Severe gastritis
February 1, 2011 | 20,00 EUR | answered by Dr. med. Olaf Stephan
Hello!
I (female, 34) have been suffering from a severe gastritis and esophagitis for about 6 weeks. I was in the hospital and had a gastroscopy where this was diagnosed. I was prescribed Pantozol 40mg and it improved. However, after stopping the medication, the same problem returned. Now I have been taking Pantozol 40 mg again for 1 week but I do not notice any improvement. I am worried because I cannot eat anything and can only drink very little, which makes me quite weak.
Symptoms: nausea, vomiting, stomach pain, loss of appetite (I cannot eat anything and have already lost 8 kg during this time).
I have had stomach issues before but never this severe.
What else can be done? Should I go back to the hospital and possibly have a second gastroscopy done, or are there more tests or medications available?
Thank you for your response.
Dear Inquirer,
Apparently, in addition to suffering from inflammation of the stomach lining (gastritis), you also have inflammation of the esophagus due to reflux (backflow) of highly acidic stomach juice into the esophagus (known as reflux esophagitis), often accompanied by a small hiatal hernia. The reflux of stomach juice into the esophagus is favored by lying down (e.g. at night), so patients should try to sleep with their upper body slightly elevated if possible. These inflammations are very stubborn and often need to be treated for a long time (sometimes many years), and there is also a high tendency for recurrences. Proton pump inhibitors such as Pantoprazole are currently the most effective medications for treating these conditions, they are generally well tolerated, and side effects, even with long-term use, are very rare. It is quite common for the stomach lining to be colonized by specific bacteria (known as Helicobacter pylori), and during gastroscopy, usually mucosal samples are tested (results are available within 24 hours), so you should check the endoscopy report again or ask the hospital discharge summary or your general practitioner. If these bacteria are present, they prevent the inflammation from healing, and they can be effectively treated with a specific combination of antibiotics (duration of 7 days), which will quickly improve the symptoms. It is also recommended to initially take Pantoprazole regularly in a higher dosage (2 x 40 mg up to 3 x 40 mg) until the symptoms disappear, then the dosage can be gradually reduced, and a maintenance therapy with 1 x 40 mg or 1 x 20 mg at night may be necessary, depending on the progression of the disease. Along with Pantoprazole, you should also take a prokinetic agent initially, which regulates peristalsis and works well against nausea and vomiting, for which MCP drops in a dose of 3 x 20 drops daily are recommended. You can easily get these medications prescribed by your general practitioner, and in my opinion, a repeat endoscopy is not necessary at this time, but even if you are symptom-free, I would recommend annual gastroscopic checks to detect chronic mucosal changes (such as Barrett's esophagus) in a timely manner. With regular intake of the medication described above, your symptoms should improve soon. Best regards, O. Stephan.
