Stomach ulcer

oldandhappy

H.Pylori....back in the 'before' they realised that ulcers can be caused by this infection my Oldest Son has been through hell and back and although still under 40 now he still has to be real careful on what he eats etc. Myself I had also suffered general ill health for many years...weight lost was a battle and much more....Around 2 years ago I had an endoscope because of stomach problems and P.H was found. I had the normal treatment for this infection but found that I still did not feel 100% so having done some research on the internet I decided that Mastika Gum was quite high on the list...I found that taking this in tablet form was a shade uncomfortable for the 1st Day but after that it was uphill all the way and continued to take it for over a year and am now thinking that maybe I should take it again as just a top up remedy having had minor discomfort of late again. I have also read about manuka honey being very effective against stomach problems. Hope this helps. Mrs Happy

ASG_2

When you've finished the antibiotics, take acidophylus to counteract the thrush causing properties of anibiotics.
For stomach ulcer try slippery elm food. (it's like an internal hug)
both available from Holland and Barrett or other health places.

mr_rush

DrFluffy - load of nonsense I'm afraid. Why should a 27 year old be referred to a gastroenterologist?

Following NICE guidelines, the patient should be offered 1 month of PPI. If symptoms persist following the trial of PPI then they should be tested for helicobacter. In the community this is best done with stool antigen test - if positive then Heliclear eradication. However this is not available universally and some areas may still rely on helicobacter antibody testing.

I know you are a medical student but to be honest, no medical student knows that much. You have a small amount of knowledge and very little practical experience - I'm guessing you are 1st year clinical (or possibly final year).

I think the OP should follow his GP's course of treatment which is both clinically good and follows (more or less) NICE guidelines.

PS - this is coming from and SHO post MRCP having worked 6months on a GI firm at a central London teaching hospital.

DrFluffy

Nice guideliens are not necessarily in the best interest of the patient. I guess I've just seen too much bad !!!!!! happening to young people and picked up on endoscopy.

I am clinical, and I did do related stuff before med school...

I think you'll find I made comment on the next testing being specifically for active H.pylori, and the use of stool testing, which incidentally is not available everywhere - certainly isn't at 'my' hospital and we a re a leading GI centre!!! It's CLO (via OGD, which needs to be done by a gastroenterologist) or just shoot in the dark treatment hoping you strike gold...

mr_rush

So are you saying that every 25 year old with dyspeptic symptoms needs referral to a gastroenterologist? If GPs followed your ridiculous advice then GI specialists would be overwhelmed. Also they wouldn't take kindly to a nonsensical referral without proper work-up being done - i.e. trial of PPI and testing for H Pylori.

Any GP would ask about alarm symptoms that actually do warrant a referral. However, these are far less likely in someone who is 27 (you write 'Given your age, I think there may be a few good reasons why you should be referred to gastroenterology... More to exclude other diagnoses').

Most London teaching hospitals are centres for gastroenterology. Just because you are a medical student on a GI firm does not put you in any position to advise regarding referral to a gastroenterologist. As I'm sure you are aware, most referrals from primary care follow protocols - either national or set by the PCT - this case would not fit any referral criteria.

mr_rush

So are you saying that every 25 year old with dyspeptic symptoms needs referral to a gastroenterologist? If GPs followed your ridiculous advice then GI specialists would be overwhelmed. Also they wouldn't take kindly to a nonsensical referral without proper work-up being done - i.e. trial of PPI and testing for H Pylori.

Any GP would ask about alarm symptoms that actually do warrant a referral. However, these are far less likely in someone who is 27 (you write 'Given your age, I think there may be a few good reasons why you should be referred to gastroenterology... More to exclude other diagnoses').

Most London teaching hospitals are centres for gastroenterology. Just because you are a medical student on a GI firm does not put you in any position to advise regarding referral to a gastroenterologist. As I'm sure you are aware, most referrals from primary care follow protocols - either national or set by the PCT - this case would not fit any referral criteria.

DrFluffy

No - as I pointed out I wasn't offereing health advice - it is against the rules of the forum, but as a 27 year old with such symptoms and non-specific tests that revealed nothing specific, then yes, personally I would want to see some one more qualified than my GP - wouldn't you????

Just becasue you did 6 months as a PrHO in GE doesn't put you in any position to advise regarding referral to a gastroenterologist!!!!

mr_rush

So a first year clinical medical student is more qualified to suggest who needs gastro referral then the 2004 NICE guidelines on dyspepsia written in conjunction with the British Society of Gastroenterology. Yep - that makes perfect sense.

And it was my 2nd SHO job in gastro.

Please PM me with what exactly your worries would be for a 27 y o with an initial presentation of dyspepsia.

DrFluffy

I am aware of the NICE guidelines - you just seem to quote their existance without actually asking the OP about warning signs/red flags/alarm symptoms/ etc...

And I note that you sidestep all fo my questions and hide behind a word that many seem to use as a get out of jail free card

So - if you had dyspepsia +/- other sumptoms, not controlled by PPIs are not H.pylori positive, what would you want to do (as a patient?).

I'm guessing NICE guidelines or not, you would be on the phone to your old gastro buddies, bypasing your GP quicker than you could say alginate!

And from what I've seen from the many, many, many clinics I've sat in on as a medical students and in my previous life, a lot of GPs do refer on despite not meeting the NICE guidelines... I've lost count of the number of over 18's I've seen with nothing sinister at all wrong with them... These are GPs, with far more experience than your 3 years post-qualification.

Edit: I was going to PM you, but thought open posting the way to go:

And the one big thing I was thinking about needing to exclude, is Crohn's - right age for first flare, anywhere from mouth to anus = mean anything to you? Rare in the absence of colonic symptoms, but not unheard of, as I found out myself in clinic. SO a GP telling a patient their age means nothing could possibly be wrong is talking nonsense. What they menat to say was 'oh it is not on our flow diagram, which is fine if you are 95% of the population, but if not, do not worry, you can bypass mer and use A&E when you actually bneed treatment urgently".

And also if complications do not occur in the under 55's, what about the 2 patients I've seen as in patients, who were refused asscess to a gastroentereologhist until they started bleeding and came in though A&E. THe youngest was in their earlier 20's.

mr_rush

OK I'll address some of the points you've made.

just becasue you did 6 months as a PrHO in GE doesn't put you in any position to advise regarding referral to a gastroenterologist!!!!
it would put that PRHO in a much better position then you to advise regarding referral. They would have passed their MBBS - you have not. They would have worked with GI patients daily (diagnosis, investigations, management) - you have not.

you just seem to quote their existance without actually asking the OP about warning signs/red flags/alarm symptoms/ etc...
I am not going to start taking a medical history over the internet. We have to assume that the OP's GP did question regarding these and there was nothing alarming in the history.

So - if you had dyspepsia +/- other sumptoms, not controlled by PPIs are not H.pylori positive, what would you want to do (as a patient?).
. THat's not the case here. All we have is a 27 y/o with (we assume) mainly syspeptic symptoms who's been on a PPI for a week. Management should be - trial of PPI, if symptoms persist then Helicobacter testing, if negative and symptoms continue then GI referral.

And the one big thing I was thinking about needing to exclude, is Crohn's...And also if complications do not occur in the under 55's . I'm sure you've heard the phrase 'common things are common' on the wards. While Crohns can present like this, it would be extremely unlikely. It could be Zollinger-Ellison couldn't it - but again very unlikely. Surely the best approach both from a patient point of view (and an economic point of view) is to exclude anything more serious from the history, do the work up for the top 2 or 3 causes of the symptoms. If all this comes back negative then you can start thinking about atypical presentations and rarer diseases.