Ideal ways to treat stomach infections now 2018
Gastroenterology
How can abdominal pain be treated
Answered by: Dr Anjan DharConsultant Gastroenterologist, Bishop Auckland Hospital, UK
Q. My 24 years old wife is suffering from pain in the abdomen. She underwent an X-ray, ultrasound, endoscopy and CT-scan of her abdomen but all these reports came normal. They are terming it as functional pain. The pain started a month back but it stopped after we stayed in the hospital for two nights. The doctors gave her painkillers and antibiotics. But the pain recurred after 15 days. This time it was more severe and she became unconscious with pain and was again readmitted to the hospital for 5 days. She was fine for another 10-12 days and now the pain has started again four days back, but this time it is bearable. The doctor found some erosion inside her stomach on endoscopy. She was given these medicines – Clonotril - 0.5, Razo 20 and Paracetamol (650 mg). Normally the pain starts in the abdomen then spreads to back as well. She is having her periods regularly but they are usually painful. Four days back, when pain started, her menses had started. But now the bleeding has stopped but not the pain.
A. I would recommend a CT enterography to rule out any small bowel pathology, a Meckel’s scan and a urine porphyria screen in the first place before the pain can be labelled functional. Also, a trial of treatment with Mebeverine 135mg TID for 4 weeks will tell whether the pain is functional or not.
How can supraumbilical and umbilical ventral hernias be treated
Answered by: Prof Suneet SoodConsultant Surgeon, Malaysia
Q. My 35 years old friend underwent a CT scan, which shows that she has supraumbilical and umbilical ventral hernias. How can this be managed? She just had surgery to repair a ventral hernia.
A. The diagnosis of an umbilical hernia, supraumbilical hernia, or of almost any other abdominal wall ventral hernia is "clinical", which means that it does not depend on a CT scan or on any other investigation.
Presuming that ventral hernia, which was just repaired, was infra-umbilical, meaning below the umbilicus: If she had a ventral hernia that needed repair, the doctor would ordinarily have diagnosed this without a CT scan. The doctor would also have picked up any associated umbilical hernia or supraumbilical hernia, and if these were present, the doctor would have repaired them at the same time. I don't know why she has undergone a CT scan now, but if she actually does have an umbilical hernia and/or a supraumbilical hernia, these should have been picked up before her surgery for ventral hernia. You should ask the doctor why he/she did not detect these before surgery.
Presuming that ventral hernia, which was just repaired, was umbilical or supraumbilical: If she now has an umbilical / supraumbilical hernia, she probably has a recurrence after surgery. Recurrence after surgery used to occur in 10-35% of patients in the past. Now, with the use of a mesh, the recurrence rate is less than 5%.
I don't know why a CT scan has been done after surgery for ventral hernia. Did the doctor notice an umbilical bulge and try to confirm the nature of the bulge
Referring to your question, "how can this be managed", the answer is that she needs surgery if she really has umbilical / supraumbilical hernias. The timing of the surgery can be discussed, but there is no other treatment.
I hope this helps. This is an unusual situation, and I may be addressing the wrong angle.
What causes persistent H. pylori infection
Answered by: Dr Venk ManiConsultant Gastro-enterologist Physician, Leigh Infirmary, England
Q. I am a 42 years old male suffering from acidity and related problems for the last four years. Six years back, I was checked for H. pylori and was given triple therapy (Amoxicillin, Clarithromycin and proton pump inhibitor) for 2 weeks and was completely cured. After two years, I was again tested for H. pylori and the blood test was positive and I received a week of the same therapy. Then I underwent endoscopy and biopsy in which the endoscopy was positive but the biopsy was negative. I was again given triple therapy HP kit for 3 weeks. I was feeling better but was continuously on proton pump inhibitor (PPI) for the last four years. Two years back, I underwent another endoscopy with biopsy, which showed antral gastritis but H. pylori negative. The doctor gave me the HP kit for one week. Last week, I got a stool antigen test done for the first time, which came out positive for H. pylori again. I have been prescribed Amoxicillin (1000 mg) twice daily for 10 days, Levoflox (250 mg) twice daily for 10 days and Rebeprazole (20 mg) twice daily for 10 days. Despite taking HP kit 4 times in the past, why is H. pylori positive again? Is it a case of resistance to antibiotics?
