instruction: hello doctor I have regular pain in the stomach while not having food in hours or so I have constant reflux air goes from both ways while burping I feel acid taste frequently after defecation I feel itching in the sphincter I am having a hard time if constipation occurs I am diagnosed with chronic gastritis and pancreas three years ago and was on medication I am seeking for a cure or for something that will get my health back in balance please help
output: 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 pyloric induced gastritis you have taken medications for it but it turns positive every time you have an endoscopy the last which was 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 pyloric infection is common worldwide with a prevalence of 50 of the world population is infected with this bacteria pyloric can cause ulcers in stomach and small intestine which is called duodenum pyloric 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 pyloric 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 pyloric 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 pyloric was positive or negative if positive then I recommend you to take the following therapy for 14 days capsule pylera bismuth submit metronidz tcn three capsules daily with a glass of water three hours after meals and at bedtime capsule esomeprazole 40 my once daily half an hour before meals for two weeks digestive 40 my half an hour before meals daily for two weeks if the test was negative then I suggest you to test pyloric stool antigen to confirm if the infection is still present if still negative then do not take capsule pylera but continue with esomeprazole and digestive the digestive 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 pyloric 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 pyloric has caused to your stomach and duodenum I hope this helps peptic ulcer disease secondary to resistant pyloric gastroparesis pyloric induced or idiopathic small intestinal bacterial overgrowth functional dyspepsia post prandial distress syndrome stool for pyloric antigen to confirm if pyloric is still present gastroparesis pyloric induced or idiopathic small intestinal bacterial overgrowth functional dyspepsia post prandial distress syndrome peptic ulcer disease secondary to resistant pyloric follow up in weeks to update about symptoms as I can reassess and guide you further treatment plan for long term