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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13339
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I have been on 40MG Nexium PPI (1 x day) for 3 weeks for suspected

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I have been on 40MG Nexium PPI (1 x day) for 3 weeks for suspected gastritis. Diagnosis was made by GP on symptoms alone. Main symptoms - bloating after meals, feel full after eating little and constant non stop burping. It seems to be a worse even though I am on medication. In the last two weeks, I developed slight prickly type pain in my stomach (upper) but it passes quickly and comes on randomly.

I am better in the mornings when I just eat cereal but lunch usually upsets me and I feel terribly bloated after eating a little. Dinner is generally better too but burping continues.

Blood test results came back ok generally - including celiac and inflammatory markers. breath test for h.pylori negative (but I was already on nexium when this was taken). I have been treated for mild gastritis and bit of reflux (diagnosed via gastroscopy in late 2010) with antibiotics (even though h,pylori negative) and was better with no medication needed for the last two years or so.

I also currently suffer from anxiety and have been very stressed about these symptoms. I am wondering if what I am experiencing is really gastritis again and should I continue my PPIs because they don't really seem to be working and I don't want to take them if I don't have to. Any idea what else it could be and if it is gastritis can it really take this long and how much longer do I have to feel this way?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Was the test for H. pylori performed during this last 3 weeks of symptoms?
Do you smoke? Drink alcohol or caffeinated beverages?

Customer: replied 1 year ago.

Yes, test was performed during last three weeks (when I have already started on nexium).


 


I am not sure if this is relevant but I had my wisdoms out during this time and was put on antibiotics (unasym) which gave me diarrhoea for a few days. I was already having the bloating / burping symptoms when I had my wisdoms out. On day 2 of my antibiotics I was started on nexium after consultation with my GP so I was taking antibiotics AND nexium at the same time for about 3 or 4 days. Since then I have only been taking nexium and probiotics. I am not sure if the antibiotics could have made me worse.

Customer: replied 1 year ago.

I don't drink and hardly smoke, maybe one stick in a couple of weeks. I don't drink caffeine they upset my stomach. But I have been under constant stress and upset for the last year and do love spicy food and now my anxiety has come back.

Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.

There are many issues to consider in this situation.

It is reasonable to make a presumptive diagnosis of gastritis in a person with typical symptoms, as your physician has done, but if the treatment with Nexium does not provide improvement, it would be appropriate to pursue further evaluation to make a definitive diagnosis. The proper diagnosis of gastritis will typically require endoscopy.

It is good that the test for H. pylori was done during this course of illness, as the infection can be acquired at any point in time (like other germs), and this infection is a common reason why Nexium would not work for gastritis. Since there is no germ present, the antibiotics used for the wisdom tooth extraction would typically not provide any benefit.

There are several other conditions that can cause similar symptoms, most often from gallbladder or pancreatic disease. It is also possible to have muscular dysfunction of the gut, and these problems are frequently exacerbated by anxiety.

To address the remaining questions: Since the Nexium is not helping, there is no reason to continue taking the drug while pursuing further evaluation. It is impossible to know how long it will take for you to feel better until the underlying cause of the symptoms is identified.

If you have any further questions, please let me know.

Customer: replied 1 year ago.

My question is that I was told that false negatives is very common if someone undergoes the breath test whilst on nexium so I'm not sure if this is accurate.


 


With gallbladder issues, shouldn't there be other symptoms like pain? Also, what else should I look out for with pancreatic disease? Lipase levels from blood test is fine.


 


Is it possible that all these symptoms is only caused by anxiety?

Expert:  Dr. D. Love replied 1 year ago.
Yes, there can be a false negative test for H. pylori if taking Nexium, but the test to determine whether there is gastritis (endoscopy) will also be able to detect if there is a false negative.

Gallbladder disease may have pain, but it is not universally present.

If the lipase level was normal, then that would exclude pancreatic disease.

Yes, as noted above, anxiety can exacerbate muscular dysfunction of the gut and cause these symptoms. However, there is no direct test to confirm that this is the cause of the problem, so would usually involve excluding other possible causes.

Customer: replied 1 year ago.

Thanks doctor


 


Just some final questions:


 


1) Can I certainly rule out pancreatic issues if lipase levels were normal?


2) If it is indeed gastritis, how long can it last for? I have read that for some people it can last for months and years.


 


 

Expert:  Dr. D. Love replied 1 year ago.
There is no test that is 100%, but a normal lipase is exceedingly sensitive for pancreatic disease, so it would be appropriate to look elsewhere.

Untreated gastritis can last for years and essentially indefinitely, but that is also why we would typically prefer to pursue a definitive diagnosis, so that appropriate treatment can be done.

Customer: replied 1 year ago.

Thanks for your help Doctor.

Expert:  Dr. D. Love replied 1 year ago.
You're welcome.

If I have answered all your questions, please remember to provide a positive rating. Thank you.

Customer: replied 1 year ago.

Hi, sorry but I forgot to ask ... it this likely to be gynaecological?

Expert:  Dr. D. Love replied 1 year ago.
No, this is not a pattern of symptoms typically seen with Gyn problems.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13339
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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