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Esophageal ulcer

Ulcers are painful and need good care to enable healing. An ulcer is an erosion, lesion, wound, or sore in the innermost lining of the stomach, duodenum (first part of intestine), or esophagus (food pipe). Depending on their site, they may be called gastric or duodenal ulcers. Peptic ulcer is a general term for an ulcer.

Symptoms

The commonest symptom of peptic ulcer is pain. This pain is usually felt in the upper abdomen, just below the chest. It may be burning or gnawing in character, and may last few minutes or several hours. It may exacerbate in the night or on empty stomach when the wall of the stomach is directly exposed to acid for prolonged periods. It may temporarily be relieved by acid-neutralizing medicines or food that buffers the acid and may disappear to return after a few days.

Besides pain, symptoms of a stomach ulcer may cause

  • Bloating
  • Burping
  • Vomiting
  • Indigestion
  • Stomach upset
  • Poor appetite
  • Weight loss
  • Night sweats

Outlook

A little care can keep H. pylori away follow these points.

  • Keep clean
  • Drink safe and clean water
  • Eat washed and cooked food
  • Wash your hands before every meal and after every use of the toilet
  • Avoid smoking and alcohol

Ulcers aren’t always serious. Complete your entire regimen of treatment for stomach ulcers. Help your ulcer heal and prevent any further damage.

Tips on healing your ulcer

To facilitate healing of an ulcer, it is good to avoid the factors that make it worse. Quit smoking and watch the quantity you are drinking. Consult your doctor and reduce your intake of NSAIDs. Reduce stress and try relaxation techniques like meditation or yoga.

Food has variously been linked to ulcers. Spicy and fried food can make an ulcer worse. Food restriction is no longer an approach to treat ulcers. It is a myth that milk can help heal ulcers. You should avoid lying down immediately after food to prevent the reflux of acid from stomach into the food pipe.

Understanding ulcers

Ulcers are caused by damage due to the acid in the stomach. Acid helps in digestion of food and may in some circumstances harm the lining of the stomach itself. There are several causes for ulcers. The commonest cause is the irritation caused by acid in the stomach. Another common cause is an infection by a bacterium called H. pylori. This cock-screw shaped germ lives on the innermost layer of the stomach and usually causes no problems. It may however, at times, disrupt the innermost lining to cause an ulcer. Essentially, an ulcer is caused by imbalance between the protective and the adverse factors. Protective chemical entities called prostaglandins are produced in the stomach by the action of cyclooxygenase, an enzyme or catalyst.

In normal individuals, the wall of the stomach is protected from the action of acid by a thin mucus layer that lines its innermost surface. Essentially, an esophageal ulcer is caused by an imbalance between the adverse factors like irritation caused by some drugs or toxins in cigarette smoke causing disruption of the mucus layer and the protective factors like prostaglandins that help to keep the mucus layer intact. Protective chemical entities called prostaglandins are produced in the stomach by the action of cyclooxygenase, an enzyme or catalyst.

Excessive production of an acid is harmful to the inner lining of stomach and defenses like the mucus lining and prostaglandins are not ample to handle extreme volumes of acid. Regular and long-term use of pain relieving medicines like the nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate or inflame the lining of your stomach and small intestine and cause an ulcer. NSAIDs inhibit action of the enzyme, cyclooxygenase and decrease the protective prostaglandins.

Smoking and excessive drinking can increase the secretion of acid in the stomach and also irritate the lining in stomach or intestines. Stress, is known to stimulate acid secretion and weaken the inner lining and hence predispose to ulcers. Rarely, a medical condition called Zollinger-Ellison syndrome can lead to ulcers due to a tumor in the pancreas that produces acid stimulating factors.

The doctor may ask for your complaints and confirm if you have been taking NSAIDs for a long term illness like pain in knees, back, or after a grievous injury. The doctor will also want to know your smoking and drinking habits and examine your abdomen.

If an ulcer is suspected, an infection due to H. pylori will need to be ruled out and for this you may need blood, stool, or breath tests.

You may need to undergo a series of X-rays after drinking a white solution, called a barium meal. This will delineate your stomach and intestines clearly and show up an ulcer, if one is present.

You may need to undergo an endoscopy. In this a flexible tube mounted with a camera will be inserted through the mouth into the stomach to take a direct look at the ulcer. If one or more ulcers are spotted, a biopsy may be done, i.e. a piece of tissue may be snipped off the ulcers to enable examination under the microscope in the laboratory.

Peptic ulcer disease is treated by first eradicating the H. pylori infection as more than half of all ulcers are caused by this bacterium and second reducing the secretion of acid in the stomach or neutralizing the already present acid. To kill the bacteria, medicines called antibiotics like amoxicillin, clarithromycin, and metronidazole are used.

To reduce acid production, H2 blockers are used. These include drugs like ranitidine, famotidine, or cimetidine. These medicines block histamine, a chemical signal that triggers acid production in the stomach.

The pumps that secrete acid in the stomach can be blocked by medicines called proton pump inhibitors (PPIs). These include omeprazole, pantoprazole, rabeprazole, or lansoprazole.

The excess of secreted acid can be neutralized by medicines called antacids. These include salts like Sodium bicarbonate (baking soda) and calcium carbonate. A combination of these agents may be used depending upon the complaints and severity of the disease.

Triple therapy is a trio of antibiotics, PPIs, and H2 blockers used to treat ulcers due to H. pylori. Antibiotics like clarithromycin, amoxicillin or metronidazole, and a PPI are used for 10 to 14 days. This forms a safe and effective regimen.

Some other medicines which may help include drugs like sucralfate that forms a coating on the lining and protects it, and misoprostol, a drug that prevents ulcers in people who take regular NSAIDs. These are called cytoprotective agents.

For the treatment of H. pylori, 10 to 14 days of treatment with triple therapy is effective in 80-90%. Other medicines like PPIs or H2 blockers may be taken for 4 to 8 weeks.

Ulcers turn serious if ignored. An ulcer can burrow through the wall of the stomach or intestine and cause a hole. This is called a perforation. The contents of the stomach and acid can then leak to infect the entire abdomen. This is called peritonitis. There can be bleeding or narrowing of the lumen of the stomach outlet or intestine. This can lead to obstruction of the emptying of the stomach into the initial segment of the intestine. Persistent bleeding can impair the capacity of the blood cells to carry oxygen and results in anemia. Worst of all, an ulcer can turn cancerous.

Some ulcers do not respond to treatment even after 8 to 12 weeks of treatment. They are said to be refractory and need an intensive therapy. An ulcer that doesn’t heal, recurs, bleeds, perforates, or causes obstruction may need surgery to either remove the ulcer or reduce the amount of acid secretion.

An ulcer may get worse over time if not treated well. A few peptic ulcer symptoms are:

  • Nausea
  • Bloody vomit
  • Bloody stools
  • Unexplained weight loss
  • Change in appetite
  • Indigestion
  • Fatigue
  • Breathless
  • Palpitations
  • Irregular heartbeats
  • Anemia

Never ignore these signs. See a doctor immediately.