Brief Answer:
I would greatly appreciate your response sir, thank you

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I need some extra information from you before I can accurately diagnose and suggest a way forward sir. I would greatly appreciate your patience and understanding in the matter, and look forward to your response to my questions.

1. How many of the following symptoms do you have:
-Heart burn
-Chest pain
-Bitter taste in your mouth some times due to acid from stomach coming into your mouth
-Food or liquid from your stomach coming into your mouth
-Cough
-Difficulty or discomfort after eating spicy food, fatty food, oily food, etc
2. If we divide your abdomen into 4 quadrants using a cross (like a plus sign), which quadrant would your pain be from (i.e. upper left, upper right, lower left or lower right)
3. Do you smoke? If yes, how much per day?
4. Do you drink alcohol? If yes, how frequently?
5. What according to you would be your level of stress at work on a scale of 0 to 5, o being absolutely nothing and 5 being extreme
6. How are your eating habits? (e.g. always eat on time, irregular, long gaps between meals, etc.)
7. How much water do you drink per day (in litres)?
8. Do you have a habit of drinking carbonated drinks through the day?

I look forward to hearing from you in order to help you better. :)

Best wishes.

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Brief Answer:
Suspecting Ulcers, sorry for delay in response

Detailed Answer:
Hello once again sir

Thank you so much for your kind response.

Based on the current information provided I am strongly suspecting some underlying gastric condition. A list of possibilities includes:

-Gastritis
-Peptic ulcer disease
-Hyperacidity
and a few others.

One of the most likely causes for the presentation could be the long gaps between your meals. From the response you provided, you mentioned eating once a day. This is extremely harmful and coupled with the high stress levels and smoking a pack of cigarettes a day, the formation of ulcers is very likely and probable.

The pain you could be experiencing could be either 6-8 hours before having a meal or 6-8 hours after having a meal. This would help determine the location of the ulcer, but all the advise you need is the following:

-You will need an upper GI endoscopy to confirm the diagnosis
-Drink plenty of water
-Avoid carbonated drinks
-Avoid spicy, fatty, fried, oily food
-Please try to stop smoking at the earliest
-Aboid alcohol completely
-You will have to eat more often; try to have 5-6 small meals instead of 1-2 large ones
-Try relaxation techniques to avoid stress levels from soaring
-Avoid all pain management tablets as they can cause an aggravation
-Medications you should start:
1. Sucralfate: Is an ulceroprotective syrup that coats the inner lining of the gastric mucosa preventing pain and further progression of the condition
2. Use antacids like omeprazole, pantoprazole which help in reducing acid production. They are available over the counter
3. Use ranitidine (available over the counter) which should help suppress symptoms like abdominal bloating
4. Antibiotics will be required but better to initiate them once the diagnosis is confirmed
5. Drink plenty and plenty of water

I am sorry for the delay in my response, but sir unfortunately you will have to visit a medical center as well. You seem to be neglecting your health and that worries me. Please understand that if this is indeed an ulcer, it is only going to get worse without treatment. So either you go now when it is bare able and get it treated or go when it is really bad and unbearable.

I hope and pray you can make it to a medical centre. Please feel free to write back to me for any further clarification, I am always here to help.

Best wishes.

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Brief Answer:
You could be right or I could be right, we need the tests sir

Detailed Answer:
Hi sir.

I appreciate your response and insight.

You could be right, or I could be right. But our ideas have to be taken with a pinch of salt at this point. Thats because we have no investigations to support either of our diagnoses.

I would recommend an upper GI endoscopy, if at all you can manage to get one done, it would greatly help sir. As for my suspicion of ulcers, ulcers can be in the stomach or even in the upper/smaller intestine sir.

I understand when you say you live hand to mouth, but unfortunately health is much more valuable than wealth, please try to save up a little for the test. I should also add, ulcers are more commonly seen in that part of the population who suffers from financial instability, thats how the text books put it at least.

As you know, I am always here to help sir. But my diagnosis is only a suspicion without the investigations to back them up.

Best wishes.

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