HEALTH TALK: An ulcer is a sore

Now that all the romance of Valentine’s has passed, we can get back on track of the serious business of health.  Today, we will take a look at PEPTIC ULCERS.

WHAT IS A PEPTIC ULCER?

A peptic ulcer is a sore on the inside lining of the stomach, duodenum (the first part of the small intestine), or the esophagus (gullet).  When you think about it, it’s just as when you have a sore on your leg or foot or other parts of your body; it is usually really an ulcer.

We’ll get to the causes and aggravating factors in a while.  Just allow me to mention that an ulcer is designated by its location.  An ulcer in the stomach is a GASTRIC ulcer, one in the early part of the small intestine is a DUODENAL ulcer (most common) and one in the gullet is an ESOPHAGEAL ulcer.

HOW DOES IT HAPPEN?

When there is a breakdown of the inside lining of these areas, the mucous layer, gastric acid and pepsin produced by special cells in the stomach to digest our food, attack these areas and a sore forms.  Don’t think that because they are inside our bodies that these acids are mild stuff.  They are strong, and they have to be, because they have to kill a lot of harmful stuff that enter our mouths.

WHAT ARE THE SIGNS AND SYMPTOMS?

The most common is pain. It’s mostly a burning pain but different persons will describe it differently. It is caused by the ulcer itself, but also when it is attacked by gastric (hydrochloric) acid.  It is mostly in the epigastrium, that is the area between your navel and the end of your chest bone.  The pain may last for minutes to hours, and is worse on an ‘empty stomach,’ if the ulcer is in the small intestine.  It tends to flare up at night, typically at 1:00 or 2:00 in the morning.  It is temporarily relived by taking in certain things that buffer acid, or by acid-reducing drugs.  And it may last days to weeks.  A lot of people have gotten relief by drinking milk at night, but some research says that the calcium in milk stimulates acid production and makes matters worse.  All I can tell you is the science, folks, you can do what you wish with it. By the way, an ulcer in the stomach feels worse after eating.

OTHER SYMPTOMS, SIGNS

Less commonly, there is hematemesis, or vomiting blood.  It can be red blood, but most often, because it has been altered by stomach acid, it comes up as a coffee-grounded color.  Blood can also come out at the other end, in what we call melena stools – black, tarry, hard – to – flush stools.  If the transit through the system is fast, then it will come out as bright red.  Of course, it will often make you anemic.  There can be nausea and vomiting, weight loss, and chest pain.

WHAT IS THE CAUSE?

Peptic ulcers are actually caused by bacteria; cock-screw shaped ones called Helicobacter pylori (or just H.pylori).  They live and multiply in the mucous layer of the affected area and initiate the process whereby acid and pepsin do their work.  They are found in food and water and can be passed from person to person by close contact such as kissing (saliva).  Have an ulcer? Starve yourself from some “sugar” for a while, in the interest of your partner.

Another factor lies in drugs we call NSAID’S which include Ibuprofen (Motrin, Advil, Naproxen (Aleve), Aspirin and others.  They inhibit a substance we call cyclo-oxygenase, which is a step toward production of prostaglandins, which in turn protect the mucous layer of the gastrointestinal tract.  Many of you will remember me asking you if you’ve ever had problems with your “stomach” such as ulcers or gastritis, so that I don’t give you medication to worsen or reactivate it.

Smoking is a causative factor, as is alcohol.  Is there nothing bad that alcohol is not involved in?  Stress can aggravate an ulcer, so you want to be mindful of this.

HOW IS A PEPTIC ULCER DIAGNOSED?

Usually a doctor will order a Barium meal, or a Barium swallow. This is a special X-Ray, where you are given something to drink which, as it goes down and down, X-Rays will show how it coats your system and if there is an ulcer, it may show up.  But not always, which is why endoscopy is sometimes done, before or after, in fact.  This is the tube with the camera which goes down your gullet, into your stomach and early duodenum.  Any thing there is seen directly, and a piece can be taken from a suspicious or definite area to test for H.pylori.

Speaking of H.pyloric, a blood test can be done to test for antibodies to it.  The problem is that the antibodies may persist for a year or more after it is gone, so in order for us not to keep treating you based on a positive result when nothing may be there, we can have you do a Breath Test, believe it or not, to evaluate the effectiveness of treatment.  There is also a stool Antigen Test to monitor the effectiveness of treatment.

WHAT ARE THE COMPLICATIONS OF A PEPTIC ULCER?

As we alluded to before, hemorrhage or bleeding can occur.  This can never be good.

The ulcer may penetrate to the other layers of the area involved.

Obstruction of food and liquid through the channel from the stomach to the intestine can occur because of scarring from a long – standing ulcer.  This causes frequent vomiting and a feeling of fullness long after eating, and means surgery might be the best option.

Perforation, meaning that the ulcer just bores a hole right through its structure, also meaning surgery, because we’re talking serious bleeding and other complications.

Can you tell by now that you don’t mess with an ulcer?

WHEN SHOULD YOU CHECK THE DOC?