A. I note from your letter that you are suffering from symptoms of dyspepsia, proven to be positive for H. pylori infection and that you have had various combination therapies but your stool is still positive for the antigen. The ideal thing to do is to continue receiving different combination of the antibiotics as you are rightly doing in the hope that you will soon be H. pylori negative. I feel one has to keep an open mind and consider other causes of gastritis. It is quite possible that you are getting recurrent re-infection and that your stomach is prone to get recurrent ulceration, though unlikely. You need to get endoscopic biopsies cultured, if not already done, to look for bacterial sensitivity to an appropriate antibiotic. It is also important to get blood test done for a hormone called GASTRIN, produced by endocrine glands, which raises the acid in the stomach to very high levels and cause recurrent ulcerations. The fact that you are receiving frequent therapy, might well have suppressed the formation of a full ulcer and showing only gastritis on endoscopy. If the gastrin levels are high you need to consult a gastroenterologist for further investigations. Next, it is very important to get recurrent biopsies from the gastritis area as there is also a condition called chronic gastritis which is independent of H. pylori induced gastritis and may be considered pre-cancerous. This would mean regular endoscopic assessment and biopsies.
Does my father need prostate surgery
Answered by: Dr Rajesh AhlawatChairman Division of Urology and Renal Transplantation Medanta Kidney and Urology Institute Medanta, the Medicity
Q. My 58 years old father’s prostate weighs 45 gm. He experiences discomfort while passing urine. His water retention is in normal range. Does he need to be operated upon?
A. Neither the age of the patient or the weight of prostate ever indicate the need for surgery. However, the symptoms decide the need for treatment after a physical examination. Treatment can be in form of medical or surgical intervention depending on severity of the symptoms. Ineffective bladder emptying with back pressure changes on the kidneys with deranged kidney functions may form straightforward indications for surgery. Thus, he needs to be evaluated for many other things by a urologist apart from the information provided by you before a decision may be taken
Why do I feel burning sensation and pain in stomach
Answered by: Dr Chandra M GulhatiEditor, MIMS, New Delhi
Q. I am a 45 years old man having pain and burning sensation in my stomach. I am having hyperacidity, gas formation and cannot tolerate spicy food and some items like potato, rice, milk etc. My digestion is very slow too. I am taking Nebicard - 5 and Franxit for the last year for high blood pressure and depression. I have tried homeopathy and ayurvedic medicines but it gave no relief. Please advise.
A. The first step should be to diagnose the cause of hyperacidity whether it is due to reflux oesophagitis or H. pylori infection (often missed) or even a malfunctioning gall bladder. With regard to high blood pressure drugs belonging to the beta-blocker class such as nebivolol (Nebicard) should not be the first option in sexually active males because of their potential adverse effect on sexual function and risk of developing diabetes. The first line therapy in young males should be enalapril (sold as Envas) 5-10 mg 1-2 times daily as required. Franxit contains two drugs: flupenthixol 0.5 mg, melitracen 10 mg and is being promoted for all sorts of depressive ailments. The product was first discovered by a company in Denmark but never allowed to be sold in that country due to problems of efficacy and safety. It has a number of side effects such as nervous system disturbances including extrapyramidal symptoms (uncontrollable involuntary neck stiffness), neuroleptic malignant syndrome (serious disorder), dry mouth, blurred vision, blood dyscrasias, acute dystonias and dyskinesia (involuntary movement of muscles), Parkinsonism, hyperprolactinaemia, ECG abnormality (QT prolongation on ECG), respiratory depression, nasal stuffiness, rash, photosensitivity, diabetes, impaired temperature regulation, convulsions, breathlessness, hyperhidrosis (increased sweating), male sexual dysfunction, gynaecomastia (enlargement of the male breast), muscle pain (myalgia), abnormal liver function tests, fatigue, agranulocytosis (lack of white cells), jaundice, suicidal ideation and attempted suicides. These side effects may be seen in some, not all, patients. Have you tried yoga for depression
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