scanning the cyst was found. On the advice of gynecologists thehystectomy was performed for the safety of future. The cyst of the ovaries found WAS NOT MALIGNED as found in biopsy.

We look forward to hearing soon.



doctor
Answered by Dr. Divakara 22 hours later
Brief Answer:
It's not gastritis but indigestion.

Detailed Answer:
HI Mr. XXXXX

Thanks for the follow up .

So first of all your wife is not having Gastritis. She is having Indigestion which is causing her Abdominal bloating and belching sensation. We need to find out the cause of this indigestion.

Indigestion could be due to problems in Liver , Pancreas or Intestine. I went through all the reports but could find any blood tests in them . So I would like to advice the following tests for her.

Liver Function tests, Serum Lipase, Anti-endomysial Antibodies, Stool for fat , Immunoglobulin A (IgA) anti-tissue transglutaminase antibody, Serum TSH, Serum Potassium levels.

Also no tests or scan has been done for back pain . Why is that so ? I would recommend initially a X ray of her Thoracic and lumbar spine AP and Lateral view . If needed we shall do MRI also but not as of now .

She has been prescribed Lactifibre , let her continue that and avoid Dairy food like Milk , Coffee , tea, Buttermilk , Curds, Butter and cheese.

Kindly revert back with the reports.

Any clarification feel free to ask .

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Divakara 1 hour later
Dear Dr Divakara,

Thanks a lot for your reply to our followup queries from you. We shall definitely undergo the diagnostic tests recommended by you. Can you suggest a good diagnostic centre or hospital in Bengalueru where all the tests suggested by you are carried out so that we can complete them in one day. We are residing in Girinagar. Distance form the residence is not at all an issue for us to go to such place for tests. We are free tomorrow the 31st March 2015. Please advice us whether the blood tests suggested by you have to be taken on FASTING STOMACH or AT ANY TIME.

Secondly, I did uploaded blood tests in which TSH was done apart from Lipid Profile and Glucose (FBS). I do not know whether the website could take all reports uploaded. Again now I uploaded but not able to see on my dashboard. May be you could access which I do not know.

The TSH done on 19-01-2015 showed an observed value of 0.712 against biological Reference Interval of o.4-0.5 .

Looking forward to your advice in this matter.After completing the above tests can we consult you in person? Regarding X-Ray result whether we have to consult an orthopedic? In case the blood tests have to be completed in fating, CLUMAX is convenient for us. Kindly advice.
Edit Delete
doctor
Answered by Dr. Divakara 14 hours later
Brief Answer:
Get it at clumax.

Detailed Answer:
HI

Thanks for the follow up .

Even I would recommend Clumax Diagnostics.

Yes you need to be in fasting condition.

TSH is in normal range , so no need to do the TSH test.

Regarding X ray first get X ray of her Thoracic and lumbar spine AP and Lateral view I will see the report and then advice whether you need to consult orthopedician or not.

Regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Divakara 21 hours later
Dear Dr Divakara,
Thanks for your guidance.
Today we could all the tests suggested by you.
The following tests were done at CLUMAX:
Tissue Transglutaminase IgA ( Report will come after 3 days)
Immunoglobulin A-Total (Report will come after 3 days)
Liver Function Test –Report Uploaded.
Lipase-Report Uploaded
Potassium (K+)-Report Uploaded
Stool Analysis-Report Uploaded-Negative for Fats
X-ray Lumbar Spine AP/LAT-Report and X-Ray Pic Uploaded
X-Ray Thorasic Spine AP/LAT-Report and X-Ray Pic Uploaded.

Regarding ANTI ENDO MYSIAL ANTIBODIES Test , CLUMAX do not do this test. We checked with XXXXXXX Diagnostics and they they also do not do this test.
Finally, we found Apollo Hospitals do this test and gave the sample at their Jayanagar 3rd Block Hospital. Report will come after 4 days .

All the three reports due viz., Tissue Transglutaminase IgA, Immunoglobulin A-Total and Anti Endomysial Antibodies will be submitted after 4 days when the same are received.

Best Regards,
XXXXX
doctor
Answered by Dr. Divakara 10 hours later
Brief Answer:
Revert back once all the reports are ready.

Detailed Answer:
HI XXXXX

Thanks for the information.

Very sorry that you need to go to Apollo for the test .

