Dr. Wojo. Healthy Living. Simplified.

One of my loyal readers and my current business trip to Dallas prompted today’s topic – ulcers.  Over the past two days, my cuisine has consisted of spicy Thai, Indian, and Mexican food.  People are always amazed at my preference and tolerance for spicy food because they associate spicy foods with ulcers.  Contrary to popular belief, spicy foods do not cause peptic ulcers.  If they did, I probably would be hospitalized.

Peptic ulcers are a common medical problem and a frequent diagnosis in the emergency department.  Patients can present with a variety of complaints, but the most serious is bleeding within the gastrointestinal tract.  Let’s take a good look at peptic disease.
What is peptic ulcer disease? In the United States, about 25 million people will suffer from an ulcer.  At any given time, about 4 million people are being treated for this problem.  Peptic ulcers occur in the stomach and the first part of the small intestine called the duodenum.

In someone suffering from ulcers, there is an imbalance between the aggressive and protective digestive chemicals within the gastrointestinal (GI) tract.  This leads to a breakdown of the lining of the stomach and intestines.  When this occurs, the lining becomes raw and fragile, eventually ulcerating to become a slow-healing sore.  If the ulcer, or sore, is near a blood vessel, rupture and severe bleeding will occur and can lead to a life-threatening event.

There are numerous risk factors.   One of the most common irritants to the GI tract is aspirin and non-steroidal anti-inflammatory drugs like ibuprofen.  Some people are very sensitive to these drugs and the process of taking just one dose might set off a cascade of internal events that lead to a significant health problem.

Other risk factors include smoking, caffeine and excessive alcohol intake.  In the recent past, research has shown that the bacteria Helicobacter Pylori (H. Pylori) cause ulcers. Stress has long been thought to be a cause, but there is no clear documentation of this. Cancer associated with an ulcer is a concern, especially if an ulcer does not heal.

What are the symptoms? Symptoms vary according to patient. Symptoms may include a gnawing pain in the abdominal area that usually worsens when hungry.  The pain may be present early in the morning or in the evening just prior to bedtime.  Some patients will notice relief from eating or using antacids.  Others may feel nauseated and may vomit.  There may also be blood in the vomitus.

More severe cases may present with no symptoms until severe bleeding occurs.  These patients may present to the emergency department feeling weak and looking pale due to the internal bleeding. They will usually have noticed black stools in the preceding days.  Black stools are a hallmark of a bleeding ulcer, but taking iron supplements will also turn stools black. Bleeding ulcers are a medical emergency and require prompt attention.

How are ulcers diagnosed and treated? If you suspect you have an ulcer, you should seek medical treatment.  Your health care provider will assess your symptoms and determine a diagnostic process.  A blood test can determine if you have H. Pylori. If positive, treatment will include antibiotics and stomach medications.

Many times, symptoms will be treated first with patient reassessment at a later date.  If there is a poor response to standard treatment, endoscopy will be recommended.  A Gastroenterologist – a physician specializing in stomach and intestine diseases – will pass a scope through the mouth into the stomach and first part of the small intestine to view the inside tract.  This is done while a patient is partially asleep and sedated. If there are ulcers, biopsies may be taken to check for cancer and H. Pylori.  Treatment will be determined on the basis of these tests.

Standard treatment begins with counseling a patient to avoid irritating factors.  Then, H2 blockers and proton pump inhibitor medications will be prescribed.  These medications are also available over the counter and known as Zantac and Pepcid, or Prilosec.  They each work by different mechanisms, but are quite effective.  Some patients may be committed to a life long course of therapy, but the situation must be monitored. Repeat endoscopy may be necessary to assess progress.

Again, if you have concerns about a peptic ulcer, you must seek medical attention.  This can be a serious illness that is simply treated.  Without attention, the condition may be life threatening.