Peptic Ulcer

[brianbrain]

Hi guys,

I've had "stomach" pains for the last couple of weeks. I visited a hospital this week and the doctor disagnosed a suspected peptic ulcer of the stomach / small intestine. I didn't get much info as it was a government hospital and the doctor spoke only a few words of English. I was prescribed some medicines (Hyoscine Butylbromide, Aluminium Hydroxide, and Omeprasole)and told to return again in two weeks if the symptoms do not subside. He mentioned I might need an endoscopy. Unfortunately, since visiting the hospital my discomfort has increased and I feel like I've been jabbed / knifed in the stomach.

Any experience of this or useful suggestions?

[chuchok]

Hi guys,

I've had "stomach" pains for the last couple of weeks. I visited a hospital this week and the doctor disagnosed a suspected peptic ulcer of the stomach / small intestine. I didn't get much info as it was a government hospital and the doctor spoke only a few words of English. I was prescribed some medicines (Hyoscine Butylbromide, Aluminium Hydroxide, and Omeprasole)and told to return again in two weeks if the symptoms do not subside. He mentioned I might need an endoscopy. Unfortunately, since visiting the hospital my discomfort has increased and I feel like I've been jabbed / knifed in the stomach. 

Any experience of this or useful suggestions?

<{POST_SNAPBACK}>

All I can give you is my own experience.

I had the same problem a few years ago, except they gave me a endoscopy to make sure that the diagnosis was correct.

The drug they gave me was Ommeprazole (Losec) 80mg per day for the first week, down to 40mg the next week and I now take 20mg a day.

Suggest that you get to a hospital and have an endoscopy to find out exactlt what it is though.

[taxexile]

if you are diagnosed with a suspected ulcer then you should also get checked for helicobacter , its a simple test for a bacteria that lives in the stomach. it can survive the acidic conditions there and can lead to ulcerative conditions , it thins the mucous layer that protects the stomach wall from attack by stomach acids. without that protection the acids of the digestive juices will irritate and eventually ulcerate the stomach wall.

the test is simple and if the bacteria is found then a course of antibiotics will eradicate it. then a course of medication is necessary to reduce the acidity in the stomach whilst the ulcer heals and possibly longer.

treating the ulcer without checking for helicobacter is incorrect.

you should definately have an endoscopy done.

raise the head of your bed or sleep on more pillows to stop stomach acid/contents flowing back into the oesophagus, this can give rise to a painful irritatation of the lining of the oesophagus.

have an ultrasound check for gall bladder stones as well.

check your symptoms on the internet and go armed with plenty of information when you go to see a thai doctor.

[brianbrain]

Tax and Chu, thanks for your advice.

Do you think the doctor was being cheapskate by prescribing the drugs without performing the endoscopy? I had considered this, but then again I thought maybe he was doing the right thing for what could be a very common complaint. The thing that concerns me now is the discomfort is getting worse. If it's like this on Monday I think I'll have to return before the two weeks are up.

[NarrLing]

My experience with this includes years of taking Zantac (steadily increasing amounts) then onto Losec for a while. Losec helped but didn't totally cure it. I suggested to the Doc he treat me for Helicobacter and that worked.

Another thing to look at is a hiatus(spelling) hernia. The endoscopy will detect that.

I find stress causes heartburn a bit now and anything with loads of preservatives as well. Bread is another thing to reduce.

I do suggest you visit a doctor and be checked. Thai pharmacists are trained in diagnosing a lot of these problems but it sounds like you need a couple of tests to make sure. Better to be safe than sorry.

cheers

NL

[chuchok]

Tax and Chu, thanks for your advice.

Do you think the doctor was being cheapskate by prescribing the drugs without performing the endoscopy? I had considered this, but then again I thought maybe he was doing the right thing for what could be a very common complaint. The thing that concerns me now is the discomfort is getting worse. If it's like this on Monday I think I'll have to return before the two weeks are up. 

<{POST_SNAPBACK}>

Both LOSEC and Zantac inhibit you producing acid. LOSEC is a better drug for most people and is used almost exclusively in Hospitals. If you have a "normal' ulcer, then by reducing the acid, it gives your body a chance to heal.

Beware of copies, as while they do work they are no where as good as the real thing IMO.Copy Losec goes for around THB200. The real thing THB1000 a pak.

