Published in Panorama
Lifestyle Changes in Treatment and Prevention of Ulcer
Abdul experienced some discomfort in the upper abdominal region after a hearty Friday meal. He downed an antacid as he always did when confronted with this feeling and after some time felt relieved. However, a couple of days later, without any warning signal Abdul brought out a vomit of blood. He was terrified and rushed to the hospital. On endoscopic investigation, Abdul was found to be suffering from an ulcer in his stomach!
“True, this can happen,” says General and Laparoscopic Surgeon, Dr.Qurban Hatim Pamina, Zulekha Hospital, Sharjah. “People have ulcers for five to six years and they get used to it. They take some antacids which relieve their symptoms for some time, so they are into a false sense of security that they are fine. But sometimes the ulcer can be present without presenting any symptoms and the patient might have no prior warning of the problem. He might just bring out a blood vomit one day!”
What is peptic ulcer disease (PUD)? Dr.Qurban explains, “It generally refers to a
spectrum of disorders that includes stomach ulcer, duodenal ulcer, ulcer in the pyloric channel. An ulcer is a break in the continuity of the mucus lining of the stomach, duodenum or the oesophagus (food pipe) which form the upper gastro-intestinal tract. It is formed as a consequence of increased acid output by the stomach or by a decrease in the amount of mucous, lining the upper gastro-intestinal tract.”
What are the factors predisposing one to peptic ulcer? Stress is cited as the most common factors, according to Dr.Qurban., “Because stress leads to certain hormones being secreted by the brain that can lead to an increased acid output in the gastro-intestinal tract. Bad eating habits – erratic eating times and eating of wrong foods, are both contributory factors. In addition, recent research point to Helicobacter Pylori (HP) as another major risk or causative factor for Peptic ulcer. This bacteria colonise the stomach in a lot of people, entering the human system through food and water. HP, due to certain enzymes it produces, predisposes the stomach to produce more acid. Anybody can get this bacteria, but not everybody who is a carrier of this bacteria, need have increased acid production and consequently get ulcer. On the other hand, there are people who have excess acid production but don’t get ulcer. It all depends on the individual reaction, on a balance between your resistance to the acid, and the acid production itself. If this balance is disturbed, you develop the ulcer.”
What about the type of food causing ulcer? This again is a subjective factor according to the doctor. Different people have different tolerance levels to a variety of foods. Dr.Qurban clarifies, “If an individual’s tolerance to a particular food, say oily or spicy food, is lacking: he will have a reflux. A predisposing factor to reflux which in turn can cause ulcer, is not only food, but smoking and alcohol, excessive tea and coffee intake, chocolate, beer, caffeinated drinks, high hormone levels as in pregnant women and obese people. In all these instances, the food is forced into the chest. The person complains of heart burn which implies that the acid which is being produced in the stomach, instead of going down into the intestine, is going up into the foodpipe. Nature has devised acid to be in the stomach only for a certain amount of time. If however, there is increased production of acid with a prolonged contact time with the intestinal tract, damage can be done!”
Who are the people at risk of developing ulcer and what ages of people does it affect? “Ulcer can develop in children as young as 7 years old,” reveals Dr.Qurban. “Hereditary factors, people belonging to certain blood group, individuals with Type A personality, holding high profile jobs involving high tension and stress levels, individuals with faulty food habits, are the most likely casualties from PUD, opines the doctor.
How does one identify ulcer symptoms? Heartburn, feeling of fullness in the upper abdomen, loss of appetite and pain, nausea, vomiting, indigestion, dyspepsia are some of the symptoms. The pain may occur before food and may be relieved on taking food, implying the ulcer may be located in the small intestine or duodenum; pain on eating may be indicative of ulcer in the stomach, according to Dr.Qurban. However, he cautions, “Not all people complaining of these symptoms need have ulcer. Even gall bladder disease may show up similar symptoms. Sometimes, even appendicitis can mimic ulcer symptoms, particularly of dyspepsia. Also, the ulcer disease is not always continuous; it can wax and wane, depending on the patient’s environmental state. If his environs keep him happy and relaxed, his PUD will automatically subside. However, if such symptoms come on in very young people or appear newly in those above the age of 40, they should seek medical help because cancer of the stomach or intestinal tract can mimic ulcer disease!
Is endoscopy the only diagnostic tool to investigate an ulcer? “Well, it’s the mainstay,” says Dr.Qurban. “This is done following a history taking and clinical examination of the patient. We test for helicobacter pylori. We also do an ultra sound of the stomach to rule out other abdominal causes of dyspepsia. In doing an endoscopy we know exactly how bad the disease is because sometimes the symptoms may be minimal but endoscopic testing may reveal widespread disease which the patient has been tolerating and has got used to over a long time. In fact before an ulcer is formed, an endoscopy might just show a swelling of the mucus lining or a redness or show signs of an acid damage, not amounting to an ulcer, but superficial erosions like a bruise, which are all in the spectrum of PUD. If this goes on for a sufficient amount of time, it can form an ulcer.”
Once diagnosed, what is the treatment for PUD? “Lifestyle changes are the most important in the treatment of PUD,” emphasizes Dr.Qurban. “Some people respond well with minimal drug therapy and major lifestyle changes. If there is no Helicobacter Pylori present, we treat patients with a broad spectrum of anti-acid drugs, depending on how much disease-control or symptom-control the patients require. If HP is present, the treatment is with antibiotics for a period of one week to 10 days. The duration of treatment of course depends on endoscopic findings and the patient’s symptoms.”
Both treatment and prevention of ulcer involves making major lifestyle changes, according to Dr.Qurban.
1. Eat at the right time and the same time everyday and don’t take very large meals at a time.
2. Eat the right kind of food with high fibres and low fat.
3. Don’t sleep for at least 1 ½ to 2 hours after eating food.
4. Reduce weight, tea, coffee, chocolate and fast food intake.
5. To the extent possible eat home made food to minimize chances of helicobacter pylori finding its way into your system.
6. Maintain hygienic habits, especially while handling foodstuff.
What are the complications caused by untreated PUD?
Dr.Qurban cautions, “If the ulcer is left untreated, it might bore through the whole thickness of the stomach and form a break. With this perforation, the person can then develop peritonitis with the infection spreading to the whole stomach and this can be fatal. Alternatively the patient could have uncontrolled bleeding since an ulcer sitting over a blood vessel, boring into it might cause catastrophic haemorrhage so much so the patient can die. An ulcer can also cause scarring, causing a narrowing of the stomach and hence obstruction of the passage of food downward. Finally, chronic ulcer can predispose the individual to cancer.