Four in every five patients that consult me, claim they have ulcer. Some claim that coke aggravates their ulcer, while malt does not. Some claim that when they take malt their ulcer worsens. Peptic ulcer has always been difficult to define.
Prof. Merric Charles said, “A peptic ulcer is a well-defined round or oval sore, where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices. A shallow ulcer is called erosion”
However, Man’s Body Manual defines peptic ulcer as “a breach in the surface of the membranes inside the body. These are ulcers of the stomach and duodenum (the first part of the small intestine). They occur if the lining of the stomach or duodenum, fails to stand up to the digestive properties of the gastric juices – that is when the stomach and intestine begin to digest themselves.”
Peptic ulcers rarely exceed three quarters of inch, across. They are believed to be caused by stress and dietary factors. Treatment focuses on hospitalization, bed rest and prescription of special bland foods. Later gastric acid is blamed for ulcer disease. Antacids and medications that block acid production become the standard of therapy. Despite this treatment there is a high recurrence of ulcers. In 1982 Australian physicians, Prof Robin Warren and Prof Barry Marshal, first identified the link between Helicobacter pylori (H pylori) and ulcers, concluding that the bacterium, not stress or diet, causes ulcers. The medical community is slow to accept their findings. In 1994, a National Institutes of Health Consensus Development Conference (NIHCPC) in United States of America, concludes that there is a strong association between H. Pylori and ulcer disease; and recommended that ulcer patient, with H. pylori infection be treated with antibiotics. The road to a cure for ulcers has been a long and bumpy one. Recent news that ulcers are caused by a bacterium and can be cured with antibiotics has changed traditional thinking. Physicians and consumers have not been informed of the good news. Certain behaviors and factors increase the chances of developing a stomach ulcer these include frequent steroid usage; smoking, excess calcium consumption, or over producing – hypercalcema, genetics, consuming alcohol frequently. Age – ulcers are more common in individuals over 50. People of any age can develop a stomach ulcer but they are much less common in children. The risk in children is higher if their parents smoke. The exact cause of peptic ulcers is not understood. It is thought that any small cut or tear in the lining is eroded and deepened by the action of the digestive juices. But why these ulcers do not occur more often (when such a cut or tear is likely to happen to all of us at one time or another), and why the erosion works through but not right across the surface, is just not known.
Some things are known to increase the likelihood of developing a peptic ulcer. These include: living under considerable stress, drinking large amount of alcohol, eating rich food, having excess acidity of the stomach, suffering frequent stomach or intentional infection, being of blood group “O”, having a family history of ulcers and being of “ personality Type A.” A class of painkillers called, Non-Steroidal Anti-Inflammatory Drugs (NSAID), also exacerbates peptic ulcer. The fact that women are much more likely to develop gastric ulcers after menopause suggests that the female hormones, estrogen may have some preventive value. The symptom of peptic ulcer include pain in the upper abdomen called epigastrum, which gets worse when the stomach is empty and can often be relieved by taking more food . There is also tenderness in the area of pain. Indigestion, nausea and vomiting may occur. There may be bloating, heartburn and loss of appetite. In some cases, the symptoms may include dark or black stool. Other symptoms are vomiting blood or material that can look like coffee grounds and weight loss. Children and the elderly may have no symptoms at all. In these instances, ulcers are discovered only when complications develop. Only about half the people with duodenal ulcers have typical symptoms, gnawing, burning, aching, soreness, an empty feeling, and hunger. The ulcer usually does not hurt on awaking, but pain develops by midmorning. The pain is steady and mild or moderately severe, and it is located in a definite area, almost, always just below the breast bone. Drinking milk, eating or taking antacids generally relieves the pain, but it usually returns after two or three hours later. Pain that awakens the person at 1.00am or 2.00am is common. Frequently the pain erupts once or more a day over a period of one to several weeks and then may disappear without treatment. However, pain usually recurs, often within the first two years and occasionally after several years. People generally develop patterns and often learn by experience when a recurrence is likely. A doctor thinks of ulcer when a patient has a characteristic stomach pain. Test may be needed to confirm the diagnosis because gastric cancer can cause similar symptoms. Also when severe ulcers resist treatment, particularly if a person has several ulcers or they are in unusual places, a doctor may suspect other underlying conditions that cause the stomach to over produce acid. To help diagnose ulcers and identify their underlying cause a doctor may use endoscopy, barium contrast, x-rays, gastric analysis and blood tests.
Bed rest is needed and use of antacids to neutralize the stomach juices. Diet should be controlled; rich strong aggravating diets should be temporarily stopped. Alcohol, strong tea and coffee must be temporarily avoided. Frequent snacks of soft bland food are taken, so that patient is eating about every two hours this also helps to reduce stomach acidity.
If the ulcer does not improve, surgery may be needed. With a stomach ulcer the part of the stomach containing the ulcer is removed. With duodenal ulcers, the amount of gastric juice reaching the ulcer is reduced. This may be done by cutting some of the nerves that trigger gastric acid production or removing a part of the stomach where production occurs or diverting the outflow past the ulcer.
To differentiate between duodenal and gastric ulcer, these points must be noted. Three hours after meals. It is made better by food vomiting is rare, and appetite is good. In gastric ulcer the pain occurs 30 minutes to two hours after meals, it is not made better by food, vomiting is common, and appetite is not very good. The dangers of persistent peptic ulcer are that perforation occurs when the ulcer eats right through the stomach or duodenal wall. This need not happen because there is a continual laying down of scar tissue during the process of erosion.
Obstruction: Peptic ulcers may block the passage of food through the stomach and, or duodenum, by causing swelling or muscular spasms. This is cured by administering special food intravenously, in the hope that the obstruction dies down when irritation is removed. If this fails surgery is needed.
Hemorrhage occurs when a blood vessel is ruptured by the ulcer. Blood is vomited, or passed in the faeces (black tarry stool). If the bleeding cannot be controlled within 24 hours, surgery will be needed.
Always be medically guided.
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