I think that the quack probably thought that he has diagnosed you correctly. If it was me, I would pop down to say BNH Hospital in silom for a 2nd opinion.(Or any other good hospital)

Also stay away from spicy foods, complex carbos, fatty food and grog …doesn’t leave much else

chok dee

[taxexile]

Do you think the doctor was being cheapskate by prescribing the drugs without performing the endoscopy? I had considered this, but then again I thought maybe he was doing the right thing for what could be a very common complaint

the gov. hospital you went to may not have the resources to do an endoscopy on every patient who turns up with stomach pain. like you say it is very common.

go back,( or better still go to a reputable private hospital in bangkok) , and ask for an endoscopy. using a doctor that you can converse with in english , or have someone who can translate the technicalities of your condition back and forth.

the exact nature of your symptoms, properly described , will help the doctor immeasurably in coming to a correct diagnosis. e.g. does the pain come on after eating , if so how long after eating , does the pain last a long time or just a few minutes , is the pain always in the same spot, does anything relieve the pain , do you feel bloated , is it worse when lying down, have you been taking a lot of neurofen or aspirin tablets lately.

good translation is essential.

if in doubt get a second opinion , and dont be a cheapskate on health costs !

pay as much as you can afford for the best you can get.

[taxout]

If you had plain heartburn, the Omeprazole would have had a pretty quick effect.

So far as I know, doctors should not diagnose peptic ulcer disease without x-rays or scoping; other things can mimic ulcers and they can't be diagnosed on the basis of reported symptoms alone.

Since your situation is getting worse, delay in seeing another doctor seems foolish.

I'd also strongly suggest one of the large private hospitals.

[NarrLing]

taxout and taxexile's advise is very sound.

Losec (Omeprazole) quickly reduced my symptoms (within a day) but doesn't seem to have done so in your case.

A visit to a good hospital is definately worth the money. It may cost a bit for the visit and tests, but will save you a fortune in medications in the long run, and possibly your life.

Ulcers and for that matter heartburn can cause very serious complications if left untreated. Apart from the obvious, the discomfort has a knock on effect on your heart and other organs.

I have a qualified pharmacist advising me as I type this to you.

They suggest you visit a doctor now.

NL

[brianbrain]

taxout and taxexile's advise is very sound.

Losec (Omeprazole) quickly reduced my symptoms (within a day) but doesn't seem to have done so in your case.

A visit to a good hospital is definately worth the money. It may cost a bit for the visit and tests, but will save you a fortune in medications in the long run, and possibly your life.

Ulcers and for that matter heartburn can cause very serious complications if left untreated. Apart from the obvious, the discomfort has a knock on effect on your heart and other organs.

I have a qualified pharmacist advising me as I type this to you.

They suggest you visit a doctor now.

NL

<{POST_SNAPBACK}>

I'm off to the hospital now.............

[Sheryl]

Tax and Chu, thanks for your advice.

Do you think the doctor was being cheapskate by prescribing the drugs without performing the endoscopy? I had considered this, but then again I thought maybe he was doing the right thing for what could be a very common complaint. The thing that concerns me now is the discomfort is getting worse. If it's like this on Monday I think I'll have to return before the two weeks are up. 

I'm a registered nurse. The drugs you were given should have provided at least some degree of relief if the pain was due to either ulcer or gastritis. The fact that it hasn't makes it unlikely that either of these are the cause. There are a number of other things which can cause abdominal pain. The doctor probably just treated you first for the most common one. It is common in Thailand -- especially in government hospitals which are under-funded -- to use a trial treatment to make or exclude a diagnosis in place of conducting diagnostic measures first.

You should return to the doctor immediately if the pain had not improved; don't wait for the appointment. And if you have any doubts about the thoroughness of the treatment you get when you return to him, go to a private hospital. If you tell me what province you're in, I can suggest one. Good luck.

[chuchok]

Tax and Chu, thanks for your advice.

Do you think the doctor was being cheapskate by prescribing the drugs without performing the endoscopy? I had considered this, but then again I thought maybe he was doing the right thing for what could be a very common complaint. The thing that concerns me now is the discomfort is getting worse. If it's like this on Monday I think I'll have to return before the two weeks are up. 

