All you need to know about ulcer

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By Joel Kosisochukwu

Ulcer is something almost everybody suffers from. Almost everyone entering the hospital, pharmacy or the chemist’s shop complains of ulcer. While trying to prescribe some drugs for you, the healthcare provider might generally ask questions like “Are you having ulcer? Have you had ulcer before?” and so on.
Let’s kick ulcer out!

Let us start by understanding the structure of the stomach. The stomach has four layers from the innermost to the outside, which are the mucosa, submucosa, muscularis externa, and serosa. The mucosal lining helps to protect the stomach and intestines from getting eroded or damaged by things entering the digestive tract, which is the major reason for ulcers.

An ulcer is a condition in which painful sores develop in the lining of the stomach or the first part of the small intestine, called the Duodenum. Sometimes, we hear different names associated with these ulcers, like Gastric ulcer, Duodenal ulcer, Peptic ulcer, Esophageal ulcer, etc. We shall get to understand what all these things mean.

Gastric ulcer refers to any ulcer that occurs in the stomach itself.
Duodenal ulcer refers to any type of ulcer that occurs in the first part of the small intestine, called the Duodenum.
Esophageal ulcer refers to any ulcer that occurs at the junction of the stomach and the esophagus, a bit above the stomach.
Peptic ulcer is sometimes used interchangeably with Gastric ulcer.

Like every other disease or infection in the body, ulcers too have their symptoms. The most prominent among many others are as follows:
• Dull or burning pain in the stomach. In most cases, the pain worsens when the stomach is empty and seems to improve when the patient eats.
• Heartburn
• Indigestion
• Bloating
• Burping or Acid reflux (this is also called Gastroesophageal Reflux Disease)
• Weight loss
• Feeling sick in the stomach
• Black stool, etc.
A patient might observe all these symptoms while some others might only notice a few of them.

The causes of ulcers are associated with a lot of things, which may specifically cause or accelerate the development of ulcers. Some of the most important include:

  1. Helicobacter pylori: The leading cause of stomach ulcers are bacteria called Helicobacter pylori. They grow and thrive more in an environment that lacks oxygen. These bacteria live in the stomach and they have enzymes called ‘ureases’ which help them withstand the harsh acidic condition of the stomach by neutralizing the gastric acid.
    They attack the protective mucosal lining of the stomach, thus exposing the inner surface of the stomach to the acid and causing erosion and injury. The exact mode of contracting this particular infection is not clear yet, but scientists and medical experts believe that it can be transmitted from one person to another via saliva during kissing or through contaminated water and foods.
    Helicobacter pylori has been coexisting with humans for thousands of years and is thought to be contracted mainly during childhood. It is statistically estimated that about half of the world’s population lives with these bacteria. In some people there might be no signs of infection, while in some others, signs of infection may be detected.
  2. NSAIDs: This means ‘Non-Steroidal Anti-Inflammatory Drugs’. They refer to those pain killers we take often, like Diclofenac, Aceclofenac, Ibuprofen, Aspirin, etc. Taking such drugs without enough water or other fluids can cause ulcers, and taking high doses can speed up the rate at which ulcers develop, especially on an empty stomach. This is because they are capable of eroding the lining of the stomach.
  3. Alcohol: Too much intake of alcohol can be deadly. It damages the liver and causes a host of other health challenges. It also erodes the linings of the Stomach and Duodenum, thus making them very prone to the attacks of the gastric acid and bacteria. Taking alcohol on an empty stomach for a very long periods can cause ulcers.
  4. Smoking: Smoking tends to reduce the production of bicarbonates in the body, which help to balance the pH of the blood and various body organs. A reduced level of bicarbonates can increase the tendency of the stomach to produce more acids.
  5. Corticosteroid Drugs: Another cause of ulcers is the use of corticosteroid drugs like Dexamethasone and Prednisolone. They do not only cause ulcers; they also reduce the strength of our immune system. These types of drugs are mainly used for the treatment of Asthma, Arthritis, severe allergies, etc.
  6. Zollinger-Ellison Syndrome: This is caused by tumors in the digestive tract, called ‘Gastrinomas’. These tumors cause the excessive production of a hormone called ‘gastrin’, which basically directs the stomach to produce more acids. The increased production of the hormone causes the release of too much stomach acid, which can cause painful peptic ulcers in the stomach and intestinal linings. The tumors can also grow in the Pancreas, Duodenum or other organs.

