I get stomach pain if I do not eat for 2 hours. Why?

Hello,

Welcome you to icliniq.com.

I can imagine how upset you have been since the start of your symptoms. I will try to provide you the best options for your treatment. So far I understand that you have H.pylori induced gastritis. You have taken medications for it, but it turns positive every time you have an endoscopy, the last which was 1.5 years back. You tend to have stomach pain which is worse on fasting plus you feel burping and acidic taste in the mouth. Anal itching, and constipation worsen your itching.

So H.pylori infection is common worldwide, with a prevalence of 50% of the world population is infected with this bacteria. H pylori can cause ulcers in stomach and small intestine which is called duodenum. H pylori responds to combination antibiotics for a duration of 10 to 14 days, however, due to excessive use of antibiotics in community, this bug is getting increasingly resistant to these first line antibiotics, hence, use of second line antibiotics are preferred. I will write down the treatment below in a while.

Secondly, due to failure of first line antibiotic therapy, the H pylori will remain in the stomach and can cause ulcers, as well as damage to nerve cells within the wall of the stomach and cause slowing of the movement of the stomach, medically termed as gastroparesis or weakness of stomach in common words.

So your symptoms may be partly defined by resistant H pylori infection causing ulcer formations particularly in duodenum plus the nerve damage within wall of stomach leading to gastroparesis causing bloating, belching, early fullness of stomach and abdominal discomfort and constipation. I want you to tell me whether your last test for H pylori was positive or negative? If positive then I recommend you to take the following therapy for 14 days.

Capsule Pylera (Bismuth Subcit K-Metronidz-Tcn) three capsules daily with a glass of water three hours after meals and at bedtime, capsule Esomeprazole 40 mg once daily half an hour before meals for two weeks, Digestine 40 mg half an hour before meals daily for two weeks. If the test was negative, then I suggest you to test H pylori stool antigen to confirm if the infection is still present. If still negative then do not take capsule Pylera but continue with Esomeprazole (proton pump inhibitor) and Digestine (antacid).

The Digestine tablet will help you to improve your stomach movement. Secondly some precaution for gastroparesis try to avoid large volume meals, instead take small frequent meals. Avoid taking fatty meals such as burger, fried things, and large carbohydrate meals like potato and sweets, and soft drinks, which further slows your stomach. Avoid taking a large volume of water while having meals.

Your stomach pain occurring when you are fasting for two hours is due to ulcers in duodenum, once your treatment with H pylori is completed plus acid suppressant medication such as Esomeprazole would help you to reduce your pain.

I want you to upload your endoscopic reports and ultrasound reports which can help me to assess the extent of damage H pylori has caused to your stomach and duodenum.

I hope this helps.

Hello,

Welcome back to icliniq.com.

Yes, you have to test first. It is stool for H pylori antigen. It should be done before the medications. So you will wait until the time report is dispatched. If positive, take the Pylera capsules as mentioned above. If the test is negative then do not purchase Pylera. This test can be performed by giving a stool sample and can be performed in every nearby labortary with ease. But you have to contact to laboratory the day before you intend to give a sample. As such no precautions are required except that you should not be taking any antibiotics for the past four weeks and any acid suppressant medication such as Omeprazole and Losek Maps for the past two weeks.

Unfortunately, I am unable to provide you prescription. icliniq is a second opinion platform and prescriptions we write are not valid cross countrywise. Pylera with this brand name is available in Canada. But in case your pharmacy find it difficult then you can simply mention them the generic name which is (Bismuth Subcit K-Metronidz-Tcn) containing Bismuth subcitrate 120 mg four times daily, Metronidazole 400 mg thrice daily and Tetracycline 500 mg four times daily all for 14 days.

Pylera is FDA (Food and drug administration) approved for H pylori infection but requires a prescription. It may be possible that you can order it online and some online pharmacies can provide you the medicine with some online formality. But in case if it does not work I suggest you to meet with your local health practitioner and ask for prescription of Pylera in writing mentioning him/her about the consultation we had.

I hope this helps.