Ulcers
Ulcers
New Causes, New Cures
The way digestion normally works, you chew and swallow your food, and it travels from your esophagus to your stomach. There the food is digested by hydrochloric acid and an enzyme called pepsin.
After that, food goes into the upper part of your small intestine (called the duodenum), where digestion continues.
When you have an ulcer, a sore forms in the lining of your stomach or duodenum, where acid eats away at your stomach lining. Though men traditionally were thought to develop more ulcers than women, the numbers are approximately equal, though no one knows for sure why, says Marie L. Borum, M.D., assistant professor of medicine in the Division of Gastroenterology and Nutrition at George Washington University Medical Center in Washington, D.C. Women are more likely to get stomach (gastric) ulcers; men are more likely to get duodenal ulcers (or ulcers in the duodenum).
The most common ulcer symptom is a gnawing or burning pain in the abdomen between the breastbone and the navel, occurring most often between meals and in the early morning hours.
THE INVASION OF THE SPIRAL-SHAPED BACTERIA
How and why does acid cause the inflammation that we call an ulcer? For years doctors thought that the acid erosion was caused by a rich diet, spicy foods, alcohol, smoking cigarettes or maybe stress. Now, research shows that a spiral-shaped bacteria called Helicobacter pylori (H. pylori) may also have a role in the development of ulcers.
Researchers know that H. pylori is an airborne bacteria, but they don't yet know where the bacteria come from or how infection occurs, says Melissa Palmer, M.D., a gastroenterologist in private practice in New York City. Researchers believe that ulcers develop when the bacteria penetrate the digestive tract's protective lining and settle in the stomach or small intestine, making the cell lining more susceptible to the damaging effects of acid and pepsin.
Ulcers not caused by H. pylori generally are caused by aspirin and nonsteroidal anti-inflammatory agents such as ibuprofen, says Barbara Frank, M.D., gastroenterologist and clinical professor of medicine at Allegheny University of the Health Sciences MCP-Hahnemann School of Medicine in Philadelphia.
Acid can be neutralized with antacid medication. Acid production can be reduced with over-the-counter H2 (histamine 2) blockers, which suppress the release of histamines, such as Tagamet HB and Pepcid AC. Both suppress acid at the pathway where most of it is made (the "histamine pathway"), says Dr. Borum.
If you've been diagnosed with an ulcer, it's important that your doctor determine whether H. pylori is present. When H. pylori infection is certain, a course of antibiotic treatment is prescribed, in combination with drugs that suppress gastric acid, to heal ulcers while reducing risk of ulcer recurrence. The great news: "Antibiotic treatment cures ulcers, so there is no longer any such thing as a chronic ulcer," says Dr. Palmer. Evidence from the United States and Europe has shown that the use of antibiotics can heal ulcers caused by H. pylori and prevent their recurrence in about 90 percent of the cases.
CODDLE YOUR STOMACH
That said, women doctors say that there may be a few lifestyle changes that women diagnosed with ulcers can and should make to quicken the healing of an ulcer and lessen the chances of a flare-up.
Shun caffeine and citrus. These can slow the healing rate of existing ulcers, says Dr. Borum. Though experts no longer think that specific
foods cause ulcers, you should still avoid foods that may aggravate symptoms, like coffee, citrus foods and juices.
When To See A Doctor See your doctor if you experience: * Severe pain between your breastbone and navel, especially between meals or early in the morning * Blood in your stool * Unexplained nausea * Vomiting * Weight loss * Loss of appetite
Maybe you have an ulcer, and maybe you don't. A doctor can sort it out.
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For aches, pains or headaches, stick to acetaminophen. If you can avoid it, don't take aspirin, says Dr. Frank. That's because those ulcers not caused by H. pylori are now associated with aspirin and other nonsteroid painkillers such as ibuprofen.
Put out your butts. "Cigarette smoking increases your chances of getting an ulcer," Dr. Palmer says. Tobacco simultaneously impairs your digestive system's protective lining and stimulates the production of acid. Smoking also slows the healing of existing ulcers and contributes to their recurrence.
Drink Virgin Marys. "Alcohol inflames your stomach lining, which will irritate existing ulcers and may help cause them," says Dr. Palmer.