Kindly revert back once all reports are available.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Divakara 5 days later
Dear Dr Divakara,

Greetings!

When I was writing this notes and uploading the reports the internet connection got terminated and I do not know whether they got uploaded and my notes is not seen on the web siote. hence I am once again dfurnishing the same.

We could complete all the diagnostic tests advised by as given below.

Tissue Transglutaminase IgA-Report Uploaded
Immunoglobulin A-Total-Report Uploaded
Liver Function Test –Report Uploaded.
Lipase-Report Uploaded
Potassium (K+)-Report Uploaded
Stool Analysis-Report Uploaded-Negative for Fats
X-ray Lumbar Spine AP/LAT-Report and X-Ray Pic Uploaded
X-Ray Thorasic Spine AP/LAT-Report and X-Ray Pic Uploaded.
ANTI ENDO MYSIAL ANTIBODIES- Report Uploaded

For a quick recap of the case, my wife Mrs Vasanthalakshmi is continuing with bloating of stomach, constipation and when pressed she gets pain in the sides.

We look forward to your advice in this regard.

Further, I would like to bring to your notice that I had already mentioned that it will take 4 days time to get Endomysial Antibody test since it is not done in Bengaluru. Now that I could get the report today ( from Apollo Hospital which they got it done from New Delhi), in line with your advice to revert back to you once all reports are available, I have uploaded all the reports suggested by you.
But the administrated of the www.healthcaremagic.com has considered certain suggestions and queries regarding the diagnostic tests like whether blood tests are done empty stomach AS FOLLOWUP QUERIES and closed the discussion for which I have to again recharge with Rs.599/-. Please advice your admin of the www.healthcaremagic.com that any question regarding the complaint of the patient only to be taken as follow up query and not those regarding clarifications on the diagnostic tests to be conducted. They are simply counting the number of times answers given without seeing the content and closing the discussion.
doctor
Answered by Dr. Divakara 16 hours later
Brief Answer:
Reports not uploaded.

Detailed Answer:
HI

Thanks for the follow up .

But none of the reports are uploaded . Kindly re post them .

Very sorry that your discussion was closed and you had to recharge again but that's their policy and I have no control over it .

Apologies for that.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Divakara 2 hours later
..
doctor
Answered by Dr. Divakara 7 hours later
Brief Answer:
It could be IBS or Lumbar Disc disease.

Detailed Answer:
HI

I got the reports into my mail.

First I shall type the results of the reports for further reference .

1. Endomysial Antibody -- Negative.
2. Serum Lipase, Serum Potassium, Liver function test-- Within normal limits.
3. X - Ray Lumbar spine -- Lumbar Spondylosis with disc disease at L3-L4 levels.
4. X-Ray Thoracic Spine -- Normal.

What was missing was Tissue Transglutaminase IgA-Report and Immunoglobulin A-Total. Need to know that too before commenting.

Now coming to X - Ray Lumbar spine -- Lumbar Spondylosis with disc disease at L3-L4 levels . This can explain her back pain . I would advise her to get a back Physiotherapy once a week and also get a prescription for Pregabalin and use it for 3 months. This will take care of her back pain.

As of her Abdominal problem is concerned if the other two ( Tissue Transglutaminase IgA-Report and Immunoglobulin A-Total) are also normal then we are left with only 2 possible diagnosis.

1. Irritable Bowel Syndrome.
2. Lumbar Disc disease causing Abdominal Discomfort .

If it is the Lumbar disc disease that is the sole cause of her back pain and abdominal discomfort then once you start Pregabalin within 1-2 weeks she shall notice a good ( but not complete ) improvement in both back and abdominal pain.

But if she notices no significant improvement in abdomen we need to consider Irritable Bowel Syndrome( IBS ) as the most likely diagnosis and I shall advise what needs to be done for that.

But do let me know the two reports , also tell me how is her condition right now ( I had advised her to restrict dairy products-- hope she is doing )

Hope this information was useful to you .
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Divakara 2 hours later
Dear Dr Divakara,
Greetings and thanks a lot for your reply.
Both Reports of Tissue Transglutaminase IgA-Report and Immunoglobulin A-Total are included in the complete test reports given by Clumax in PDF format downloaded from Clumax website. Both reports are not separate in the said file but continuing one after another.

I) Transglutaminase IgA –Observed value: 9.7 (units) while reference value is
30: Positive.