If you keep going to the Pharmacy week after week, to get your antacid, but only get temporary relief, time for a visit to the office.  Of course, you have enough sense to know that any sight of blood, fresh or otherwise, means the same thing.

HOW IS AN ULCER TREATED?

The treatment has to involve a two-pronged attack.

•    We have to kill the bacteria,
•    We have to reduce acid.

We kill bacteria with antibiotics, and to kill H.pyloric, we have different strategies and antibiotics.  We may use three for two weeks, four for one or two weeks, and so on, with  what are called H2 blockers, such as Zantac, or Proton Pump Inhibitors such as Losec, Nexium, Prevacid, and so on.  These are acid – reducers, not eliminators, because we need some acid.  We may also use substances containing Bismuth in the strategy with antibiotics and those acid-reducers I just mentioned.

They seem to inhibit H.plori’s activity.  Pepto-Bismol is one.

ULCERS FAIL TO HEAL

•    Because patients don’t use their medication AS PRESCRIBED.
•    H.pylori becomes resistant to antibiotics.
•    People continue to use Advil, and Aleve and others.
•    People continue to smoke and drink.

Rare causes include
•    Zollinger – Ellison Syndrome, which causes ulcers throughout the digestive system, heart problems, etc…
•    Infection with bacteria other than H.pylori
•    Chron’s disease or other digestive tract disease.

SURGERY: WHEN NECESSARY?

When the complications occur, and when there is relentless pain and when medicine seems to fail.  There is what is called truncal vagatomy, where the vagus nerve, playing a role in acid production, is cut.  There is selective vagatomy, where portions of the nerve going to particular parts of the stomach are cut, and then there is highly selective vagatomy where the nerve fibers going to the actual acid- producing cells are cut.

HOW TO HELP YOURSELF

Abstain —–From alcohol and tobacco, from foods that increase pain, from NSAID’S (Advil, etc…) and control reflux of acid from your stomach into your esophagus. We’ve talked about this and many of you have got the handout.

See you next week.

Dr. Victor Emanuel has been an educator of medical professionals in training, and the public, for over 20 years in Dominica. The contents of his articles are based on facts and research conducted, and not of his opinion.

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10 Comments

  1. LG
    February 17, 2011

    So this means when you have period you cannot take ibuprofen or naproxen because the chemical in it contribute in giving you an ulcer????

    • Anonymous
      February 17, 2011

      oh ok , just to clarify something, it does not mean that if you have your period or other pain that you cannot take ibuprofen.. what actually MAY lead to the ulcer is a prolonged and repeated usage.. for instance there are some persons who may suffer from arthritis.. now because arthritis is a form of inflammation, the person may be required to take NSAIDs (non steroidal anti inflammatory drugs) such as ibuprofen maybe on a daily basis, such persons are at increased risk of getting an ulcer because they use the drug on a more frequent basis…

      hope this helps to clarify a bit!

  2. LG
    February 17, 2011

    In the seond paragraph under ” What is the cause” He spoke about the NSAID’S we take in and it contains a chemical which protects the mucous layer of the gastrointestinal tract and in the last paragraph he speaks about abstaining from them. So if women using ibuprofen, Naproxen etc for period,should he discontinue using it since it is a contributing factor for ulcers? What if these are the things that make her feel better during period pain?? I would like to get some clarifications.

    • Playboy
      February 18, 2011

      Try to follow what the doc said: 1) Prostaglandins proect the mucosal layer ot the gastrointestinal tract.
      2) cyclo-oxygenase is an enzyme which is necessary in one of the steps
      to produce prostaglandins.
      3)some , most perhaps, NSAID’S INHIBIT cyclo-oxygenase which then block the production of prostaglandins which protect the lining of your gatrointestinal tract, leaving it open to attack.

      ‘Anonymous’ did a good job of shedding some more light on the subject.

  3. PAIN
    February 17, 2011

    Doc, am suffering with this thing when ever I take acidic drinks, eg grapefruits, sour oranges, sodas. So I stop taking these things and I am getting a good relief.
    Taking in milk helps me a great deal to.

  4. NatureBoy
    February 17, 2011

    Excellent article. Scientific but simplified enough for the average person to understand, without sounding childish. Good sense of humor now and then made the points despite the humorous way of expressing it. Thanks alot, Doc.

  5. kangaroo@hot mail .com
    February 16, 2011

    thanks doc i have it also and suffering a lot, but one thing interested topic like that u see no comment, ,. if is against the government u will see more than 300 comment. that can show u where Dominican negative, where is mouth of south?. and the others , backward people.

  6. Grateful
    February 16, 2011

    I love the way you explain things, Doc. Thank you. I hope an Archive is being kept online on your papers because I have missed so many. By the way, where is your office these days?
    Bless you and your lovely family.

    • Anonymous
      February 17, 2011

      Yes an archive of his papers is kept online..
      all u need to do is click on columns , and then health issues… u’ll see papers you might have missed
      His office..Halsbro med centre right beside National bank..Roseau
      I hope I answered ur question

  7. Jay Jay
    February 16, 2011

    Thanks for the interesting topic, but Doc I would like you to talk about the menstrual cycle and colic

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