The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.
This is Dr. D.J., experienced Internal Medicine Specialist.
I am here to address your concerns and provide great service.
I am sorry to hear about the sufferings your husband has been going through.
Although Ct scan is normal, this does not rule out ulcer disease completely.
Duodenal ulcer is still a possibility.
He is not responding to dexilant.
Sometimes increased doses of PPi is necessary for ulcer treatment.
Also H pylori bacterial infection can be coexistent in the ulcer.
So, that also needs to be checked.
He will need upper GI endoscopy definitely along with H pylori testing.
There can be other possibilities as well:
1. Non functioning gallbladder--if the gallbladder is not functioning well, that can cause pain--usually associated with meals though.
A HIDA scan ( nuclear medicine scan) is better to assess gallbladder function.
2.Chronic mesenteric ischemia--this is due to the reduced blood circulation in the intestines causing intestinal angina.
The pain is apparent within an hour of eating food but subsides after 2-3 hours.
The diagnosis is made by the doppler ultrasound to detect the narrowing or blockage of the blood vessels.
3. Infiltrative granulomatous diseases--Sarcoidosis
and Crohn's disease can sometimes affect the duodenum
This can be diagnosed by the upper GI endoscopy.
Your husband should avoid any NSAIDs like advil, aleve for now.