Much of what we used to believe about peptic ulcers turns out to be wrong. In place of yesterday's bland diets (including plenty of milk), antibiotics and acid-reducing drugs are now the first line of attack against this common digestive ailment.
A peptic ulcer is an open sore in the lining of your stomach or duodenum (the upper part of your small intestine). It's immediate cause is your own digestive juices--hydrochloric acid, an enzyme called pepsin and other chemicals your stomach secrets to break down food (see illustration below). Even though these juices are as corrosive as car battery acid, the linings of your intestine and stomach usually are protected by a layer of mucus and other defences. But if those defences fail, you may get an ulcer, which most commonly announces itself with bouts of gnawing pain in your upper abdomen.
In 70 to 90 percent of cases, the culprit is Helicobacter pylori bacteria. Many people harbour this organism, but experts believe certain genetic and lifestyle factors, as well as immune system abnormalities, can make H. pylori harmful for some individuals. The bacteria burrow into your stomach lining, wreaking havoc by thinning the protective mucus and causing inflammation. The second most frequent cause of ulcers is the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which disrupt the stomach's anti-acid defence system. Ulcers afflict about 30 percent of the population at some point. They are more common in certain ethnic groups, especially Chinese, Vietnamese and Japanese.
LIKELY FIRST STEPS
Not so long ago, an ulcer was generally viewed as a life sentence, manageable with antiacids and diet but not curable.
The prognosis changed dramatically in 1994, when the medical establishment accepted the key role played by H. pylori. If it's causing your ulcer, your doctor will treat you with drugs that eliminate the bacteria. Under this regimen, you should begin to feel better in just a few hours, and your ulcer should heal fully within a month of killing off the bacteria. Sometimes a follow-up test is suggested to confirm that all the bacteria are gone. (For ulcers caused by NSAIDs see box on shortly).
Medications
H. pylori is one tough bug, so you'll need more than a single drug to wipe it out and repair the damage it has done. Commonly treatment is prescribed as a combination of drugs (Pylorid-KA Compliance, Losec HP 7, Klacid HP 7). All these drug regimens to treat ulcers contain two antibiotics, taken together for seven days. Your doctor may prescribe a broad-spectrum penicillin
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Oral antibiotics Two are prescribed for greatest effectiveness.
------------------------------------------------------------------------------------------------------------------------------------------
PPIs/H2 blockers Cut down on stomach acid secretion.
-------------------------------------------------------------------------------------------------------------------------------------------
Bismuth Protects against acid and bacteria.
Contrary to yesteryear's conventional wisdom, doctors now believe that a bland diet is no help against ulcers, that frequent small meals are no better than full ones a day and that milk stimulates rather than protects against acid secretion. What to do in the face of changing advice? Stick with the following sensible strategies:
NSAID-induced ulcers
-----------------------------------------------------------------------------------------------------------------------------------------
Nonsteroidal anti-inflammatory drugs (NSAIDs)--aspirin, ibuprofen (Nurofen) and naproxen (Aleve, Naprogesic)-- are a boon to people with chronic pain conditions. But they are also the second most common cause of ulcers, especially stomach ulcers: 15-30% of chronic NSAID users develop ulcers. To help:
Up to 15% of people with ulcers have some bleeding. This is more likely to happen if NSAIDs, not H. pylori, induced the condition. If your bleeding is chronic and hidden, the only indications you may have are the symptoms of anaemia, such as fatigue and shortness of breath. Let your doctor know if you suspect bleeding, even though it usually stops spontaneously. Severe bleeding is a different story. Signs are tarry or bloody stools, and vomit with blood or what looks like coffee grounds. For this you'll need immediate emergency care. The bleeding can often be stopped with endoscopic treatment, in which a surgeon uses heat, electricity or medications, delivered via a lighted telescopelike tube.
If you have symptoms of complications, you may need an endoscopy, in which a long, flexible viewing tube is passed down your digestive tract and repairs are made. Traditional surgery is reserved for uncontrolled bleeding, a blockage (obstruction) or a deep ulcer that causes intestinal contents to spill into your abdomen.
Natural methods
Studies show that deglycyrrhisinated licorice (DGL), a liquorice derivative, has ulcer-healing properties. Take tablets or tincture according to the manufacturer's label instructions. Use for about three months to maximise healing.
What is happening
A peptic ulcer is an open sore in the lining of your stomach or duodenum (the upper part of your small intestine). It's immediate cause is your own digestive juices--hydrochloric acid, an enzyme called pepsin and other chemicals your stomach secrets to break down food (see illustration below). Even though these juices are as corrosive as car battery acid, the linings of your intestine and stomach usually are protected by a layer of mucus and other defences. But if those defences fail, you may get an ulcer, which most commonly announces itself with bouts of gnawing pain in your upper abdomen.
