Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|edgor - Tue Nov 24, 2009 4:03 pm||
I have had chronic stomach pain for around 5 months (minus a one month period where things felt ok). About 2wks ago it erupted into stronger pain during the day an hour after eating, and then last week it started really hurting overnight. One week ago, the doctor diagnosed an ulcer and initially prescribed 20mg/prilosec a day (taken in morning), but then 3d later I was feeling horrible overnight, so he upped it to 40mg/day (20mg twice daily). So I'm on my third day of being on 40mg/day. I had an h.pylori blood sample taken yesterday.
Question: After someone starts on a PPI like prilosec, how long have you found it generally takes before the patient notices a significant lessening of symptoms? It seems like the lows during the day aren't quite as bad already, but the overnight pain still makes it hard to sleep.
One other question: This whole disturbance caused some reflux which has caused irritation in my chest so that when I eat, it sometimes causes me to cough at the end of a breath. A pharmacist told me that now that I'm eliminating the cause of the irritation by being on Prilosec, you have to wait out the healing of your chest area... and that it may take up to 3mos to heal. Is that timeframe right, or what have you found it generally takes?
|Dr.M.Aroon kamath - Thu Dec 31, 2009 6:13 am||
Peptic ulcer healing rates vary from patient to patient depending on many factors.Some of which are...
- site(duodenal vs gastric),
- size (giant ulcers require longer healing times),
- cause (H.pylori/NSAID/Zollinger-Ellison syndrome),
- concurrent medications (ex; continued NSAID use),
- tolerance of or resistance to medications,
- smoking/alcohol/emotional stress, etc.
- Genetics: certain individuals carry a gene that regulates an enzyme called CYP2C19 that reduces the effectiveness of proton-pump inhibitors (PPIs). Approximately 20% of Asians, who may not respond well to the PPIs may be carrying this gene.
On an average, in the best of circumstances, proton pump inhibitors are expected to heal duodenal ulcers in more than 95 percent of patients at four weeks and gastric ulcers in 80 to 90 percent of patients at eight weeks.
Refractory peptic ulcers (i.e., ulcers that fail to heal after eight to 12 weeks of PPI therapy) may be caused by the factors which i have already alluded to.One other factor for non-healing is an malignant ulcer.
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