II) IgA-Immunoglobulin A- Observed value 450.5 (mg/dL) while reference value
is 70-400

However, as desired by you, I have uploaded both the reports separately for your kind reference and examination.

As there was a problem in uploading reports, today morning I had complained to Healthcare.com and Mr XXXXXXX responded immediately over my XXXXXXX and asked me to attach the files and send it to him which he confirmed that he had forwarded. I understand there is some limit of uploading reports to six or so. Therefore, I have deleted certain old reports which you had already seen.
I am extremely thankful for your prompt guidance from time to time and also enquiring about her condition.

She is complaining back pain, bloating of stomach and abdomen pain in the sides. But she is attending to her daily routine household jobs.
She takes only two cups(150ml) of coffee (with milk ) and very small quantity of curds along with meals as usual. She completely avoided butter and cheese which at least once in week or twice was being taken with bread.

Her general eating timings: She takes breakfast only after 9-30Am and usually around 10Am (earlier) on completion of XXXXXXX and takes lunch between 1-30PM and 2 PM. One cup of coffee at 7AM and another cup of coffee at 5PM. Fruits at ^Pm and night dinner with two pulkas and small quantity rice with curd.
I look forward to your advice based on the complete reports.

Best Regards,

XXXXX
doctor
Answered by Dr. Divakara 11 hours later
Brief Answer:
Start Pregabalin.

Detailed Answer:
HI

I got those reports too.

Tissue Transglutaminase IgA = 9.7 ( < 20 negative )
Serum IgA = 450.5 ( normal 70-400 ) Mildly elevated.

Well there are certain conditions where IgA level is elevated but since the level of elevation of IgA is mild I don't think it is necessary to evaluate for the conditions causing IgA elevation.

My advice is to start Pregabalin and observe for the response ( see for 2 weeks ) , if there is a noticeable improvement we shall continue this drug for few months , but if there is not such noticeable improvement then there are two options .

1. Repeat Serum IgA and if it is still elevated to do evaluation of causes of elevated IgA.

2. Initiate treatment for Irritable bowel syndrome.

Also for her back pain get physiotherapy . This medicines will also reduce her back pain . But if there is no significant reduction in her back pain get a MRI Lumbar Spine done and revert back .

I would also recommend her to learn and do Yoga . This will give a lot relief for her.

Hope this information was useful to you .

Any clarifications feel free to ask.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Divakara 12 hours later
Dear Dr Divakara,

Greetings!

At the outset I am very thankful to you for the way you investigated the case and analysed.

Please advise us on the following:

Specific dosage of Pregabalin -‘mg’ and ‘frequency in a day’ with details of whether to be taken before food or after food.

Is the food timings of my wife given earlier are in order OR any change is suggested.

Can she take milk products ie., milk in coffee and curds as mentioned earlier. Whether she can take cheese and butter with bread.

Advice to Physiothearpist to do what type of therapy. Is it necessary to use LS belt? (US massage or/and back stretch exercises etc. This is query is based on my personal experience when I had a level 1 compression L2-L4 or so when Orthopedic specialist prescribed physiotherapy for me)

After how many days, the test for Serum IgA to be done again.

After hearing from you, can I close this discussion and wait for the outcome of taking Pregabalin.

Best Regards,

XXXXX
doctor
Answered by Dr. Divakara 15 hours later
Brief Answer:
Repeat IgA after 6 weeks .

Detailed Answer:
HI

Well I am not supposed to give a full prescription as it is against the rules of the site . So I advise you to get a valid prescription from a doctor.

Usually I advise my patients to start with 75mg capsule every night after food . One thing I want to mention here that in the initial few days she may have giddiness. But nothing to worry . But if in case the giddiness is very severe then stop the drug and revert back ( Unlikely to happen )

Her food timing and order is fine .

I would recommend she reduces further intake of milk, curds and avoid cheese and butter.

As of physiotherapy I recommend both US massage for 2-3 sessions and back stretch exercise to be done daily . ( No need of physiotherpist for that , just learn how to do the exercise )

IgA testing , we shall repeat it after 6 weeks only if her condition is not showing any significant improvement .

If there is no further queries you can close the discussion. Kindly provide your feedback while closing the discussion .

Wish your wife a good health and speedy recovery.

Regards.,



















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

Internal Medicine Specialist

Practicing since :2006

Answered : 2358 Questions

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