Medical Mondays 2Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our archives  for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This week, she reaches out to Dr. Brian R. Landzberg, Clinical Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the Weill Medical College of Cornell University—a gastroenterologist in private practice in New York City and a member of our Medical Advisory Board—for answers to questions from a woman who has “constant discomfort in the area of my lower esophagus and stomach.”



Dear Dr. Pat:

I am 48 and have long suffered from heartburn, indigestion, reflux—all the names apply to the constant discomfort I have in the area of my lower esophagus and stomach. I experience burning pain when I wake up, which is alleviated with OTC Nexium taken every morning and then Tagamet taken at night before bed.  Otherwise I have burning during the night. I gave up chocolate and wine and all alcohol, but cannot give up my morning coffee. I am otherwise healthy.

I really had to push to get my insurance company to cover a visit to a gastroenterologist, who strongly recommended an endoscopy.  The insurance refused to pay, but I knew I needed this, so I paid for it myself.  The results showed some inflammation at the end of the esophagus where it goes into the stomach, and some inflammation in the lining of the stomach, but no ulcers.  However, the test for H. pylori was positive.  I now have to take lots of drugs for two weeks.  What is H. pylori?  How did I get it?  What would have happened if it had not been diagnosed?  Is the two weeks of medication likely to get rid of the infection?  Am I likely to feel better after?  I really enjoy reading your medical articles; I hope that you can answer my questions. 



Dr. Landzberg Responds:

Dear Connie:

Thank you for your astute questions, which boil down to the controversial issue of whether the treatment of H. pylori infection helps patients with non-ulcer dyspepsia. Let’s define some terms.

Non-ulcer dyspepsia refers to upper abdominal discomfort lasting more than a month in a patient in whom endoscopy has found no ulcer disease.

H. pylori is a chronic bacterial infection of the stomach, usually acquired in adolescence. It may cause no symptoms, but is clearly associated with peptic ulcer disease, gastric carcinoma, and gastric MALT lymphoma. Whether treatment of H pylori will improve upper abdominal complaints in patients without peptic ulcer disease has been the subject of several studies, many of which were well done but unfortunately yielded conflicting results. Because of its association with peptic ulcer disease and gastric cancer, most gastroenterologists will treat H. pylori when found, even if it will not improve symptoms. There is a small group of experts in the area, however, who feel that treatment of H. pylori without a strong indication is inadvisable, as it may increase risk for reflux and cancers of the esophagus as well as cause other antibiotic complications   This is a minority viewpoint, however.

My practice generally is to treat H. pylori when found in a dyspeptic patient. Many of these patients do get better and will have a decreased risk of ulcers and probably cancer. Many of my patients stay the same, but very few are ultimately worse off from the treatment. The therapy, which usually consists of two antibiotics and an acid suppressant, can be somewhat challenging to take for the 10 to 14 days, but has a very high success rate (in the 90s percent) for permanent cure. After therapy, proof of eradication may be obtained using a urease breath test, stool antigen test, or a repeat upper endoscopy.  Blood antibodies should not be used as a test to document eradication, because they will often stay positive even though the infection has been cured.

Hope that helps!

Brian R Landzberg, M.D.

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