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I Am A 38 Year Old Female. I Have Been

Posted on Tue, 1 Sep 2020

Question: I am a 38 year old female. I have been experiencing upper gastric discomfort for several weeks. Some of my symptoms include bloating, sustained dull and sometimes sticking pain from the upper right and left portion of my abdomen, as well as the middle above my navel. I also have an increase in acid and burning sensation that gets worse at nights.

My first doctor visit requested an ultrasound to test for gallstones. The results indicated that my gallbladder was fine but liver was slightly swollen and fatty. All Blood tests were fine. I received 40mg of Omeprezole. Some symptoms slightly decreased but the pain returned.

I then went to a gastrointerologist who said that all my blood tests are fine and it might be an ulcer or gastritis and I may have to do an endoscopy.

For a second opinion, I went to another doctor to see if H Pylori could be the issue but he ordered an ultra sound instead. Both doctors refuse to do the HP test and I am wondering why they would not want to rule that out first, instead of making me do an invasive and expensive procedure.

I need guidance.

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
antigen test of H. Pylori in stool is best before endoscopy.

Detailed Answer:
Hello and welcome to Ask A Doctor services.
I have read your query and here is my advise.

* As per my clinical experience, symptoms of upper gastric discomfort with
sticking pain may be part of
- H. Pylori infection
- Peptic ulcer
- Motility related issues
- Digestive enzyme disturbances
- Gut flora imbalance
- Others

* There are various ways to diagnose the various possibilities in such cases
which include non invasive as well as invasive procedures.

* The lab data consists of antigen test for H. Pylori in stool or Urea breath
test which detects only H. Pylori infection of stomach or intestine ; and no
other information of structural or anatomical abnormalities obtained.

* The radiology with ultrasound has been carried out and next comes the
invasive one Endoscopy, which is direct visualization of stomach and small
intestine.
There are pros and cons of endoscopy such as

Advantages

- direct evaluation of stomach, small intestine under vision
- stomach, intestine biopsy possible
- OPD based procedure
- can be performed with sedation only
- relatively painless

Disadvantages

- costly
- invasive
- stress provoking in many patients
- some may suffer side effects of sedatives

* So , overall decision making depends upon multiple parameters such as
symptomatic severity, patient and consultant concerns, response to
current therapy, mediclaim status and others which help decide the next
course of action.

* In my opinion, stool HP test is best next step, depending upon its results
further guidelines can be figured out rather than directly approaching for
the upper GI endoscopy.

Wish you best recovery.
Let me know if I can assist you any further.

Take care.
Regards.
Dr Bhagyesh ( MS consultant surgeon )

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (4 hours later)

Thanks for your response. It is very helpful.

Answered by Dr. Bhagyesh V. Patel (4 hours later)

Brief Answer:
follow up.

Detailed Answer:
Thanks for the kind words.

Always welcome.
Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyesh V. Patel (15 hours later)

Hi again Dr. XXXXXXX

I was wondering if an X-Ray or complete abdominal Ultrasound effective in detecting an ulcer or gastritis?

I am back at my doctor right now.

Answered by Dr. Bhagyesh V. Patel (8 minutes later)

Brief Answer:
follow up.

Detailed Answer:
Hi

* Complete ultrasound is depicting only stomach wall thickness, any
obviously gross size tumor, intestine dilation and others but not
characteristic features of ulcer which are usually microscopic findings.

* The x-ray series consisting of barium meal and follow up which shows
linings of stomach, small intestine are nowadays outdated and no one
prefers it over the most convenient and sensitive tests such as endoscopy.
However, that remains the prime concern for underdeveloped countries
with limited financial resources.

Hope this piece of information will help you ahead.
Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (1 hour later)

Thanks. Again, this is very helpful in me making a decision.

Answered by Dr. Bhagyesh V. Patel (7 hours later)

Brief Answer:
follow up.

Detailed Answer:
Again welcome always.
Wish you best recovery and day ahead.

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj