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Forum Name: Gastroenterology Topics

Question: Ulcer & Treatment Protocol


 wizbanger - Mon Oct 20, 2003 8:32 am

My wife had classic symptons of an ulcer, belching, distress etc. When she went to the Doctor he scoped her and said yes she has an ulcer. However his treatment regiment was to place her only on a Proton Pump Inhibitor(PROTONIX). I have called and left many messages with no reply as to if they found helicobacter P. My understanding is that most ulcer are the result of an infection agent mostly but not limited to helicobacter. If this is so I am worried that she is not getting the proper treatment regiment of a proton pump inhibitor and two antibiotics. She ran out of the Protonix med, the symptons returned and the Doctor prescibed Protonix again and wants to scope her again in a few weeks.

I feel once scoped and only an ulcer found, that either the blood test, or possible C13/C14 or the new stool test could be used to test for active Helicobacter and take the cost and small risk factor out of being scoped yet again ($$$$). Additionally, when I asked the Doctor about the missing antibiotics he said "I don't care what the literatures has to say".
The literature I had in mind was Journals of Internal Medicine July 1998 were it indicates that 2% are cured of ulcers with a Proton Pump Inhibitor alone.

Am I off base - I am currently looking for an Infection Disease Specialist in our area whom might agree with what I feel is the right treatment regiment.

Thanks.
Seeking Good Medicine :?
 Dr. Tamer Fouad - Mon Oct 20, 2003 12:27 pm

User avatar Wizbanger,

First, I would like to refer you to this page that discusses peptic ulcer disease.

Peptic Ulcer

As you can see from this page, Helicobacter pylori is present in most but not all. Sometimes its only a co-existing factor. The guidelines do require that you verify the existence of H.pylori infection and then treat accordingly. What your doctor seems to have done is he has initiated anti-helicobacter therapy emperically (the antibiotics). There are many antibiotic regimens for irradication of H.pylori and no one regimen is known to be superior to the other. So it's not like your doctor is treating her with proton-pump inhibitors alone he has infact given the combined therapy (or so it seems). Again as you will see from the page i have referred you to, his decision to scope her again is warranted.

Best wishes.
 wizbanger - Tue Oct 21, 2003 12:25 pm

In Re: to My Wife's diagnosed Ulcer my point was that I cannot get the results of the biopsy (if one was taken) and the Doctor has only prescribed a proton pump inhibitor in her case .

I agree with the Website you provided (excellent data) but would add that it is my understanding that this family of microplasam agents had other such in this same class that aren't available to test for less one has a PRC lab handy and are also indicated in ulcers, but the treatment is never-the-less the same (the triple regiment). Hence, with Helicobacter being almost always present and the leading cause as I understand - the cure rate is extremely poor it seems without the triple regiment being used. Remember she is only on a proton pump inhibitor.

I am not surprised as soon as my wife stopped taking the proton pump inhibitor alone for about 4 weeks her symptons returned. I feel that re-scoping at this point is expensive and to what end? Could not the breath test (c13/c14) or the stool test now be used (cheaper and less invasive)? Would not it be better as you say to treat emperically with the triple regiment (and I understand this comes in several flavors). Then if unresponsive perhaps re-order the scope.

When my wife is on the proton pump it seem as though it takes away the discomfort, when she stop the symptons return. Doesn't this indicate that all one has done is knock down the Helicobacter P which is found in most all ulcers but it returns because the triple regiment was not employeed. Further, what I haven't mentioned in my first email is now I am beginning to show signs of an ulcer further making me believe that helicobacter is involved and being passed.

I appreciate very much your input and if you chose to respond - I promise I won't have another go of it - I just felt (see below) you missed reading my earlier comments when you said he is treating her with the triple regiment - he is not (which in my way of thinking would be the first line of treatment) with or without the biopsy (again others in this class of microplasam infections I believe can be the cause). Thank you very much - I appreciate and am honored that you have taken the time that you already have.

Sincerely Bob Tiger #
Below your earlier reply
What your doctor seems to have done is he has initiated anti-helicobacter therapy emperically (the antibiotics). There are many antibiotic regimens for irradication of H.pylori and no one regimen is known to be superior to the other. So it's not like your doctor is treating her with proton-pump inhibitors alone he has infact given the combined therapy (or so it seems).

_________________
1). Doctors treat and God Heals
2). Work hard Play Hard
3). Stay Healthy and Blessed
 Dr. Tamer Fouad - Tue Oct 21, 2003 2:03 pm

User avatar Yes you are right i missed your point. I thought that she was already on the triple regimen. I agree with you completely, she should receive the antibiotics after testing for helicobacter. A breath test is usually sufficient. Do not worry about catching peptic ulcer off her its not a contagious disease as you well know. Helicobacter is just one factor in many that lead to the development of PUD. There is only one way to diagnose it and thats through a scope or a barium series (rarely used).

Best of luck and you can have as many goes at this as you like!

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