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BN Doctors’ Lounge: Peptic Ulcer Disease

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Black doctorsWhat is Peptic Ulcer Disease?
Breaking down your eba and edikaikong (or steak and mashed potatoes) into the basic nutrients that can be used by your body is pretty hard work and is the job assigned to an impressive array organs collectively referred to as the Gastrointestinal Tract (GIT).

This breakdown of food requires the use of powerful ‘digestive juices’ which are produced throughout the gastrointestinal tract. One of these juices- Gastric Acid is mostly comprised of pure concentrated hydrochloric acid and at its maximum secretion the acidity in the stomach is at least 3 million times greater than the surrounding tissues and organs.

Gastric acid in conjunction with the enzyme Pepsin (not to be confused with the cola drink) is so powerful that it is capable of liquefying a solid slab of beef within minutes.

Have you ever wondered what stops the stomach from digesting itself? Well, the stomach and duodenum (the first few inches of the small intestines) cleverly protect themselves from auto digestion by:

Using a thicker reinforced kind of cell in their inner lining (tall columnar cells instead of flat epithelial cells)
Coating their inner walls with an acid resistant layer of mucus
Tightly regulating the concentration of the acid produced in the stomach
Limiting the duration of contact time between the acid and the organs
And in the case of the duodenum producing an ‘alkaline’ solution to neutralize the acid coming from the stomach

Peptic ulcer disease occurs when these protective mechanisms fail and gastric acid begins to digest the walls of the stomach or duodenum. *Ouch!* :’(

What Causes PUD
Anything that strips away the acid resistant mucus coating of the stomach will most likely lead to ulcer formation. The most implicated substances are Aspirin (and other aspirin like drugs called NSAIDs), Cigarette smoke and Alcohol. In addition any condition that causes gastric acid to stay in contact with the stomach lining for longer than necessary (delayed gastric emptying) will also predispose a patient to ulcers.

Some people produce more acid in their stomachs than others. If you have a genetic predisposition to hyperacidity, you could be more likely to develop ulcers.

The most common cause of ulcers in the stomach and small intestine is an infection with the bacteria called Helicobacter pylori. Once in the host’s body, the bacteria burrow past the stomach’s protective lining in search of food and as it digs in, it takes with it pools of acid. Over 90% of patients with duodenal ulcer and 70% of patients with gastric ulcer have a confirmed infection with H. pylori.

Symptoms of a PUD
It is important to know that each patient will have their own peculiar set of symptoms and severity. In some patients symptoms may last for an hour or two while in others it can go on for days or weeks. Generally however, patients describe a burning, peppery or chewing pain anywhere in their tummy but usually between the navel and the breastbone. Depending on how deep the ulcer has eaten, the patient may also feel pain at the back or shoulder.

Acid is released into the stomach when a person is about to eat and throughout the time they are eating, and so some patients feel pain just before they eat, during meals or immediately after eating. But acid can also collect in the stomach if a person has gone for hours without food so others feel pain only when they are hungry.

Patients in the first category may loose appetite for food completely in a bid to avoid the pain and as a result present with weight loss. Patients in the second category may tend to over eat to prevent the onset of pain and as a result present with excessive weight gain.
Some patients feel bloated or nauseated and may vomit.
More serious symptoms include –
Vomiting blood or passing brownish-red stool and this occurs when the acid erodes into a blood vessel causing intestinal bleeding.
Sudden severe abdominal pain and abdominal rigidity sometimes accompanied by loss of consciousness. This is caused by the ulcer perforating the entire thickness of the gastrointestinal wall and causing spillage of gastric contents into the abdominal cavity.

Did that sound like you? Oya, Hospital! Quick!

How Can the Doctor Be Certain I Have PUD?
In addition to symptoms and signs elicited on physical examination, your doctor will want to confirm the diagnosis of PUD by requesting a test for H.pylori. Also, your doctor can request for an Endoscopy which is a test where a small camera on a flexible tube is put into the stomach through the mouth to visually inspect the ulcer.

