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Now that all the romance of Valentine\u2019s has passed, we can get back on track of the serious business of health.\u00a0 Today, we will take a look at PEPTIC ULCERS.<\/p>\nNow that all the romance of Valentine\u2019s has passed, we can get back on track of the serious business of health.\u00a0 Today, we will take a look at PEPTIC ULCERS.<\/p>\n
WHAT IS A PEPTIC ULCER?<\/p>\n
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).\u00a0 When you think about it, it\u2019s just as when you have a sore on your leg or foot or other parts of your body; it is usually really an ulcer.<\/p>\n
We\u2019ll get to the causes and aggravating factors in a while.\u00a0 Just allow me to mention that an ulcer is designated by its location.\u00a0 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.<\/p>\n
HOW DOES IT HAPPEN?<\/p>\n
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.\u00a0 Don\u2019t think that because they are inside our bodies that these acids are mild stuff.\u00a0 They are strong, and they have to be, because they have to kill a lot of harmful stuff that enter our mouths.<\/p>\n
WHAT ARE THE SIGNS AND SYMPTOMS?<\/p>\n
The most common is pain. It\u2019s 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.\u00a0 It is mostly in the epigastrium, that is the area between your navel and the end of your chest bone.\u00a0 The pain may last for minutes to hours, and is worse on an \u2018empty stomach,\u2019 if the ulcer is in the small intestine.\u00a0 It tends to flare up at night, typically at 1:00 or 2:00 in the morning.\u00a0 It is temporarily relived by taking in certain things that buffer acid, or by acid-reducing drugs.\u00a0 And it may last days to weeks.\u00a0 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.\u00a0 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.<\/p>\n
OTHER SYMPTOMS, SIGNS<\/p>\n
Less commonly, there is hematemesis, or vomiting blood.\u00a0 It can be red blood, but most often, because it has been altered by stomach acid, it comes up as a coffee-grounded color.\u00a0 Blood can also come out at the other end, in what we call melena stools \u2013 black, tarry, hard – to – flush stools.\u00a0 If the transit through the system is fast, then it will come out as bright red.\u00a0 Of course, it will often make you anemic.\u00a0 There can be nausea and vomiting, weight loss, and chest pain.<\/p>\n
WHAT IS THE CAUSE?<\/p>\n
Peptic ulcers are actually caused by bacteria; cock-screw shaped ones called Helicobacter pylori (or just H.pylori).\u00a0 They live and multiply in the mucous layer of the affected area and initiate the process whereby acid and pepsin do their work.\u00a0 They are found in food and water and can be passed from person to person by close contact such as kissing (saliva).\u00a0 Have an ulcer? Starve yourself from some \u201csugar\u201d for a while, in the interest of your partner.<\/p>\n
Another factor lies in drugs we call NSAID\u2019S which include Ibuprofen (Motrin, Advil, Naproxen (Aleve), Aspirin and others.\u00a0 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.\u00a0 Many of you will remember me asking you if you\u2019ve ever had problems with your \u201cstomach\u201d such as ulcers or gastritis, so that I don\u2019t give you medication to worsen or reactivate it.<\/p>\n
Smoking is a causative factor, as is alcohol.\u00a0 Is there nothing bad that alcohol is not involved in?\u00a0 Stress can aggravate an ulcer, so you want to be mindful of this.<\/p>\n
HOW IS A PEPTIC ULCER DIAGNOSED?<\/p>\n
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.\u00a0 But not always, which is why endoscopy is sometimes done, before or after, in fact.\u00a0 This is the tube with the camera which goes down your gullet, into your stomach and early duodenum.\u00a0 Any thing there is seen directly, and a piece can be taken from a suspicious or definite area to test for H.pylori.<\/p>\n
