GERD gastric reflux and stomach pain since a year, maybe ulcer, where can a Thai go for good care ?

[gamesgplayemail]

Hello,

 

Knowing a Thai who has stomach main and reflux since a year or more, do you know if any public hospital will do a gastroscopy easily, or if only private hospitals do it for high cost ? If no choice I will pay a private hospital for this person but if you think that a public hospital around Pattaya can help, please tell me.

 

If the process is too slow at public hospitals, I know that he will give up. He already tried to take antibiotics for Pylori bacteria, but it seems that it didn't work, so maybe this is not the problem ? Reflux medicine also does nothing (just reduce the reflux).

Could it be an ulcer ? Only a gastroscopy can tell the truth ? But my experience is that public hospitals just give more antibiotics and won't do deep check easily ? Or is there a public hospital where we can pay more (but less than private) to have the things done ? Or people at public hospitals can only be victims ? :-)

 

Also, what can happen if this problem is no treated ? Can it be dangerous ?

 

If you do not have all the replies but know a doctor (private or public) who helped you around Pattaya, please tell me. And please also tell me if it's in Bangkok.

My plan is to bring this family member and try to get this checked even if it takes 1 full day, but it should be done after one day because it will be difficult to bring him another time.

 

Thank you for your help.

 

[Rally123]

12 hours ago, gamesgplayemail said:

Could it be an ulcer

Stomach ulcers are caused by the 'H Pylori' bacteria. A simple way to check if you have this bacteria in your gut is to have a stool test done. If positive then you need to undergo a 2 week course of special antibiotics to kill it. Side effects of the antibiotics are enough to make you feel ill but stick with it. Google is yer friend. Good luck

 

Quote

H. pylori is a common type of bacteria that grows in the digestive tract and has a tendency to attack the stomach lining. It infects the stomachs of roughly 60 percent of the world’s adult population. H. pylori infections are usually harmless, but they’re responsible for the majority of ulcers in the stomach and small intestine.

 

Edited March 11, 2018 by Rally123

[Sheryl]

Public hospitals will do a gastroscopy if medically indicated.  That would mainly be to rule out gastric cancer. Before coming to that point they would first empirically treat for gastric ulcer disease, which means h. pylori treatment and PPIs. Treatment is the same regradless of whether there is an actual ulcer or only gastritis so determining whether or not an ulcer is present is not really important. the main issue with something like this is to exclude gastric cancer. Since that requires expensive tests and the vast majority of people with these symptoms do nto have cancer, it is reasonable to first treat for gastritis and GERD and reserve further investigations for those who do nto respond.

 

As it sounds like this has already been tried (assuming he fully complied with what will have been a long course of treatment, and did not simply stop after a few days because he didn't feel better yet) , he should go back to the government hospital which has been treating him and tell them so. Some persistance is indeed necessary, the wheels turn slowly but they do turn. This is not all that different from care under a national health system in western countries.

 

He is eligible for free treatment only in the hospital where he lives and any other that they refer him to, If he comes to Pattaya for treatment, he will have to pay full fee. In addition, he would effectively have to start the process all over at a government hospital, he cannot go directly to a specialist nor demand an endoscopy.  This can be done at a private hospital, but will be very costly....and it is not yet  clear from the limited information given that it is even necessary.

 

It would help to know:

 

1 - where he lives/what his local hospital is

 

2- how long he actually took the h. pylori medication for, and for how long after that he continues with PPI (probably omeprazole). Usually needs at least 2 months in gastric ulcer disease.  It is not unusual for patients to stop too soon because they think it is not working when they do not feel better quickly.

 

Based on the above I will advise further. The first preference would be to get what he needs from the public health system, and it might be possible for him to get a letter of referral from his local hospital to either the cancer hospital in Bangkok or a regional-level hospital.

 

 

 

 

[xylophone]

13 hours ago, gamesgplayemail said:

He already tried to take antibiotics for Pylori bacteria, but it seems that it didn't work,

There are several regimens of antibiotics to take to treat H. pylori (along with a PPI) this especially if the bacteria is resistant to one of the antibiotics in the dual antibiotic therapy, because the standard amoxicillin/clarithromycin/PPI can have a cure rate as low as 60%! 

 

And as Rally123 has said, the clarithromycin can be a little hard on the body, so some folks don't stick closely to the regimen.

 

Having said all of that there are a couple of other antibiotic and PPI combinations which can be tried if the first did not work.

 

A test will confirm whether the H. pylori is still there, and if it is then the second level of treatment should be tried.

 

However a gastroscopy is a great way to see exactly what's going on and to check for cancer and ulcers. This would be my first step.

[Rally123]

5 hours ago, xylophone said:

However a gastroscopy is a great way to see exactly what's going on and to check for cancer and ulcers. This would be my first step.

Each to their own but I had the gastroscopy done first and a sample of my gut taken. I was high H Pylori and went on the triple course of antibiotics. The gastroscopy was really a waste of time and money and a simple 500 Baht stool test would have shown why I was having my problems. 

[xylophone]

55 minutes ago, Rally123 said:

Each to their own but I had the gastroscopy done first and a sample of my gut taken. I was high H Pylori and went on the triple course of antibiotics. The gastroscopy was really a waste of time and money and a simple 500 Baht stool test would have shown why I was having my problems. 

Sure, but you wouldn't have known whether the bacteria had cause gastritis, early signs of ulcers or indeed cancer!  

[Sheryl]

Indeed ruling out gastric cancer - which has a higher incidence in Asia  than in the  west - is a prime reason for doing an endoscopy. But it is not unreasonable to first treat for gastric ulcer disease, as a means of weeding otu which patients really require endoscopy and controlling costs.

[gamesgplayemail]

Thank you for the replies.

 

Can you confirm this:

1- someone with long time stomach pain and GERD always has the Pylori bacteria ? (but what if he has pain and the Pylori is not found, it can be only cancer?)

2- GERD reflux is not related to the Pylori ?

3- so what can we think when someone has both stomach pain and reflux ?

4- endoscopy is maybe not needed but if someone is ready to pay, it can be a way to save some time and know quickly if there is a cancer around ? and doctor will also find with endoscopy if the problem is the Pylori ? (do you know what endoscopy shows when it's Pylori and when it's cancer ? we can be 100% sure about the result ?)

 

Thank you again to all.

 

 

 

 

Edited March 11, 2018 by gamesgplayemail

[xylophone]

9 hours ago, gamesgplayemail said:

1- someone with long time stomach pain and GERD always has the Pylori bacteria ? (but what if he has pain and the Pylori is not found, it can be only cancer?)

2- GERD reflux is not related to the Pylori ?

3- so what can we think when someone has both stomach pain and reflux ?

4- endoscopy is maybe not needed but if someone is ready to pay, it can be a way to save some time and know quickly if there is a cancer around ? and doctor will also find with endoscopy if the problem is the Pylori ? (do you know what endoscopy shows when it's Pylori and when it's cancer ? we can be 100% sure about the result ?)

I'll have a crack at this but Sheryl, who has more knowledge, will be along soon to help......

 

1- someone with long time stomach pain and GERD always has the Pylori bacteria ? (but what if he has pain and the Pylori is not found, it can be only cancer?) Not necessarily........GERD is mainly as a result of a weakened esophageal sphincter which allows stomach contents and acid to get through it and damage tissue. Long term stomach pain can be caused by other things such as gastritis (not always caused by H pylori) due to excess alcohol or use of painkillers and stress is also a cause. Less common is an auto-immune disease in which the body attacks its own stomach lining. It is also thought that some people do produce more stomach acid than others which can be a problem.

 

2- GERD reflux is not related to the Pylori ? They can exist together, but GERD usually has a different cause.

 

3-- so what can we think when someone has both stomach pain and reflux ? Could be two separate things in play; see above.