Can It Be Treated?
Most uncomplicated ulcers can be treated fairly easily and with proper care should heal within a week or two. Your doctor will prescribe an antibiotic to clear out the H.pylori infection, give you a drug that covers the stomach and small intestine with a protective acid resistant coating and then another drug to reduce the activity of the acid producing cells in the stomach. This is called the ‘Triple Therapy
Other drugs that neutralise the hydrochloric acid in the stomach (antacids) are also useful.
Complicated ulcers that have begun to bleed or have perforated the stomach or intestinal wall would require surgical repair.

How Do I Prevent Further Episodes?
The most common cause of relapse in my experience is FAILURE TO COMPLETE THE DRUG DOSE. It doesn’t matter if you feel better after two days on your triple therapy. Keep taking it for the duration prescribed by your doctor.

Common Triggers
Some of the most commonly reported triggers in no particular order are:
Peppery or spicy foods
Cigarette smoking
Alcohol
Plantain
Cassava based foods
Gym workouts
Anger
Stress
Hunger
Aspirin and NSAIDs like Feldene™, Ibuprofen™ etc.

Patients ask me about drinking milk to stop an acute ulcer attack, in my opinion it does not work as well as an antacid would. Carry a small bottle of antacid with you for those unexpected episodes of ulcer pain.

In a Nutshell
Peptic ulcer disease is caused by a disruption in the auto-digestion protective mechanisms in the stomach and duodenum. The most common cause is an infection with Helicobacter pylori which burrows into the gastrointestinal walls taking digestive juices with it. The standard treatment for uncomplicated cases is the ‘triple therapy’ while complicated cases may require surgery.

If you suspect you have PUD, please see a physician.

Did You Know?
Intensely emotional people are said to be more likely to have ulcers. The vagus nerve which originates in the brain is responsible for acid secretion in the stomach and it can also be triggered by feelings of intense emotion including anger, jealously and believe it or not love (ever heard of butterflies in the tummy?). These strong emotions trick the vagus into activating acid secretion in the stomach causing transient or persistent hyperacidity.

Disclaimer: This article is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.
Photo Credit: 123rf.com
________________________________________________________________________________
David Olamide Craig is a Physician, Pastor, Photographer, Poet and Playwright. He graduated Bachelor of Medicine and Bachelor of Surgery from the University of Ibadan and holds a Masters in Occupational Health from the Institute of Occupational and Environmental Medicine, University of Birmingham. He is passionate about healthy living and sustainable energy.
When he is not seeing patients, Dr. Craig spends his time stretched out on his favourite couch, reading books, magazines, and blogs.
Catch him on www.ijgb.com.ng and follow him on twitter @RevDrCraig

David Olamide Craig is a Pastor, Physician, Sex Educator and Relationship counsellor. Follow him @RevDrCraig or visit www.surulerelove.com

18 Comments

  1. Aibee

    March 19, 2013 at 3:29 pm

    Very educating piece. Thank you BN and Dr. Craig.
    BN, can we make this a regular feature, more regular than BN Cuisine. As regular as the Celebrity Interview – say like once a week? Thank you BN. I love you guys.

  2. theKekere!

    March 19, 2013 at 3:46 pm

    Story of my life! The worst pain and discomfort ever!

  3. loreben

    March 19, 2013 at 4:11 pm

    Yay! BN, please make this a permanent segment on your blog. So you can help educate your readers on various health related issues which can help/improve the current lifestyle of your readers 🙂

  4. kesh

    March 19, 2013 at 4:34 pm

    I am glad you guys are doing this health aspect of your blog it is highly needed.

  5. Dee

    March 19, 2013 at 4:35 pm

    Me too, I tend to avoid food sometimes so thanks so much for the added information. Hopefully with this knowledge I won’t suffer as much again.

  6. dobby

    March 19, 2013 at 4:40 pm

    luvly info! Very informative too …..Bookmarking this page

  7. noni

    March 19, 2013 at 4:56 pm

    great section keep it up.