Speaking of H.pyloric, a blood test can be done to test for antibodies to it.\u00a0 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.\u00a0 There is also a stool Antigen Test to monitor the effectiveness of treatment.<\/p>\n
WHAT ARE THE COMPLICATIONS OF A PEPTIC ULCER?<\/p>\n
As we alluded to before, hemorrhage or bleeding can occur.\u00a0 This can never be good.<\/p>\n
The ulcer may penetrate to the other layers of the area involved.<\/p>\n
Obstruction of food and liquid through the channel from the stomach to the intestine can occur because of scarring from a long – standing ulcer.\u00a0 This causes frequent vomiting and a feeling of fullness long after eating, and means surgery might be the best option.<\/p>\n
Perforation, meaning that the ulcer just bores a hole right through its structure, also meaning surgery, because we\u2019re talking serious bleeding and other complications.<\/p>\n
Can you tell by now that you don\u2019t mess with an ulcer?<\/p>\n
WHEN SHOULD YOU CHECK THE DOC?<\/p>\n
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.\u00a0 Of course, you have enough sense to know that any sight of blood, fresh or otherwise, means the same thing.<\/p>\n
HOW IS AN ULCER TREATED?<\/p>\n
The treatment has to involve a two-pronged attack.<\/p>\n
\u2022\u00a0\u00a0 \u00a0We have to kill the bacteria,
\n\u2022\u00a0\u00a0 \u00a0We have to reduce acid.<\/p>\n
We kill bacteria with antibiotics, and to kill H.pyloric, we have different strategies and antibiotics.\u00a0 We may use three for two weeks, four for one or two weeks, and so on, with\u00a0 what are called H2 blockers, such as Zantac, or Proton Pump Inhibitors such as Losec, Nexium, Prevacid, and so on.\u00a0 These are acid \u2013 reducers, not eliminators, because we need some acid.\u00a0 We may also use substances containing Bismuth in the strategy with antibiotics and those acid-reducers I just mentioned.<\/p>\n
They seem to inhibit H.plori\u2019s activity.\u00a0 Pepto-Bismol is one.<\/p>\n
ULCERS FAIL TO HEAL<\/p>\n
\u2022\u00a0\u00a0 \u00a0Because patients don\u2019t use their medication AS PRESCRIBED.
\n\u2022\u00a0\u00a0 \u00a0H.pylori becomes resistant to antibiotics.
\n\u2022\u00a0\u00a0 \u00a0People continue to use Advil, and Aleve and others.
\n\u2022\u00a0\u00a0 \u00a0People continue to smoke and drink.<\/p>\n
Rare causes include
\n\u2022\u00a0\u00a0 \u00a0Zollinger \u2013 Ellison Syndrome, which causes ulcers throughout the digestive system, heart problems, etc\u2026
\n\u2022\u00a0\u00a0 \u00a0Infection with bacteria other than H.pylori
\n\u2022\u00a0\u00a0 \u00a0Chron\u2019s disease or other digestive tract disease.<\/p>\n
SURGERY: WHEN NECESSARY?<\/p>\n
When the complications occur, and when there is relentless pain and when medicine seems to fail.\u00a0 There is what is called truncal vagatomy, where the vagus nerve, playing a role in acid production, is cut.\u00a0 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.<\/p>\n
HOW TO HELP YOURSELF<\/p>\n
Abstain —–From alcohol and tobacco, from foods that increase pain, from NSAID\u2019S (Advil, etc\u2026) and control reflux of acid from your stomach into your esophagus. We\u2019ve talked about this and many of you have got the handout.<\/p>\n
See you next week.<\/p>\n
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.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"Now that all the romance of Valentine\u2019s has passed, we can get back on track of the serious business of health.\u00a0 Today, we will take a look at PEPTIC ULCERS. WHAT IS A PEPTIC ULCER? A peptic ulcer is a…","protected":false},"author":15,"featured_media":26227,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_cbd_carousel_blocks":"[]","footnotes":""},"categories":[49],"tags":[],"class_list":["post-27869","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-talk"],"acf":[],"yoast_head":"\n