Endoscopy likely to affect treatment?

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I have a suspected peptic ulcer and I'm booked in for upper GI endoscopy in 10 days time.

My problem is a knee injury which requires minimising activity until the flare-up settles, and I need to decide whether to postpone the endoscopy (for the second time, probably for another couple of weeks).

So my question is, what are the chances that the endoscopy would result in a change in treatment and quicker healing? Or is it merely to confirm the diagnosis? I'm currently on 20mg of omeprazole (PPI) twice daily. H. pylori has been ruled out, it seems very likely the cause was long-term use of OTC NSAIDs. Symptoms: initially acid reflux, but since taking the medication just occasional brief sharp pains, that's all.

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  • Posted

    On the face of it, you are receiving the correct treatment for an NSAID induced Peptic Ulcer and so an Endoscopy would not normally change the treatment or make any difference in the speed of healing.

    The problem is that your diagnosis at the moment is based on an assumption.

    Firstly, you say that h.pylori has been ruled out. How ? Presumably you have been given a breath test. Probably the best test of those available but still not 100% accurate.

    Secondly Gastric Ulcers - as distinct from Duodenal Ulcers - can give rise to very serious complications, and in the treatment of which time is of the essence.

    Strangely as an ulcer and knee sufferer, I strongly suggest you put up with the discomfort of the latter and get your Endoscopy results as soon as possible. This will tell you exactly what is happening - confirm your h.pylori situation - and put your mind at rest.

    In any case, if you opt for a local anaesthetic (I didn't and wished I had) you will need someone to take you to and from hospital.

    Best wishes

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    • Posted

      Thanks a lot Derek. I gave blood and stool samples, didn't have a breath test. Really think it was the ibuprofen, I'd stupidly upped the dose beyond recommendations not long before first ulcer symptoms.

      GP thinks it's duodenal because food tends to ease the discomfort.

      Re aneasthetic, I seem to remember reading that I'd not only have to be accompanied for travelling but overnight, not at all convenient having moved here recently and knowing few people. Though of course nobody's going to check...

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    • Posted

      Hi Robin

      Blood tests for h.pylori are useless. You can buy cheap blood tests online but not normally given by GPs the results are so poor. Stool tests are OK but a bit unusual these days when breath tests are cheaper and probably ? give better results.

      Well now you know. Just how damaging NSAIDs can be. I feel guilty to tell you I sometimes take Naproxene - four over two days max - plus Ibuprofen Gel for my knee problem. but I always take it with Cimetidine to reduce the acid contents. I have taken PPIs but very reluctantly. (Not as bad as over use of NSAIDs but still need to be careful about long term use).

      Yup - as an ex Duodenal sufferer - sounds right. Food eases the pain.

      Duodenals usually heal for a time and then break out again. The problem is that continual scarring eventually gives rise to worse and even dangerous issues.

      Re Endoscopy - you don't have to be accompanied if you don't have the anaesthetic - it makes you slightly woosy. (I didn't).

      And I know of scores of people who have had Endoscopies. I have never heard of anyone being kept in overnight.

       

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    • Posted

      Thanks again Derek.

      Do you choose Naproxene over other NSAIDs for GI reasons?

      Didn't know that about duodenals, very good to know if somewhat scary.

      Think I will skip the aneasthetic, though I didn't mean to imply being kept in, just not being alone overnight.

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  • Posted

    Hi Robin

    For me Naproxene is a wonder drug. The speed at which it reduces my knee inflammation is incredible. I am always amazed that four tablets in two days can change me from agony to "what was all the fuss about".

    Quite rightly, I am often warned by a very good GP about taking an NSAID with my history. (She's very good but we often have a laughing argument about Gastric issues. She says whatever she tells me I put forward a contrary argument. But she knows I have had a lifetime's experience studying the subject).

    But I seem to have cracked  any short term damage from the NSAID

    by taking Cimetidine at the same time (I thought you were going to ask me why an H2 Receptor Blocker and not a PPI).

