Tell Me About Ulcers - In An 18 Y/O?

[jyl]

18 y/o daughter has increasing abdominal pain over three days, we go to urgent care, are directed to ER. No recent change in diet, no nausea, pain limited to upper front of abdomen. Tests rule out kidney liver pancreatitis or gallbladder, ER diagnoses gastritis and sends her home, upon eating a small amount pain quickly increases to "10" level, return to ER, CT scan shows what doctors think is an ulcer or a stomach antritis, admitted, on a PPI pantoprazole and morphine w/ additional pain med as needed. Unknown if any ulcer is perforated, bleeding, etc. No endoscopy done (yet?). Don't know if is any infection.

Pain level is high. This kid has had third degree foot and leg burns w/o complaint, and she says current pain is much worse.

Is it typical for an ulcer to manifest so rapidly? What's typical treatment - PPI drug to suppress stomach acid and pain meds, but otherwise let it heal? Antibiotic?

Some talk of unlikely, but possible, surgery - I thought surgery for ulcers was a thing of the past?

Causes? Apparently early in the summer (June) she was taking a lot of ibuprofen but only for 2 weeks. Been working as cook at a mountain camp all summer. Some alcohol, but not a lot. No drugs since the two weeks of ibuprofen. Had a sudden bout of nausea/diarrhea in mid July, resolved w/ IV for dehydration and a day's rest. Has been working hard in the kitchen but not, AFAIK, stressed.

Aren't ulcers in teenagers pretty unusual?

[BlueSkyJaunte]

H. pylori?

I'd get her to a real gastroenterologist ASAP. Good luck.

[porsche4life]

Yes get her to a gastro.

And ask her if she ever took the ibuprofen right before bed without drinking much water? That caused me to have a small discomfort once, but my doc said it ould have been much worse. Basically the pill doesn't get washed in with enough water to dissolve, and it lays against the lining of the stomach and starts the ulcer.

[jyl]

Doctor says have ruled out any significant perforation, although CT scan did not rule out very small perforation. Getting antibiotic for H. Pylori, pending test results (no stool sample produced so far to test). No endoscopy for now. Waiting for Protonix to help, pain to diminish and her to be able to take food. Currently receiving no solid or liquid food by mouth, just IV.

[jyl]

For two weeks was taking appx 2-3 ibuprofen daily with lots of water. Seems not enough to cause an ulcer, but who knows. Doc saying most ulcers due to H. Pylori infection.

[jyl]

Wow it always amazes me how quickly the meds stack up when a person is hospitalized. She's on:
- Clarithromycin and metronidazole for possible H. Pylori
- Lorazepam (Ativan)
- Ondansetron for nausea
- Morphine and oxycodone
- Diphenhydramine (Benadryl IV)

[Nickshu]

I went down that same road, but not as a teenager, but I guess it could happen at any age. Did an endoscopy with GI doc, gastric biopsy tested + for H.Pylori, took the triple therapy (Metro/Clarithro/PPI) and cleared out at least symptoms and hopefully the H.Pylori. Now I'm on lifelong PPI. If I forget to take my PPI in the morning (Nexium) by 10am my stomach is bubbling. Diet seems to have minimal effect on it, meaning if I eat a totally bland diet I still have dyspepsia. GI doc told me that some experts think that no one ever 100% clears H.Pylori once you have it, some think it goes into an inactive form and hides inside gastric cells. They told me nearly everyone gets exposed to H.Pylori, but only like 20% of us become chronically infected and have symptoms.

Basically in the end over the past 5 years I have been fine and symptom free on a PPI, after going thru triple therapy. The initial "event" really sucked, I really feel for your daughter, it's no fun.

[stuartj]

Interesting. I had regular duodenal stomach ulcers between the ages of 15 and about 30. I had more gastroscopies than I can remember during that time. Ulcers can be annoying, or ultterly, wickedly incapacitating and put you in hospital very quickly from blood loss.

That type is caused by a bacterial infection, and its curable. IIRC correctly, the doctor that identified and developed the cure won a Nobel prize. Ulcers kill a lot of people. Since the course of antibiotics I took about 20 years ago, Ive never had another.

[Brando]

Not sure if mine are from H. Pylori or taking 800mg of aspirin every day for 2 months. Definitely see a gastro specialist. Don't wait til she vomits blood like I did. No bueno.

[jyl]

Thanks, guys. When you got on antibiotics/PPI, how long before you felt better? Were you hospitalized and if so, how long?