In 70 to 90 percent of cases, the culprit is Helicobacter pylori bacteria. Many people harbour this organism, but experts believe certain genetic and lifestyle factors, as well as immune system abnormalities, can make H. pylori harmful for some individuals. The bacteria burrow into your stomach lining, wreaking havoc by thinning the protective mucus and causing inflammation. The second most frequent cause of ulcers is the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which disrupt the stomach's anti-acid defence system. Ulcers afflict about 30 percent of the population at some point. They are more common in certain ethnic groups, especially Chinese, Vietnamese and Japanese.
- Antibiotics to fight H. pylori bacterial infection.
- Other medications to reduce digestive acids and promote healing.
- Moderation in diet and other lifestyle changes.
- Abstinence from alcohol and aspirin and other NSAIDs, especially if ulcer is caused by these drugs.
QUESTIONS TO ASK
- Should I make any major changes to my eating habits?
- I've been taking a daily dose of aspirin to help me with heart disease. Should I continue to do so?
- Does having H. Pylori put me at risk for stomach cancer?
- Will I need follow-up testing to make sure the ulcer has healed? How will I know that the bacteria have been killed?
Treatments
Not so long ago, an ulcer was generally viewed as a life sentence, manageable with antiacids and diet but not curable.
Medications
H. pylori is one tough bug, so you'll need more than a single drug to wipe it out and repair the damage it has done. Commonly treatment is prescribed as a combination of drugs (Pylorid-KA Compliance, Losec HP 7, Klacid HP 7). All these drug regimens to treat ulcers contain two antibiotics, taken together for seven days. Your doctor may prescribe a broad-spectrum penicillin
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Oral antibiotics Two are prescribed for greatest effectiveness.
------------------------------------------------------------------------------------------------------------------------------------------
PPIs/H2 blockers Cut down on stomach acid secretion.
-------------------------------------------------------------------------------------------------------------------------------------------
Bismuth Protects against acid and bacteria.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Eat & drink moderately Keeps stomach pain at bay.
----------------------------------------------------------------------------------------------------------------------------------------------
Avoid NSAIDs Can cause and/or aggravate certain ulcers.
---------------------------------------------------------------------------------------------------------------------------------------------
Eat & drink moderately Keeps stomach pain at bay.
----------------------------------------------------------------------------------------------------------------------------------------------
Avoid NSAIDs Can cause and/or aggravate certain ulcers.
PROCEDURES---------------------------------------------------------------------------------------------------------------------------------------------
Endoscopy Detects and treats complications.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Liquorice Deglycyrrhisinated (DGL) promotes healing.
called amoxycillin with clarithromycin (Klacid), a new macrolide antibiotic. Metronidazole (Flagyl) can also be paired with amoxycillin or clarithromycin. Antibiotics can cause intestinal queasiness, but it's important to tough it out and to stay on them so that your ulcer will heal completely.
In addition, the combination treatment you will be given will contain a drug that cuts down on the acid your body secretes. The preferred medication of this type is a proton pump inhibitor (PPI).
There are five PPIs: omeprazole (Losec, Acimax), rabeprazole (Pariet), esomeprazole (Nexium), lansoprazole (Zotion) and pantoprazole (Somac). All suppress acid production by turning off the molecular pumps that secrete acid into your stomach. A somewhat less effective alternative is an H2 blocker, such as famotidine (Pepcid), cimetidine (Tagamet) or ranitidine (Zantac). These block the body chemical that triggers acid secretion.
Your doctor may also recommend a fourth drug, one that helps your intestinal lining protect itself against acid and bacteria. (Some doctors use this group of drugs instead of a proton pump inhibitor or H2 blocker). Sucralfate (Carafate) sticks to the ulcer and shields it from further damage; bismuth (Pepto-Bismol) coats the stomach lining with an antimicrobial substance. For short-term relief, you might take a nonprescription antacid, such as Mylanta (aluminium and magnesium combinations), which neutralises digestive acids. You should check with your doctor or pharmacist first: antacids can interfere with some prescription drugs if taken simultaneously.
TAKING CONTROL
Endoscopy Detects and treats complications.
NATURAL METHODS
-----------------------------------------------------------------------------------------------------------------------------------------------
Liquorice Deglycyrrhisinated (DGL) promotes healing.
called amoxycillin with clarithromycin (Klacid), a new macrolide antibiotic. Metronidazole (Flagyl) can also be paired with amoxycillin or clarithromycin. Antibiotics can cause intestinal queasiness, but it's important to tough it out and to stay on them so that your ulcer will heal completely.
In addition, the combination treatment you will be given will contain a drug that cuts down on the acid your body secretes. The preferred medication of this type is a proton pump inhibitor (PPI).
There are five PPIs: omeprazole (Losec, Acimax), rabeprazole (Pariet), esomeprazole (Nexium), lansoprazole (Zotion) and pantoprazole (Somac). All suppress acid production by turning off the molecular pumps that secrete acid into your stomach. A somewhat less effective alternative is an H2 blocker, such as famotidine (Pepcid), cimetidine (Tagamet) or ranitidine (Zantac). These block the body chemical that triggers acid secretion.
