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Old 10-18-2003, 09:00 AM   #1
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Post There's a Hole in My Stomach -- Ulcer -- H. Pylori

After no symptoms, a month ago I had sudden violent abdominal pain, my stomach became hard as a board and I violently threw up a lot of what looked to be coffee grounds -- dried blood. I was checked into a hospital in San Francisco, CPMC, where I was stabilized with IV's and given morphine every two hours for 5 days. Nothing could pass through my stomach -- not air, gas, water, or food. Numerous tests revealed "nothing" to be the cause but the pain and bloating continued. An ulcer was ruled out early because they could see no evidence of one -- the tests given were MRI, CT scan, sonogram, x-ray, blood work and, finally, laparoscopy. (An upper GI tract barium test was given later.) Everything inside looked healthy but, during the laparoscopy, they saw remnants of a ruptured ovarian cyst so, prematurely, that became their diagnosis and I was released from the hospital. Of course that diagnosis was over-turned several days later -- I was still feeling miserable! -- when a lab report determined the necrotic tissue from the cyst was over three months old. The lab also found that stomach fluid was outside my stomach and it was infected. It contained something called eosinophilia. So I was once again a mystery and checked back in to have an endoscopy. That test revealed that I had a diverticulum, a kind of hole -- an inch and a quarter in diameter -- in my stomach. It was something the doctors said they'd never seen before. They also saw evidence that an ulcer had been in that hole and suggested that was the reason the miserable sore didn't show up on any of the other tests -- it was hidden! Their diagnosis is now "Peptic Ulcer Disease". I was also informed that I have "acute inflammation of the stomach lining" and "acute gastritis". Of course, I was found to be positive for the nefarious Helicobacter Pylori bacterium, so I've just embarked on a fourteen day “relationship” with all these poisonous pills. (!) I feel simply awful. But I understand that before I can begin to heal, I need to eradicate these bacteria as this is the first step on the path to eventual healing. I can tolerate eating just about nothing still and am on a special bland/no fiber diet. I'm writing this forum to provide general anecdotal information and also wondering: Has anyone ever heard of a diverticulum in the stomach? Could an ulcer have created the hole? Does the hole need to be fixed surgically? Has anyone else had these problems with no prior symptoms? I must add that I am 51, slim and quite fit. The majority of my diet has always been fresh organic produce, grains and lean meats. My doctors say the photos of my organs look like a teenager’s so my general diet must have been working all these years.


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~Robin
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Old 10-18-2003, 10:12 AM   #2
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Wow, sorry to hear your story. You must have felt miserable and you may be luck to be alive. Diverticulitis is inflammation of an abnormal pouch (diverticulum) in the intestinal wall usually located in the colon. There is also what's called Meckel's diverticulum which is a common congenital formation that consists of a small pouch called a diverticulum, located off the wall of the small bowel. The diverticulum may contain stomach or pancreatic tissue. This may be related to what you have.

An untreated ulcer can perforate through your stomach which is a hole. Usually you will have symptoms of an ulcer (pain) before it reaches this stage but not always. I know someone that one day all of a sudden collapsed and was rushed to the hosiptal. He had an ulcer that had perforated through the stomach causing a lot of internal bleeding. He was given blood and required surgery.

If an ulcer doesn't heal, surgery may be required. I was dx with acute gastritis and duodenitis along with a duodenal ulcer 6 months ago. I had a lot of pain following shortly after meal and I was bloated all the time. I started passing black tarry stools which I knew could be upper gi bleeding so I went to the hospital. My ulcer was caused by NSAIDS and not the bacteria.

Hopefully the anitbiotics will kill the h-pylori bacteria which it usually does in most cases. H. pylori peptic ulcers are treated with drugs that kill the bacteria, reduce stomach acid, and protect the stomach lining. Antibiotics are used to kill the bacteria. Two types of acid-suppressing drugs might be used: H2 blockers and proton pump inhibitors. There are several approaches to killing the bacteria. Some folks require more than one dose of treatment for sucessful results.

Many people unknowingly carry the h-pylori bacteria w/o even knowing it. But there are cases like yours where the bacteria can cause damage. Also, the older you get, the more at risk you become.

Good luck with your treatment and I hope all goes well.


