Ulcers (Peptic)

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is a peptic ulcer?

A peptic ulcer is an open sore in the lining of your stomach or duodenum (the upper part of your small intestine). Its immediate cause is your own digestive juices—hydrochloric acid, an enzyme called pepsin, and other chemicals your stomach secretes to break down food (see illustration below). Even though these juices are as corrosive as battery acid, the linings of your intestine and stomach usually are protected by a layer of mucus and other defenses. If those defenses fail, you may get an ulcer, which most commonly announces itself with bouts of gnawing pain in your upper abdomen.

In 70% to 90% of cases, the culprit is the 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 burrows 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 defense system.

Who is at risk for peptic ulcers?

Ulcers afflict about 1 in 5 men and 1 in 10 women at some point.

Treatment for peptic ulcers

Not so long ago, an ulcer was generally viewed as a life sentence. Antacids and diet might have managed it, but it couldn’t be cured. 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 days. 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.

Medications for peptic ulcers

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. Nearly all drug regimens to treat peptic ulcers begin with two antibiotics, taken together for 10 to 14 days. Your doctor may prescribe a broad-spectrum penicillin called amoxicillin with clarithromycin (Biaxin), a new macrolide antibiotic. (A cost-saving alternative is tetracycline, which also works well with amoxicillin.) Metronidazole (Flagyl) can also be paired with amoxicillin or clarithromycin. Antibiotics can cause intestinal queasiness. It’s important to tough it out and to stay on them so your ulcer will heal completely.

Your doctor will probably also want you to take a drug that cuts down on the acid your body secretes. The preferred (and most expensive) medication of this type is a proton pump inhibitor (PPI). There are five PPIs: omeprazole (Prilosec), rabeprazole (AcipHex), esomeprazole (Nexium), lansoprazole (Prevacid), and pantoprazole (Protonix). All suppress acid production by turning off the molecular pumps that secrete acid into your stomach. A somewhat less effective (and less costly) alternative is an H2 blocker, such as famotidine (Pepcid AC), 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 an OTC antacid, such as Maalox or Mylanta (aluminum and magnesium combinations), which neutralizes digestive acids. Check with your doctor or pharmacist first: Antacids can interfere with some prescription drugs if taken simultaneously.

Lifestyle Changes

Contrary to yesteryear’s conventional wisdom, doctors now believe a bland diet is no help against ulcers, that frequent small meals are no better than three squares 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:

• Eat in moderation. Don’t supersize your meals. Stretching your stomach can cause pain. 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 what you drink. Limit caffeinated beverages and acidic juices. Avoid alcohol: It irritates the stomach’s mucosal lining.
• Don‘t smoke. Smoking delays 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.
• Practice 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.

Related Procedures for Peptic Ulcers

If you have 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.

Alternative Therapies for Peptic Ulcers

Studies show that deglycyrrhizinated licorice (DGL), a licorice derivative, has ulcer-healing properties. Chew one or two DGL wafers of 380 mg each about 30 minutes before each meal. Use them for about three months to maximize healing.

Questions for Your Doctor

• Should I make any major changes in 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 the bacteria has been killed?

Living with Peptic Ulcers

If you have an ulcer, here are a few quick tips to help you take control:

• Consider prepackaged therapy if your drug regimen seems too complicated. In this approach, the medications you need to take are conveniently grouped together. One of these packages is Prevpac, which combines amoxicillin and clarithromycin (antibiotics) with lansoprazole (a proton pump inhibitor). Another is Helidac, which pairs tetracycline and metronidazole (antibiotics) with bismuth (a germ-fighter). Ask your doctor if one of these is right for you.
• Speak up if your stomach still hurts. If your treatment doesn’t make your symptoms disappear, tell your doctor. Your ulcer may have failed to heal, or you may have an altogether different medical problem. H. pylori is a stubborn bacteria. About 10% to 20% of patients need a second course of antibiotics to beat it.