An Introduction to Peptic Ulcers
Recently, a friend of mine hurt her back. Her doctor suggested she take ibuprofen and steroids to get rid of the pain. Unfortunately, the pain got worse and a new symptom arose: shortness of breath. Before she could get a x-ray to check for pneumonia and a CT scan to look at her back, her shortness of breath got worse, she was very pale and downright exhausted. These new symptoms got so bad she wound up in the ER and was told that if she had waited another day she’d be dead from a bleeding ulcer! How did her symptoms go from a sore back to a life threatening bleeding ulcer so quickly? - Probably the medications.
Peptic ulcers are very common. If a peptic ulcer is in the stomach it is generally called a gastric ulcer whereas a peptic ulcer in the beginning of the small intestines is known as a duodenal ulcer. Most ulcers only harm the first layer of stomach lining and generally heal on their own. They can however progress to the point of being very dangerous.
Symptoms of ulcers may include stomach pain, nausea, fatigue, heartburn, indigestion, chest pain and vomiting or diarrhea. If the bleeding is substantial the vomit and diarrhea will take on a wet coffee grinds appearance due to the digested blood present.
Ulcers can be caused by medications such as Non-steriodal anti-inflammatories (NSAIDs) or corticosteroids but the most common cause is a bacteria known as H-Pylori. It is important for the doctor to know the cause of the ulcer as the cause dictates treatment.
Many different things may done in order to evaluate the presence of an ulcer. In order to look directly at a suspected ulcer, an endoscopy will often be performed. During this procedure the patient is given sedation medication and then a thin camera is inserted down the esophagus to the stomach and into the small intestines. During the procedure tissue samples will be taken in order to help confirm the presence of H Pylori and to look at the severity of the damage. There are also stool and breath tests that can be done now to look for the presence of H Pylori if an ulcer is suspected and the doctor doesn’t feel an endoscopy is necessary. Blood work and stool samples will also be taken to check blood counts/confirm internal bleeding. All of these tests can also be used to rule out other conditions that may mimic the symptoms of an ulcer.
Treatment for an ulcer centers around getting the bleeding to stop and healing the ulcer. In my friend’s case, her ulcer was bleeding so profusely she needed blood transfusions while the doctors were evaluating the location and severity of her ulcer. After the immediate danger from bleeding is gone, the patient will start on a drug regime. If H Pylori is present this drug plan will include an anti-biotic. In most cases the plan will include any combination of H2 blockers, PPIs, etc. It is very important to take the medication as long as the doctor prescribes in order to keep the ulcer from coming back.
For some people a short term treatment plan is all that is necessary especially if the cause of the ulcer is no longer present. For example, in my friend’s case if she no longer needs the pain killers and steroids, it’s possible a short term medication plan will be enough. Alternately, if the ulcer is caused by H Pylori then it’s possible that taking the anti-biotics along with the acid reducing medications as prescribed will be enough. Diet may need to be considered as often times some foods will make symptoms worse. For others though, the ulcer may be the beginning of a long term need for reflux/ulcer preventive medication and/or surgery.
Working closely with your doctor to come up with a plan that is best for you is vital to your ultimate health.