Your doctor may also recommend a fourth drug, one that helps your intestinal lining protect itself against acid and bacteria. (Some doctors use this group of drugs instead of a proton pump inhibitor or H2 blocker). Sucralfate (Carafate) sticks to the ulcer and shields it from further damage; bismuth (Pepto-Bismol) coats the stomach lining with an antimicrobial substance. For short-term relief, you might take a nonprescription antacid, such as Mylanta (aluminium and magnesium combinations), which neutralises digestive acids. You should check with your doctor or pharmacist first: antacids can interfere with some prescription drugs if taken simultaneously.
TAKING CONTROL
- Consider endoscopy if your symptoms don't improve . Other signs that would suggest you need this investigation include weight loss, loss of appetite, if you are anaemic or if you have suddenly developed these symptoms and you are over 40 years of age.
- Speak up if your stomach still hurts. If your treatment doesn't make your symptoms disappear, tell you doctor. Your ulcer may have failed to heal, or you may have an altogether different medical problem. H pylori is stubborn, and about 10-20% of patients need a second course of antibiotics to beat it.
Contrary to yesteryear's conventional wisdom, doctors now believe that a bland diet is no help against ulcers, that frequent small meals are no better than full ones a day and that milk stimulates rather than protects against acid secretion. What to do in the face of changing advice? Stick with the following sensible strategies:
NSAID-induced ulcers
-----------------------------------------------------------------------------------------------------------------------------------------
Nonsteroidal anti-inflammatory drugs (NSAIDs)--aspirin, ibuprofen (Nurofen) and naproxen (Aleve, Naprogesic)-- are a boon to people with chronic pain conditions. But they are also the second most common cause of ulcers, especially stomach ulcers: 15-30% of chronic NSAID users develop ulcers. To help:
- Discontinue the offending NSAID. An NSAID-induced ulcer will usually heal once the problem medication is stopped. If a complete break isn't possible, at least lower the dosage.
- Switch to a different pain reliever. Paracetamol is better for the stomach, but it won't reduce inflammation. COX-2 inhibitors, such as celecoxib (Celebrex) and rofecoxib (Vioxx), are prescription NSAIDs, with less likelihood of hurting the digestive tract. Check with your doctor for what's best for you.
- Reduce acid with proton pump inhibitors, H2 blockers or antacids, Bismuth or sucralfate protect the stomach as it heals.
- Try misoprostol (Cytotec) to prevent a recurrence if you must continue NSAIDs. This drug works by increasing your levels of prostaglandin, a protective substance in your stomach lining.
Up to 15% of people with ulcers have some bleeding. This is more likely to happen if NSAIDs, not H. pylori, induced the condition. If your bleeding is chronic and hidden, the only indications you may have are the symptoms of anaemia, such as fatigue and shortness of breath. Let your doctor know if you suspect bleeding, even though it usually stops spontaneously. Severe bleeding is a different story. Signs are tarry or bloody stools, and vomit with blood or what looks like coffee grounds. For this you'll need immediate emergency care. The bleeding can often be stopped with endoscopic treatment, in which a surgeon uses heat, electricity or medications, delivered via a lighted telescopelike tube.
- Eat in moderation. Don't superize your meals; stretching your stomach can cause pain. And skip foods that make you feel worse.
- Choose foods rich in flavonoids, which may inhibit H. pylori. These include cooked apples and onions, and cranberry juice.
- Watch that you drink. Limit caffeinated beverages and acidic juices. Avoid alcohol; it irritates the stomach's mucosal lining.
- Don't smoke. Smoking delays the healing of ulcers because it stimulates the secretion of stomach acid.
- Avoid aspirin and other NSAIDs unless needed for preventing blood clots. They eat away the body's natural protective barriers.
- Practise good hygiene. H, pylori can be transmitted through stool, so always wash your hands after bowel movements.
- Reduce stress. Being a Type A personality can keep an ulcer from healing. Look into relaxation techniques if stress is an issue for you.
- An oral vaccine now in clinical trials has shown promise in immunising people against H. pylori. known as Helivax, the vaccine is being developed by Antex, a US biotech company. If successful, it comes not a moment too soon. Some strains of the ulcer-causing bacteria are starting to show resistance to the antibiotics commonly used to treat them.
If you have symptoms of complications, you may need an endoscopy, in which a long, flexible viewing tube is passed down your digestive tract and repairs are made. Traditional surgery is reserved for uncontrolled bleeding, a blockage (obstruction) or a deep ulcer that causes intestinal contents to spill into your abdomen.
Natural methods
Studies show that deglycyrrhisinated licorice (DGL), a liquorice derivative, has ulcer-healing properties. Take tablets or tincture according to the manufacturer's label instructions. Use for about three months to maximise healing.
No comments:
Post a Comment