    Thanks Dr Craig- very informative

  8. linda

    March 19, 2013 at 5:00 pm

    thanks Doc, i am a PUD patient and taking antacid and abstinence from alcohol has really help me recover fast. thanks for the info.

  9. Numb my

    March 19, 2013 at 5:22 pm

    Mine was brought on by a freakin diet pill…and now I live on anti-acids!

  10. Ms. Jayee

    March 19, 2013 at 5:25 pm

    Good piece. Can BN Doctor’s Lounge discuss Urinary Tract Infection or Bladder Pain next ?

  11. Pharm

    March 19, 2013 at 7:18 pm

    Dear Dr,
    Thank you for your informative post. I believe you mean “failure to complete the course” rather than dose. In addition, ibuprofen is not a trademark but the actual drug name. Brands include Nurofen, Anadin, Brufen, Advil and many more.

    • Dr. Craig

      March 20, 2013 at 2:14 am

      Dear Pharm,

      Corrections gratefully taken. Thank you for looking out for the team.
      Warm regards,

      Dr.Craig

  12. concerned

    March 19, 2013 at 11:49 pm

    Comment for the “treatment section”…..Dr Craig says “your doctor will prescribe an antibiotic” please note this is not the case with all PUD.Only need this if there is a positive result for H.pylori. Also heartburn can also be a symptom for other diseases….please always see a good doctor for reliable diagnosis. Good article but u dont want everyone going to their doctors demanding antibiotics after reading this……Trained medical doctor working in the UK! : )

    • Dr. Craig

      March 20, 2013 at 2:11 am

      Hello My dear colleague in the UK,

      Heart Burn is classified under a different category called Gastro Esophegeal Reflux disease, (GERD) and is outside the scope of this article.
      Treatment protocol in Nigeria for PUD (which this article is about) consists of Triple therapy as first line. As you should be aware, local protocols based on local patterns of H.pylori infection are the recommended WHO guideline. Furthermore, I am not aware of any 2013 alterations to the UK Oxford protocol on PUD, but the October 2012 revision clearly states (evidence based medicine) that eradication of Helicobacter Pylori will cure a large percentage of all Ulcers. I can understand your reservations on antibiotic prescription, but MRSA is not as big an issue here as it is in the UK.
      Also, as was clearly stated in the disclaimer, this article is written for patient education and does not attempt to cover the full scope of this condition. I could not possibly begin to elucidate on the H.pylori positive/negative, NSAID positive/negative classification of ulcers or cover extensively Zollinger Ellison syndrome and other rarer causes of PUD.

      BN readers are please encouraged to discuss whatever treatment protocols they may have learnt from this and other articles with their physician, even if it means the doctor having to explain why such and such treatment modality is not suited for you. In my experience, an educated and informed patient is often the most satisfying to treat.

      Dr.Craig

      1
  13. Emmz

    March 20, 2013 at 10:07 am

    Thank you Dr Craig. This is a very informative piece. We can like to have this feature every week, to continually inform us on healthy living. I have ulcer and the main triggering agents are my emotions and stress(my body can’t take too much hardwork at a time so I get stressed out). It hurts so much that the pain gets to the back and shoulders. I’ve been on the triple therapy but to be honest, it didn’t improve.(took about 3 antibiotics at that time). Afterwards I promised myself to not take any more of those antibiotics cos they knocked me off the entire month(too strong for me). So I’m basically controlling it with my lifestyle change and antacids( with calcium, magnesium don’t work for me). This is the most annoying pain ever cos its burning. Anyway, emough with the lamenting and back to work. Yawn yawn yawn!

  14. Ides of March

    March 23, 2013 at 4:51 am

    Yup, i had a terrible case of PUD and had to have surgery. They used lasers to cauterize the perforations in my stomach, good thing i was passed out.

  15. Bee

    April 24, 2017 at 2:38 pm

    treating H pylori currently and its the worst pain ever..need advise though on what foods to consume, my second week of treatment on the pylo kit but theres still that burrowing pain..any suggestions please

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