[stuartj]

the antibiotics for the cure (as opposed to ulcer treatment drugs which I had had many times before the cure was developed) were wicked. A two week course, some unpleasant side effects, diet, nastiest antibotics Ive ever had. But Ive never had another ulcer, so it was a small price to pay.

Also that was 20 years ago- things must have been refined since then.

[BlueSkyJaunte]

Wow, hope your daughter feels better fast. I remember getting tested for h. Pylori, but it was some sort of breathalyzer-like thing?

My wife was on ondansetron for nausea during all of her pregnancies. It pretty much saved her life (and the babies'). She was unable to keep anything down otherwise.

Once again, good luck!!

[Bill Douglas]

Good luck to your daughter. 18 year olds should be out there having fun.

[livi]

Sorry to hear of your daughters situation. It is fairly common however and sometimes dependent on the Helicobacter pylori bacteria that in it self is a very frequent guest in our stomach lining. Often arguably not causing any trouble. But when it does, a combination of antibiotics like the one your daughter is prescribed, will mostly eradicate the little villain and heal the inflammation.
Many times however, there is no bacteria to be found and you have to rely on the standard acid reducing medications. It is common that the treatment is successful but often needs to be repeated and many time for longer periods, like 4-8 weeks.

[911SauCy]

Let's take this in a different, non-antibiotic, direction. It's just a thought as I'm gathering the drugs are fixing the current issue.

What is your daughter's current state regarding life stress? School, getting into college, job, sports, friends, boyfriends etc etc?

Reason I ask: Last November I had almost identical to described abdominal pain, so bad I couldn't stand up, and nothing was going down or coming out. Went to the ER, they doped me with an IV, bunch of other crap and told me my vitals were good so I "wasn't about to die"...sent me packing. I would have been angry but I couldn't think straight the pain was so bad.

Went to my regular doctor the next day, CT/MRI, see nothing to be concerned about but this pain is still terrible, they wanted to put me on anti-b's. I refused to take drugs for something they weren't sure about.

I called a friend, my wife's OB, and he told me to go see a buddy of his, supposedly best gastro locally. I sit down with this guy, he asks me what's happening in my life...nothing Doc.

No really, what are things you have going on?

Me: My wife is due with our first child in 3 weeks, my boss is about to get fired for fudging #s, I'm trying to wrangle another job, I'm selling a car, selling a house, and it's Christmas time...

He laughs and says, "you haven't considered stress?"

Turns out I was having stress induced intestinal contractions, my large intestine was having muscle spasms to the point where it literally knotted itself.

Took a little magic pill called Bentyl for 3 days, have been 100% since.

Also, been actively trying to keep myself wound less tight...

[jyl]

I'm sure there is some stress but a lot less than, say, last year. She's spent the summer working as a cook at a summer camp in the Sierras. This is her third summer there and she loves it, the kitchen staff work hard but she also does a lot of hiking in the mountains on her day off. She got lots of praise and was told that she will probably be named head of kitchen next summer. In late Sept she is headed to college, is excited about it, has her schedule, has visited the town, school and dorm, four friends are starting there too, and it is only 2 hours from home.

[911SauCy]

Originally Posted by jyl

I'm sure there is some stress but a lot less than, say, last year. She's spent the summer working as a cook at a summer camp in the Sierras. This is her third summer there and she loves it, the kitchen staff work hard but she also does a lot of hiking in the mountains on her day off. She got lots of praise and was told that she will probably be named head of kitchen next summer. In late Sept she is headed to college, is excited about it, has her schedule, has visited the town, school and dorm, four friends are starting there too, and it is only 2 hours from home.

Sounds like she's rockin', good for her.

[jyl]

First water by mouth since Sat afternoon, and trying some soup which will be first food since then. If she can eat and drink, then doc will send her home to continue medication and rest. Pain still considerable but now better controlled, since they increased dose/frequency of oxycodone. Still waiting on H Pylori serum test, not sure why it takes 48 hrs.

[Rikao4]

it's being cooked..(culture)
it's the reason it took so long to discover..
early days lab work came back all clear..
had they 'cooked' it a bit (which happened by accid. )
they would have seen the HP...

Rika

[gsxrken]

Sorry to hear about her pain but please watch the OxyContin. It could take down Mother Theresa.

Many people have left the hospital with bigger issues than they went in with thanks to that drug.