 

4- endoscopy is maybe not needed but if someone is ready to pay, it can be a way to save some time and know quickly if there is a cancer around ? and doctor will also find with endoscopy if the problem is the Pylori ? (do you know what endoscopy shows when it's Pylori and when it's cancer ? we can be 100% sure about the result ?) I have had a few endoscopy's due to GERD and just recently had another one which showed my GERD damage had cleared but I had H pylori with mild gastritis!! H pylori can be detected and the surgeon will/may take a very small biopsy of anything suspicious to test for cancer and the results may take a few days to a week.

 

There are other possible causes of stomach pain..........as I said above, and others could be some sort of non cancerous growth causing an obstruction in the intestine, or an obstruction caused by some other malfunction in the intestine (my sister has had two operations because of this) and stress has already been mentioned BUT it can cause stomach muscles to tighten and poss cause pain. A doctor friend once said............remember the old saying  "gut feeling" and "worry guts" and similar, well there's a lot of truth in that.

 

I just did exactly as I described above because of stomach pain and I wanted to see how my GERD was progressing and was very pleased that I did. 

[Sheryl]

11 hours ago, gamesgplayemail said:

Thank you for the replies.

 

Can you confirm this:

1- someone with long time stomach pain and GERD always has the Pylori bacteria ? (but what if he has pain and the Pylori is not found, it can be only cancer?)

2- GERD reflux is not related to the Pylori ?

3- so what can we think when someone has both stomach pain and reflux ?

4- endoscopy is maybe not needed but if someone is ready to pay, it can be a way to save some time and know quickly if there is a cancer around ? and doctor will also find with endoscopy if the problem is the Pylori ? (do you know what endoscopy shows when it's Pylori and when it's cancer ? we can be 100% sure about the result ?)

 

Thank you again to all.

 

1. No. But people with gastritis and ulcer disease - which is a common cause of stomach pain, though certainly not the only one - usually have H. pylori. For that matter, h. pylori is implicated in the development of stomach cancer.

 

2. & 3. They are separate problems, though it is not at all unusual for someone to have both.

 

4. Yes, endoscopy is the quickest way to identify the problem and rule out gastric cancer. Note that it will only rule out gastric cancer..,,when people say they have "stomach pain" often they really mean abdominal pain. (And certainly this is so when translated from Thai). It would help to know exactly where in the abdomen this pain is.  Abdominal pain not in the gastric region can have many causes, including gall bladder disease,  irritable bowel disease, colitis, cancer of the pancreas or colon, etc. However it sounds like the hospital that has been treating him thinks the pain is gastric.

 

And yes, endoscopy can determine in h. pylori is present though there are other less costly ways to do that. They will take a sample and test it for the presence of the bacteria and the report will clearl yindicate positive or negative for h. pylori and if positive, indicate the quantity of bacetria present.

 

Gastroscopy if done competently is quite accurate for ruling out gastric cancer, and also for identifying if gastritis or ulceration is present.  It cannot identify cancer elsewhere in the abdomen. If the gastroscopy found nothing to explain the pain then the next step would likely be ultrasound of the abdomen and possibly CT scan.

 

Gastroscopy will also show if there are esophageal changes due to GERD and whether the GERD is due to a hiatal hernia.

 

I have tried to explain how he can get this done through the public health system. If for whatever reason you prefer to pay for it privately, can certainly do so. I would suggest the government cancer hospital in Bangkok:

 

http://www.chulabhornhospital.com/

 

Cost under 10K. It would be free there if he had a letter of referral from his home hospital. Or, if he lives  far from Bangkok, his local hospital  can refer him to a regional hospital for specialist follow up.

 

The govt cancer hospital will likely need one visit just to make the appointment and then another visit for the test, though you can try having a Thai speaker call. (usually does not work).

 

If you prefer to do this in Pattaya, it will cost many times more (around 30K) at Bangkok Pattaya Hospital, I recommend this doctor there

 

https://www.bangkokpattayahospital.com/en/doctor-profile?v_id=240&depid=11

 

She is only there on Sundays (9 AM - 5 PM) . Get an appointment first thing with having not eaten from midnight the night before and she can probably do the endoscopy on the same visit.