 
Old 10-18-2003, 11:06 PM   #3
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Thanks for your quick reply to my post. I learned about diverticula in colons and other places but never in a stomach and that's why I'm mostly interested in other cases where a hole or diverticulum was found in a stomach. I'm thinking the ulcer was there a long time and was working it's way through the stomach lining? And maybe the ulcer finally perforated the stomach, caused the hole, and that's why the stomach fluid was outside the stomach, in the abdomen. I forgot to mention that a gastric obstruction was created at the same time I was throwing up all the blood -- maybe the old blood was remnants of a ruptured ulcer? I also wonder what would cause an ulcer to rupture? Also, although I've known for a year that something was seriously "wrong" with me, I couldn't put my finger on a salient symptom. I certainly never had the acid reflux symptoms and pain that other folks mention. I must add though, that that same year found me entirely caught up in an enormous blood-sweat-&-tears project that ended, literally, the night before the day I had the "event" that led me to the emergency ward. Maybe my body just said, "enough!"

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Old 10-19-2003, 04:33 PM   #4
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Robin, make sure you eat a lot of yogurt and take a high quality probiotic while you're taking the mega doses of antibiotics for the H Pylori. I finished Prevpac last week and still have a yeast infection and a sore red tongue ( also from yeast). I ate yogurt and took three probiotic capsules a day and it didn't prevent an attack of the "yeasties".

 
Old 10-19-2003, 06:12 PM   #5
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Thanks, Saraly. I have been eating yogurt but I've also been wondering if I shouldn't be waiting until AFTER the PrevPac has done it's work. Maybe the probiotics counter the effects of the antibiotics? I certainly don't want to go through this again! Just wondering..
~Robin

[This message has been edited by robinreese (edited 10-19-2003).]
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Old 10-19-2003, 08:39 PM   #6
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Harry HB UserHarry HB UserHarry HB UserHarry HB UserHarry HB UserHarry HB UserHarry HB UserHarry HB UserHarry HB User
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Robin,
Probiotic supplement will not interfear will the antibiotic treatment.

I read your message -- I have heard of perforated ulcers and also know a person that was treated surgically. I just didn't know they would treat you like they are???. It sure seems like a surgeon should be involved ---How does the hole close without stomach contents getting in your abdomenal cavity. It sure sounds like sloppy procedures!!!

Diverticulars are caused by pressure in the colon and are like pockets or pouches. I had half of my colon removed because of chronic diverticular bleeding. I have never heard of a diverticular in the stomach.

At any rate I wish you well---Harry

 
Old 10-21-2003, 10:37 PM   #7
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Thanks, Harry. I'll post what I find out about surgery to close or reinforce the "hole". I'm definitely getting a second opinion! Best regards,
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Old 10-24-2003, 08:41 AM   #8
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I just finished the PrevPac last night. I'll speak to the doctor today. Can anyone think of other questions I should ask? Here is my list of questions so far:

Is the H. Pylori bacteria completely gone? I'd like at least one test soon to find out.

Are you absolutely positive that my stomach diverticulum is congenital and not caused by something else?

I'm concerned about the already thin skin of a gastric diverticulum being damaged by an ulcer. Would you consider surgery on the diverticulum because the already thin lining was weakened by ulcer? And how about scarring in both the diverticulum and the intestinal opening? Could it have narrowed the canal?

Why was stomach fluid found in abdominal cavity? Where does the eocinophilia, that the lab found, fit in?

How long will it take to heal "acute gastritis" and the "acute inflammation" of the stomach lining? Am I now predisposed to gastric problems?

Would you consider performing another endoscopy to make sure the lining has healed properly. Can you tell how thick or thin the wall of the diverticulum is?

Since I can't take aspirin or advil for pain, will you prescribe painkillers, like Vicodin or Codeine3 that won't bother my stomach -- (Tylenol has absolutely no effect.)

Thank you.

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Old 10-24-2003, 10:00 AM   #9
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Those are really good questions and I would really like to know the answers so keep us posted. I may ask what symptoms, should they occur, warrant another doctor's visit or ER trip. Should all your pain be gone, or are you going to have to learn to live with a certain degree of discomfort, ... Basically what symptoms should alarm me that something isn't right. Something like that.

My gastrits and duodenitis and ulcer was labeled as being caused by NSAIDs. My gi told me to stay away from NSAIDs (ibuprofen, vioxx, ...) but my gp keeps giving me vioxx to take for inflammatioon. I won't take it so I would also like to know what pain killer should I ask for. I have fioricet which I take when really needed and it works ok.

I am also really interested in the answer to:

Can you tell how thick or thin the wall of the diverticulum is?


Good luck and keep us posted.

 
Old 10-24-2003, 10:05 AM   #10
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Great question- just added. Thanks!