Ulcers can be tested for in the laboratory. Whenever you notice any ulcer symptoms, it is very advisable that you meet your doctor, who will request for the appropriate laboratory test. Aside knowing that you have an ulcer, the cause of the ulcer should also be ascertained so as to select the best choice of treatment.

Ulcers, like many other diseases, are quite treatable once diagnosed. It should be noted that the treatment depends on the cause. Some would say that ulcers do not have specific drugs for treatment, but they actually do. However, the ulcers can return after a while, especially when one has the Zollinger-Ellison Syndrome. This is the reason why one’s lifestyle and use of medications is very important.

• If your ulcer is caused by the bacteria Helicobacter pylori, doctors usually recommend any of the antibiotics called ‘Macrolides’ like Clarithromycin or Azithromycin together with antiprotozoal drugs like Amoxicillin, Tinidazole or Metronidazole. Also, drugs called ‘Proton pump inhibitors’ like Omeprazole, Pantoprazole, Lansoprazole, etc and ‘Histamine blockers’ like Cimetidine, Ranitidine, etc can be used together with an antacid. The combination of the antibiotics and antiprotozoal drugs will help kill the bacteria, while the Proton pump inhibitors or histamine blockers combined with the antacids helps to reduce or inhibit the production of gastric acid.

• If the ulcer is caused by the use of NSAIDs, one is advised to discontinue such use and switch to other pain relief medications. High doses of these drugs are very dangerous as they can erode the stomach lining, especially when taken without meals or enough water. However, taking the appropriate dosage as prescribed can be helpful.

• If it caused by excessive intake of alcohol, smoking or incessant use of corticosteroid drugs, then such things should be discontinued immediately and treatment to correct the damage should be initiated.

Basically, there are three main categories for ulcer treatment medications. They include:
Triple therapy: The patient takes the antibiotic Clarithromycin, a Proton-pump inhibitor like Omeprazole, and either Metronidazole or Amoxicillin for 7-14 days.
Quadruple therapy: The patient takes a Proton-pump inhibitor called Bismuth subsalicylate together with Tetracycline and Metronidazole for 14 days.
Sequential therapy: The patient takes a Proton-pump inhibitor and Amoxicillin for 5 days, followed by another Proton-pump inhibitor, Clarithromycin, and Tinidazole for another 5 days.

• Avoid taking NSAIDs on an empty stomach. Take them with enough food and water.
• Take note of foods or drinks that worsen your ulcer and avoid them.
• Avoid smoking.
• Avoid too much intake of Corticosteroids.
• Avoid excessive intake of iron, salt or caffeine.
• Avoid too much intake of alcohol.
• Taking garlic and ginger may help cure the ulcer if it is caused by bacteria, as they contain phytochemicals called ‘Flavonoids’, which have antimicrobial properties.
• Take Vitamin A or foods that contain it. Research has shown that Vitamin A helps increase the production of mucus in the stomach.
• Take foods that are rich in fiber, like apples, carrots, nuts, etc.
• Drink a lot of yoghurt, as it contains probiotics. Probiotics are live microorganisms that are beneficial to human health.
• Avoid drinking too much milk. Milk may seem to reduce the pain, but it actually increases the production of stomach acid, which will eventually worsen the ulcer.
• Drink lots of water, as it is very helpful and does not have an overdose.
• Also pay enough attention to your body’s response to drugs and foods.

Stay safe and healthy always.

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