H. pylori, a corkscrew shaped bacteria is a normal habitant of our stomach. Little did you know that this may be the culprit behind the persistent burning you have faced for past few years.
An ulcer is erosion in the innermost lining of the stomach that can lead to a sore or wound. It may also be situated in the duodenum (first part of intestine) or esophagus (food pipe). According to location in the digestive tract, an ulcer may be called gastric or duodenal ulcer. A peptic ulcer is a broad term used to describe the presence of an ulcer.
More about Ulcers
Ulcers are not always serious but may turn into one if left untreated. An ulcer may perforate, i.e. form a hole by penetrating into the whole thickness of the wall of the stomach or intestine. The contents of the stomach and acid can then leak to infect the entire abdomen to result in a condition called peritonitis. An ulcer may erode the blood vessels and cause bleeding which may be trivial or severe. The area where the ulcer is located may form a scar that contracts to narrow the lumen of the intestine or the outlet of the stomach, hence resulting in an obstruction. All these conditions are medical emergencies. Small but prolonged bleeding can impair the capacity of the blood cells to carry oxygen and results in anemia. Worst of all, an ulcer can turn into a cancer of the stomach or the intestine.
Causes
Ulcers are caused when the acid in the stomach acts on the lining of the stomach or intestine to damage it. This can occur by multiple means. A very common cause of an ulcer is the disruption of the lining by a bacterium called H. pylori which usually inhabits the stomach and becomes problematic at times. The lining of the stomach is usually covered by a slimy protective mucus layer. The integrity of the mucus layer is maintained by various factors. The stomach produces hormone like chemicals called prostaglandins by action of a catalyst called cyclooxygenase. Pain relievers like the nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit this enzyme and disrupt the balance of the protective prostaglandins, hence making the lining vulnerable to attack by the acid and produces irritation and then ulcer. Smoking and excess alcohol also destroys the mucus lining to expose the underlying wall to acid and hence cause ulcers. Stress whether due to illness or lifestyle, can lead to increased secretion of acid and also weaken the defensive mucus layer. Sometimes, ulcers are due to a medical condition called Zollinger-Ellison syndrome which is characterized by hypersecretion of acid in the stomach, due to a tumor in the pancreas that stimulates acid production.
Risk Factors
Ulcers are common in people who smoke, consume excess alcohol, and have stress in daily life. These are also seen after artificial respiration, surgery or prolonged hospitalization. Ulcers are more likely in people who have taken long term treatment with NSAIDs for a chronic painful condition like backache or knee joint pain. People who have had ulcers earlier are at risk for more in future.
Treatment
Ulcers are treated using medicines in regimens of various combinations. It takes 4 to 8 weeks for an uncomplicated ulcer to heal with proper medical treatment. H. pylori infection needs treatment for 10 to 14 days. Some obstinate ulcers are said to be refractory and may not respond to treatment even after 8 to 12 weeks of treatment. These need 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.
Ulcers due to H. pylori infection
The doctor may test for the infection in your blood, breath, or stool. A sample of blood collected by a finger prick may be tested for specific proteins called antibodies that are produced by the body in response to an infection. Breath test is done after drinking a solution of radioactive carbon. In presence of H. pylori infection, the radioactive carbon appears in breath. A sample of stool may be tested for protein markers, called antigens of the bacteria. In addition, the ulcer may be visualized by taking a series of X-rays after drinking a milky barium solution or by inserting a flexible tube with a camera mounted on tip through the mouth.
Ulcers are treated by multiple medicines that reduce secretion of acid, neutralize it, or foster the defensive mucus layer. Since H. pylori is a common culprit, eradication of the germ is essential. Medicines called antibiotics like amoxicillin, clarithromycin, and metronidazole can kill the bacteria. H2 blockers like ranitidine, famotidine, or cimetidine reduce acid production by blocking the action of a chemical signal called histamine that stimulates acid production. Several tiny pumps eject acid into the stomach and these can be blocked by medicines called proton pump inhibitors (PPIs) which include omeprazole, pantoprazole, rabeprazole, or lansoprazole. Excess volume of acid that has been produced neutralized by medicines called antacids which include sodium bicarbonate (baking soda), calcium carbonate, etc. One or more agents may be used to control the damage due to acid. Cytoprotective agents like sucralfate that forms a coating on the lining, and misoprostol, a drug that prevents ulcers in people who take regular NSAIDs, act to protect the lining of the stomach from acid exposure.
H. pylori, if identified as the cause of an ulcer, can be effectively treated with a therapy known as ‘triple therapy’ for a duration of 10 to 14 days. This treatment involves a combination of antibiotics, PPIs, and H2 blockers. Antibiotics such as clarithromycin, amoxicillin, or metronidazole are used to eliminate the bacteria, while a PPI helps in managing acid secretion. It is important to complete the entire regimen as prescribed, as it is both safe and highly effective.
Triple therapy can lead to an upset stomach, diarrhea, a metallic taste in mouth, headache, or a dark tongue. There may be flushing and palpitations after consuming alcohol and the skin may get more sensitive to the sun. The side effects are not usually serious to give up treatment.
Self-Care
Quit smoking and limit alcohol. If you need to take NSAIDs for some medical condition, talk to your doctor to check the daily dose of these drugs and add some other options for your pain control. Reduce stress. Relax. Go for yoga or meditation. Prevent infection due to H. pylori. Cook food well and wash everything thoroughly before consuming. Wash hands before every meal and after every use of the toilet. Drink clean water. Stick to your medicines and complete the entire treatment regimen.