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Old 10-24-2003, 10:36 AM   #11
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Hi Robin, I tried posting this under a separate heading but I'm not sure if you caught it or not. Anyway, I'm from the SF bay area as well, and I noticed you went to CPMC for your med surgery and testing. I had the capsule endoscopy done there earlier this year and my primary doctor is referring me back their for a second opinion since my anemia and GI symptoms are getting worse. They want to start testing again....I have an unknown GI bleed that's causing anemia (I've had to have a few iron infusions to try and keep my levels up) and I've tested positive for occult bleeding several times. I was wondering who you saw at CPMC? It sounds like you've had some problems with them - is this right? What did you think of your overall care and the facility? Thanks for your help!

 
Old 10-24-2003, 10:39 AM   #12
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Quote:
Originally posted by actudan:
Those are really good questions and I would really like to know the answers so keep us posted. I may ask what symptoms, should they occur, warrant another doctor's visit or ER trip. Should all your pain be gone, or are you going to have to learn to live with a certain degree of discomfort, ... Basically what symptoms should alarm me that something isn't right. Something like that.

My gastrits and duodenitis and ulcer was labeled as being caused by NSAIDs. My gi told me to stay away from NSAIDs (ibuprofen, vioxx, ...) but my gp keeps giving me vioxx to take for inflammatioon. I won't take it so I would also like to know what pain killer should I ask for. I have fioricet which I take when really needed and it works ok.

I am also really interested in the answer to:

Can you tell how thick or thin the wall of the diverticulum is?


Good luck and keep us posted.

Vioxx is actually not an NSAID - it is selective COX-2 inhibitor and is much safer for treating inflammation than NSAIDs. Other selective cox-2 inhibibitors are Tylenol, Celebrex, and Bextra. You want to AVOID drugs like aspirin, Bayer, Excedrin, Advil, Motrin, and Aleve.

[This message has been edited by fudd (edited 10-24-2003).]

 
Old 10-24-2003, 11:27 AM   #13
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You are right about the vioxx. I should have said more clearly that I didn't want to take vioxx because of the chance that it can cause bleeding. I know it's supposed to be a safer alternative (when considering the stomach) than aspirin, ibuprofen, aleve, ... but I have really become scared to take any of them. My GI also clearly told me not to take anything like aspirin and such but he also included vioxx in his what not to take list.

But to continue my point on my gp prescibing NSAIDs, he told me to take two aleve in the morning and two at night for my bursitis. I did however tell him the vioxx wasn't helping even though I didn't take it. I guess I was hoping to get prescribed something stronger and safe for the stomach. Next time I will come right out and tell him that I don't feel safe taking those drugs and ask is there anything else.

 
Old 10-24-2003, 11:46 AM   #14
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Regarding California Pacific Medical Center (CPMC)in San Francisco, I was quite satisfied with the treatment I received there. The nursing staff went out of their way, it seems, to make me feel comfortable. I was in a great deal of pain and they really kept their eye on my meds and general comfort level. I highly recommend the facility.

The hospital doctors just didn't have much to work with! Of course they need to work in terms of test results and I looked great "on paper". "Ulcer", as a cause of my symptoms, was ruled out early because the thing didn't show up on any of the tests. (I'm not sure, however, why they didn't do an endoscopy in the hospital because that is, of course, how the peculiar "hole" in my stomach was discovered -- the hole that was hiding the remains of an ulcer.) Basically, it's hard to fault them for a "miss".

I can recommend a doctor over there, in private practise. His name is Martin Liberman, M.D. and he's a gastroenterologist; After a week in the hospital I was referred to him. He invited me into in his book-lined office (not an examination room,) and wanted to know "the whole story". He asked many good questions. He must have listened to me for at least a half hour. He was trying to get the big picture on what caused my "event". He's the one who recommended and performed the endoscopy and he's the one to whom I'll address my questions this afternoon (I hope.)

And to Amwood: I'm so sorry to hear about your situation. It sounds terrible (!) and I'll be among the first to say that it's simply awful when no one knows what's the cause of your symptoms. Good luck!!

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~Robin

[This message has been edited by robinreese (edited 10-24-2003).]
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Old 10-24-2003, 01:50 PM   #15
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Robin, thanks so much for your reply! I feel better about going back to CPMC - my experience there the first time was good, but I was only there for a day, and it was just for the capsule endoscopy. I'm seeing Dr. Binnmoeller again and he seemed to be a good doctor - thorough, listened to me, and explained things pretty well. My primary doc was impressed with his write-up of the test I had there. Overall, I've heard good things about that facility, but considering the severity of your case, it was good to hear what you thought of it as well. Good luck to you - I hope you can get all of your questions answered!

 
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