    Yes, an Endoscopy is quite invasive and for various reasons it is a good idea to be with somebody overnight. I am a widower and reluctant to bother the family with my problems, so I didn't.

    Though they got quite angry when I refused their kind offers to take me for the Endoscopy. As I mentioned, I wished that I had taken them up and had had the throat spray. But whatever the discomfort it is hugely worthwhile.

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  • Posted

    PS  Talk of Endoscopy reminds me of a rather interesting incident following my own. An Endoscopy nurse gave me the results and told me that they were sending a note to my GP advising of my treatment. As kindly as I could I told her she had got it all wrong and that there was no way that the treatment she was suggesting was the right course of action.

    She looked surprised and asked me if I wished to discuss it with the Gastro Enterology Consultant. The Consultant came out and chatted about my knowledge - said that the nurse had got it wrong - and offered to give me the whole course of treatment from the hospital rather than from my GP. Which I did. You need to be on your toes don't you.

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  • Posted

    I would be very interested in the findings of your Endoscopy.

    Best of luck

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    • Posted

      Sorry Derek but I'm afraid I went against your advice and postponed it for another two weeks, it's now in mid-October. It's partly down to you though! What you said confirmed the liklihood of it being duodenal as opp. gastric. And the knee is being SUCH a pain just now. sad

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    • Posted

      Ok Robin

      Prepared to take the blame. HaHa !

      Understand that Gastric would require more immediacy than Duodenal.

      But of course we're only guessing.

      Let me know how you go on.

      Hope the knee improves.

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  • Posted

    Got called by clinic staff member and persuaded to return to previous arrangement so it's now this Wednesday. More to do with NHS statistics than my wellbeing I suspect!

    Meanwhile another question has occurred to me. Neither of the doctors I've spoken to have said anything about diet, but despite being on twice daily omeprazole I find I have to be very careful, to minimise discomfort, so no tomatoes, alcohol, tea, coffee or chocolate, or anything very fatty. Is that normal?

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  • Posted

    Well you know what I feel about the need to get on with it - so I won't repeat it.

    No question about it - alcohol worsens inflammation - I do take it that you don't smoke  - an absolute no no ?

    Tomatoes are very acidic.

    Tea, coffee and chocolate I don't think have ever been a problem to me. though Tea is certainly acidic.

    Intolerance of fatty foods sounds more Gall bladder than Gastric issues.

    Incidentally, I have found a daily Probiotic plus Live Yoghurt to be very helpful.

    Not a great issue - but in clinical trials - Lanzoprazole has been found to be more slightly more effective than Omeprazole.

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    • Posted

      Thanks again Derek.

      No I don't smoke! Actually a wee bit of an anti-smoking nazi. With what we all know about it these days how can anybody possibly bring themselves to do it? Sorry, off-topic.

      Even one normal strength beer feels like it goes straight to the ulcer to irritate it.

      Coffee is definitely acidic, just like tea. You're lucky if you get away with it.

      If you google "peptic ulcer diet" you'll find many advise against fatty foods, though I seem to get away with bacon and full fat milk, at least in small amounts. Fat's not acidic but it is relatively indigestible so tends to stimulate acid production. Or that's my understanding. I regularly eat live yogurt too, but small amounts again.

      As you were kind enough to express an interest I'll report here after the endoscopy.

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  • Posted

    Sounds as though you know more about dietary issues than I do.

    Over the years I've never bothered about diet.

    For me it's always been the case of "If it hurts - fill my self full of Calcium Carbonate". But of course these were days long before the coming of H2 Receptor Blockers and PPIs. (Or even when the idea that a bacterium could live in the highly acidic contents of the stomach - was laughable).

    Look forward to the results.

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    • Posted

      Just got home from endoscopy. Quite unpleasant when the gag reflex kicked in a couple of times but endurable. Seems I don't have an ulcer! Just some inflammation. So where I go from here I have no idea, apart from discussing it with the GP, of course. And google!

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