<{POST_SNAPBACK}>

I'm a registered nurse. The drugs you were given should have provided at least some degree of relief if the pain was due to either ulcer or gastritis. The fact that it hasn't makes it unlikely that either of these are the cause. There are a number of other things which can cause abdominal pain. The doctor probably just treated you first for the most common one. It is common in Thailand -- especially in government hospitals which are under-funded -- to use a trial treatment to make or exclude a diagnosis in place of conducting diagnostic measures first.

You should return to the doctor immediately if the pain had not improved; don't wait for the appointment. And if you have any doubts about the thoroughness of the treatment you get when you return to him, go to a private hospital. If you tell me what province you're in, I can suggest one. Good luck.

<{POST_SNAPBACK}>

He's in BKK and I think he popped off to the Doc at about 4.30Pm today.

[brianbrain]

Okay, I'm back from the hospital (well two actually) and so here's the update.

Following on from your good advice and my general concerns about how the condition was worsening, I returned to the original hospital for another consultation. You may wonder why I returned there, but it's the nominated hospital for my Thai social-security medical insurance. The out-patients department was closed (5:00pm) and so I headed to the emergency room instead.

After entertaining the receptionist with my Thai for a few minutes - seemed like she didn't want me to visit the doctor at all - I managed to see a doctor. His English was "okay" but not fluent enough to converse about types of pain etc. At one point he suggested my condition might be nothing other than a pulled muscle. He went on to say that if I had a peptic ulcer I could not expect improvement until at least several days of treatment - basically I should just wait and see what happens. I asked about other treatments and whether cost was the issue, and he said no. I then returned home, wondering if I was getting bothered for no good reason.

Just a while ago I decided that I still wasn't satisfied and so I took a trip to Bumrungrad. There I registered as a new patient and got to see a doctor in less than 30 minutes from arrival. All the paperwork and conversations were in English. The doctor herself spoke good English and seemed to understand everything that I said. She didn't rule out a peptic ulcer but thought that it could be something else - she mentioned several things that it could be. I've an appointment to go back tomorrow morning for an ultrasound scan. Incidentally, my appointment to see the doctor today cost just 280 baht.

Thanks everyone.

Edited December 17, 2004 by brianbrain

[chuchok]

I hope all goes well for you.

good luck

[brianbrain]

I'm back from my second visit to Bumrungrad Hospital. They did an ultrasound scan of my abdomen and everything appeared okay. The doctor was inclined to rule out the possibility of a peptic ulcer. He thought it much more likely I have a bacterial infection of the gut (E. Coli or salmonella, I think he said) or perhaps Giardia. This would link with a recent bout of diarrhoea I had.

They took a stool sample and I was given two new medicines to replace those issued by the other hospital. The new medicines are Ciprobay 500mg, one tablet twice daily, and Flagyl 400mg, one tablet three times a day. I've another appointment later this week to review my progress and check the lab results. He advised taking the medicines before getting the results back, as he reckons the results don't always show up the infection.

Today's charges were as follows:

Facility 80

Doctor's fee 500

Ultrasound 1030

Radiologist's fee 650

Medicine 1060

I'd guess I could have bought the medicine much cheaper myself, but otherwise the fees seem okay. And at least I know they are not fake medicines.

Edited December 18, 2004 by brianbrain

[waldwolf]

As others have mentioned, would strongly recommend you also be checked for H. pylori (Helicobacter pylori), as up to 95% of people having gastric or duodenal ulcers symptons were found to be infected with the H.pylori bacteria.

A simple, inexpensive blood test or breath test should provide ample evidence, one way or the other. If an endoscopy is performed, a small samples of the stomach lining can be obtained and tested for H. pylori.

Failure to rule out H. pylori is a high-risk decision, as people with this bacterial infection have up to 6 times greater chances of developing gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphoma.

Health is not something to do "on-the-cheap".

Good luck and keep us posted on your progress.

cheers

[brianbrain]

Hi Guys,

This should be my last post on this matter.

Anyone who has read my previous posts will know the government hospital diagnosed (suspected?) a peptic ulcer whereas the doctors at Bumrungrad thought this unlikely, giving much more credence to some bacterial or other infection.

After three days of taking the new medicine I started to feel much better, though not 100%. I guess this could have been the results of the first medicines which I had stopped taking or the speedy results of the next medicines, the problem is I will never know.

On Thursday last week I returned to the hospital to check the lab results but the tests were all clear. I had been forewarned this could happen even in the case of an infection. Still feeling a bit unsure about the differing diagnoses I then restarted the medication for the peptic ulcer; Bumrungrad never said I had to stop that treatment, just that I could do so if I wished.

I've still got just a few more days to go with the peptic ulcer medicine, and pleased to say that for whatever the reason I am feeling very nearly my former self. My guess... well I really don't know what I had. The symptoms were how I would imagine an ulcer to feel, but the other treatment seemed to result in an improvement.

[astral]

Unfortunately you are experiencing the lack of good diagnostic skill in the Thai medical profession.

Government hospitals can be downright dangerous.

Read this related item.

Even in the private hospitals the skills are not as high as we would probably expect in our own countries.

I hope you will be feeling better soon.

[wilson steer]

I had acid stomach and stomach ulcers for years. I was on omeprazole for years and years, tagamet, everything.

Then I met a herbal doctor who made a suggestion; begin eating 2 Raw onions a day, lots of scallion (spring onion) and garlic. I stopped the omeprazol a week later and that was two years ago.

I have had no problems with acid, ulcers or heartburn since, and I still eat onions with every meal. Luckily I love them.

I can eat what I want, drink beer and even eat hot thai food, no acid problems.

Surely it's worth a try? What do you think?

Wilson Steer.

[brianbrain]

I had acid stomach and stomach ulcers for years. I was on omeprazole for years and years, tagamet, everything.

Then I met a herbal doctor who made a suggestion; begin eating 2 Raw onions a day, lots of scallion (spring onion) and garlic. I stopped the omeprazol a week later and that was two years ago.

I have had no problems with acid, ulcers or heartburn since, and I still eat onions with every meal. Luckily I love them.

I can eat what I want, drink beer and even eat hot thai food, no acid problems.

Surely it's worth a try? What do you think?

Wilson Steer.

<{POST_SNAPBACK}>

Wilson,

I frequently eat spring onions and garlic though I'm not sure I could stomach two whole raw onions a day. Do you mix them in with something? If I ate that much I think even the soi dogs would stay clear of me. Actually, I'm still uncertain whether I had / have a peptic ulcer as the doctors gave different diagnoses. Right now I feel okay though I get a bit of discomfort if a meal is delayed or skipped altogether. Does that symptom sound familar?

Thanks for your advice.

[Team Bukowski]

brian I've been suffering similar symptoms, with my stomach constantly gurgling and feeling very bloated...I think I better get to a doc.

[NedKelly]

Waldwolf is right.....the blood test for heliobacter is important. I had it at BNH Hospital.......they gave me the all clear for that but still gave me anti-biotics for about two weeks.......as well as an oversupply of other drugs to treat symptoms......eg bloating, pain etc.......I took the anit-biotics and some of the bloating meds. but left the rest.

Mysymptoms went away however I have had themback but much less severely and not very often......... I also monitored my diet.......everytime I got the symptoms I werotye down what I had eaten that day.........I really was not very succesful in my scientific research but there are a couple of suspicious things I try to avoid now.....one is msg.....the other is Thai dishes that use coconut milk and chilli together sucvh as Tom Yum soup........i have it without coconut milk and have no problems.

Stress is a real cause.......get some excercise..........also, think about fibre in your diet......if your ssytem is not working efficiently maybe you are clogged up !! Spare the thought.

[advice]

Could someone translate peptic ulcer in Thai please? and if you could me point in the direction of a website with peptic ulcer info in Thai. = HUGE THANKS!

BTW> I just realized the thread is 3 years old... Most of the people are still around by the looks of it.

Edited February 11, 2008 by advice

[taxexile]

rok yeua bu pew korng grapoh ahaarn , literally "disease tissue film lining surface of stomach"

โรคเยื่อบุผิวของกระเพาะอาหาร

[advice]

rok yeua bu pew korng grapoh ahaarn , literally "disease tissue film lining surface of stomach"

โรคเยื่อบุผิวของกระเพาะอาหาร

Many many thanks taxexile!