What could cause ulcers for 16 months?

[Sar_square]

My best friend has been throwing up every morning since April 2018. She has had a colonoscopy, endoscopy, MRI, blood tests, and stool tests. When this began in April of 2018, she could not hold down food or liquids for weeks. She went in for a scope and they said she has 5 ulcers at the top of her stomach opening. They aren't peptic ulcers. Her doctor said she likely developed the ulcers from taking too much Advil, because she has debilitating cramps when she's on her period. He prescribed Prilosec to reduce stomach acid production and told her to start taking tylenol instead.

Since that diagnosis, her ulcers have not healed. She is very careful to eat bland, non-fatty foods. She does not take advil, drink alcohol, or drink anything caffeinated. With the aid of the acid reducer, she is able to eat, but she throws up every single morning. She has dropped a lot of weight, but her doctor does seem concerned and is not coming up with anything new to help her.

What could cause ulcers to last this long??

[Ken_PA]

Hi, one way to approach this is to start with the assumption that everything has the same ultimate cause: perhaps stomach sensitivity/inflammation causes the vomiting and also the ulcers. So I'd ask the doc to switch from the PPI to an H2 blocker like Pepcid and all of those others. That gives the chance to be anti inflammatory. Pepcid is called an antacid, but it really works by being an antihistamine (though it's a different kind than Benadryl). Besides, PPIs have bad effects long term, which the H2 blockers might not.

Another approach is to try Vitamin K, which was first proposed as anti-ulcer at least two decades ago. That could be food (even cabbage juice has been used) or supplements.  I'd especially think of this if the ulcers are bleeding - and if so also be careful to avoid blood thinners. There is even a family of plants called coumarins that work against vitamin K, which is how the famous drug Coumadin works. Cinnamon is one such. (Vitamin K is necessary to make the coagulation proteins which are in the blood naturally.)

Or she could ask her doc why she's not been given an ulcer coating drug like Carafate - though that is just handling a symptom and not the cause.

And the "debilitating cramps when she's on her period" might also have the same origination.


You're a good friend to her, Sar_square. Bravo to you.

[auntiejessi]

I had duodenal ulcers from NSAIDs. I didn't know until I was vomiting blood.

I agree with Sara that Zollinger-Ellison needs to be ruled out - https://www.healthline.com/health/gastric-and-duodenal-ulcers#risk-factors

Mine healed fairly quickly, but what dose of the prilosec is she on? If she's only on 20 mg a day, she should talk to her doctor about going up to 40. She may also want to consider a second opinion at this point.

I hope she feels better soon!

[Sara_MHModerator]

Hello and welcome to the forum.  Thanks for your question.  I'm glad your friend is working with a doctor.  Since they have determined the cause of her ulcers being due to overuse of an Nsaid, that is probably the why to your question.  Is there a reason you don't think so?  Did they do any lab work to see if she has H. Pylori? That is another common cause of ulcers. It does sound like they have done some extensive work to diagnose her so imagine they have ruled that out but if not, it should be.  

Your friend should reconnect with your doctor about having these symptoms continue and what her next step should be. They may do a medication change and also want to confirm she is not using any nsaids at this point.  This article talks about situations when ulcers don't heal.  They are fairly rare, but eventually if this continues they may want to investigate if she has  Zollinger-Ellison syndrome which is an extreme overproduction of acid or Chron's.  Let's hope that is not the case and this can be resolved with a med change.  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

Let us know what her doctor says.