Stomach Ulcer

INTRODUCTION

As the country is getting tougher, more people are developing peptic ulcer disease, PUD. Simply put, PUD is a wound inside your oesophagus, stomach or intestinal walls. Naturally, if you had a wound on your skin, air blowing over it will cause it to clot and seal up. This is not so, however, in PUD where the wound is constantly bathed in different fluids including gastric acids, foods and spices, alcohol and carbonated drinks etc. Imagine you pour acidic water or pepper water on that wound on your skin, it would probably get worse right? It’s a no brainer therefore that we must watch what we eat if we have PUD, time we eat, quantity of food we eat etc.

CAUSES

PUD results when our stomach acid eats away at the walls of our gut. This happens under 2 circumstances:

1. when the bacteria, Helicobacter Pylori, destroys the protective mucous membranes of the stomach walls, or
2. due to the effect of a class of medications called NSAIDs. Ibuprofen, diclofenac, naproxen and aspirin all belong to this class of drugs. The NSAIDS also destroy the protective walls of the gut.

Some rarer causes include being acutely sick and the immune system becomes so compromised, or having a surgery or prolonged usage of steroids.

WHO IS LIKELY TO GET PUD

The following conditions increase your likelihood of getting PUD:

1. being elderly
2. Taking NSAIDs and steroids concomitantly, or prolonged use of NSAIDs alone
3. Taking alcohol and cigarettes
4. being a woman
5. having a family history of PUD
6. having liver, kidney or other chronic diseases

HOW PUD MAKES YOU FEEL

Stomach ulcers have some classical symptoms. It could give you :

1. pain in your stomach or your back. This pain may stop briefly when you take an antacid or when you eat. It may be worse at night. Sometimes the pain may bring several levels of discomfort when you lie down, seat or stand. It can get terrible atimes.
2. heartburn
3. dark stool
4. bloating and purging
5. nausea and vomiting
6. weight loss

HOW TO KNOW IF YOU HAVE PUD

PUD is easily diagnosed in the laboratory. Your doctor or pharmacist may direct you to run an occult blood test (OBT) which detects blood in your stool, and a H.Pylori test, to check if you have the bacteria. Doctors may also require you to run an endoscopy, x rays or scan to know the location of the ulcers.

TREATMENT

It is untrue that PUD cannot be treated. It is easily treated over several weeks if you can adhere to instructions. A faithful intake of drugs and adherence to the non drug treatment improves the outcomes of treatment.

The drugs used may include

1. Proton pump inhibitors e.g omeprazole, esomeprazole
2. H2 receptor antagonists e.g. cimetidine, ranitidine
3. Gastroprotective agents e.g. sucralfate, antacids
4. Antibiotics for h.pylori

Non drug instructions includes:

1. Time of food. An ulcer patient should endeavour to eat very early in the morning. Also, time when you eat: don’t wait till you are hungry before you eat. If you wait till acid comes out (when you are hungry) you may be worsening the wound.
2. Water is the best antacid. Consume large quantities of it, even in the middle of the night (personal experience).
3. Avoid or reduce intake of any food that worsens the symptoms you feel. Such food may include: beans, milk, meat, oranges, apple, pineapple, garden egg, peppery and fried foods, any bottled or carbonated drink including soft drinks, malt, alcohol, glucose drinks.
4. Natural or unsweetened yoghurt is your friend, as is water melon, banana, and cucumber. Pap is also a good food for ulcer patients.
5. Exercise and eating balanced meals help in most illnesses.

PUD may get completely healed within 2 months of proper adherence to treatment. However, ulcer could reoccur, especially when the H.pylori wasn’t completely eradicated initially or in cases of continued usage of NSAIDs.

BUST THE MYTHS

Contrary to popular folklore:

1. ulcer is not caused by not eating enough food
2. milk will not stop ulcer but may actually worsen it. Milk will reduce the pain momentarily, but because it produces gas and also causes more acid to enter the stomach, it will definitely make it worse.
3. ulcer can be treated. Don’t listen to anyone who tells you otherwise
4. ulcer is not caused by eating too much peppery or spicy foods.

PUD and ARTHRITIS

Patients with arthritis, whether rheumatoid, osteo or gouty, normally have pains that make them take pain medicines frequently. For this class of patients, taking NSAIDs is contraindicated. However, there are NSAIDs that contain another content that tries to protect the stomach walls. For example, the products with the combination of diclofenac/misoprostol or diclofenac/cholestyramine. Misoprostol replaces the prostaglandins that stimulate the production of the protective mucous membranes and reduce the secretion of acids while cholestyramine binds bile acids which is thought to be involved in the formation of ulcers. Neither of these combinations have the magic bullet to really protect ulcer patients and must be consumed with caution and with food.

Arthritis patients could benefit from other pain medications not NSAIDs.

NOTES FROM PHARMPLUG

Our pharmacist is always available to hear you out, advise you on the best course of action and monitor your treatment. Ulcer can be treated if done properly. If you have arthritis and ulcer, we could help you get your drugs at cheaper rates if you pre-order or send us your prescription.

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