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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18423
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Three months, been experiencing a persistent burning

Customer Question

For past three months, been experiencing a persistent burning pain in stomach area, on occasion heartburn symptoms, and waves of nausea, notice after food. Also noticed upon releasing bowel motions the burning pain increases though the day.
Have had fbc blood test, showing anemia 8.8 level, a calprotectin stool test showed high, inflammation, blood in stool. And a CA125 blood test, showed high level.
Please could you advise to next step to feel better
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.Have you had an endoscopy or colonoscopy?How long have you been taking the ranitidine and lansoprazole?When were these stool tests done?
Customer: replied 1 year ago.
Hello I have been put forward for endoscopy, I had a ultrasound a few weeks back. Asked to concentrate around gallbladder area and liver, unfortunately sonigrapher could not get clear images to show issues, but noticed fatty liver. Been taking ranitdine ,since burning in stomach started three months, suppressed slightly only to return each day.
The stool tests were taken month ago, but GP has not told me anymore, but calprotectin test showed inflammation blood in stool, also had a Ca125 blood test, which showed high level, should I have concerns if anything serious.
Expert:  Dr. D. Love replied 1 year ago.
Did you also start the lansoprazole three months ago?
Customer: replied 1 year ago.
Yes, but stopped due to feeling unwell on this medication, so only been taking ranitdine since, and gaviscon on occasion.
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information. I ask about the timing of the lansoprazole and the stool tests because the lansoprazole can affect some of the tests. The fecal calprotectin test is a measure of inflammation in the GI tract. However, the lansoprazole and other medicines in the same class can cause a false elevation of the fecal calprotectin level. If you were only on the lansoprazole briefly, then the fecal calprotectin level checked a month ago is probably a true elevation. In this situation, the next step would be an endoscopy and colonoscopy. There are a number of conditions that are a concern, and some of them are serious. The symptoms you describe, along with the elevated calprotectin, blood in the stool, elevated CA125, and significant anemia are worrisome for an ulcer or significant inflammation of the stomach or small intestine, inflammatory bowel disease, or an abnormal growth in the gut. The CA125 can be elevated in many different conditions of the GI tract, and particularly in liver disease,so the calprotectin and blood int he stool is more indicative of a condition with the stomach or intestines. At your age, a cancer of the GI tract is less common, but it certainly is possible. If there is found to be an ulcer or inflammation of the stomach or early small intestine, there also would be concern about whether there is an infection of the stomach by a specific bacteria called H. pylori. The doctor can test for this during the endoscopy, but there also are other non-invasive tests that can be done for this germ. If they cannot get good ultrasound images of the gallbladder, then a CT scan or a hepatobiliary scan can be done. So, the next step would typically be the endoscopy and colonoscopy. Until this can be scheduled, there are a couple of options to consider for easing symptoms. The usual approach when ranitidine is not sufficient would be to use a proton pump inhibitor, such as the lansoprazole. Since you had side effects from the lansoprazole, it would be reasonable to augment the ranitidine with a liquid antacid, and this can be used relatively frequently, using it 1 and 3 hours after each meal and at bedtime. If I can provide any additional information, please let me know.
Customer: replied 1 year ago.
Thankyou, one more question, all the symptoms starting upon taking metformin , got diagnosed in December with type 2 diabetes, prescribed metformin, took in month of January 2016 then all the symptoms of burning stomach begun, could there be a connection to this medication, could it have eroded or caused stomach inflammation, have not taken metformin since February while trying to locate stomach issues , is there a connection
Expert:  Dr. D. Love replied 1 year ago.
Metformin will frequently cause diarrhea or flatulence, but it is not reported to cause ulcers or inflammation of the stomach or upper small intestine, or inflammatory bowel disease. It may be that you were developing one of these GI disorders, and the metformin causing diarrhea or flatulence may have been enough to precipitate other symptoms. But it is not reported that metformin would cause this level of problem as a direct effect of the metformin.
Customer: replied 1 year ago.
Thank-you, lastly forget to mention, while this has happened with stomach issues, upon rising from bed in morning, get cough, that causes a gagging reflex to bring up a clear sticky type bile, sometimes frothy white bile with mix inside mucus cattrah, and fullness of saliva, is this connected to burning stomach issues, this is my last question thankyou
Expert:  Dr. D. Love replied 1 year ago.
Yes, this can be related to your other symptoms, although it would be more related to the occasional heartburn that you describe. Heartburn is usually due to the acidic stomach contents entering the lower esophagus, which is called acid reflux or gastroesophageal reflux disease/GERD. If the acid reflux is more severe, then the acidic fluid can get into the throat or the airways of the lungs, and can cause cough, gagging, or shortness of breath. It is also common for acid reflux to get worse while lying down, because gravity is no longer helping to keep the stomach contents where they belong, so will frequently be more noticeable upon arising in the morning.
Customer: replied 1 year ago.
Hello doctor,I really appreciate your response to my concerns and questions.
With the anemia, is it safe to leave without medication or treatment while waiting for investigate tests.
Concerned because told the level from blood test was 8.8
But GP has not prescribed iron supplements or any treatment while showing low level.
One GP at my surgery mentioned blood transfusion, but no more has been told to me.
As you can read, I am very anxious and worried regarding decline in health.
I do suffer from anxiety and agoraphobia which I have had prior to these health symptoms and now very anxious to have endoscopy.
I have spoke to endoscopy unit regarding my anxiety and feel sedation would be advisable for procedure,
My GP has given me valium to take car journey to hospital, but endoscopy unit, feel taking them on top of sedation may make things difficult for me, any advice.
And due to anxiety would you feel getting endoscopy and colonscopy tests taken together on same procedure, rather than going separtley on different times and causing me increased anxiety, can the GP arrange both tests to be done at same time. Greatly appreciate your response to these concerns thank-you.
Expert:  Dr. D. Love replied 1 year ago.
The hemoglobin level of 8.8 usually would not require transfusion, unless it is significantly dropping. Starting iron as soon as possible is reasonable, but since iron can be irritating to the GI tract, your doctor may be hesitant to start iron supplementation until there is better control of symptoms. IV sedation is frequently used for endoscopy and colonoscopy. It is usually not an issue if an oral benzodiazepine is taken, as long as it was ta***** ***** enough that the levels are not continuing to increase while the IV drugs are being administered. For Valium, that would mean that it should be taken at least 2 hours before the procedure is scheduled. If Valium is taken shortly before the procedure, the steady increase in blood levels from the oral drug is more difficult to predict, so the doctor would usually be cautious about giving the IV drugs. We will frequently schedule both endoscopy and colonoscopy to be done one after the other and during one long episode of sedation.
Dr. D. Love and 2 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Thank-you. Does the CA125 BLOOD TEST, need further testing, my GP only told me high levels and will revert. Having test this week, what is ca125 blood test looking for in health issues
Customer: replied 1 year ago.
Doctor, with the list of health issues explained, should I be going to A&E department at the hospital or can I wait for each scheduled testing and investigation on appointment referrals, not been feeling well, but unsure if need prompt evaluation at the hospital.
Expert:  Dr. D. Love replied 1 year ago.
I am sorry for the delay, but I was away from the computer. As I said above, there are many different conditions that can cause an elevation in the CA125, so I would usually not perform a separate evaluation for the elevated CA125. You should not go to an A&E for the additional testing. These tests typically need to be scheduled and there would need to be a cleaning of the colon for preparation for the colonoscopy If your symptoms are more severe and do not respond to the augmentation with liquid antacids, then it may be appropriate to be seen in A&E for consideration of medicines for relief of symptoms, but not for getting these tests done.