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Is that stomach pain an ulcer?

Sores can be caused by a common bacteria, not by stress or food

Sores can be caused by a common bacteria, not by stress or food

December 04, 2006|by JULIE E. GREENE

The holidays can be a stressful time.

The list of things to do is endless, plus there's company to entertain.

Then there's the food. People are setting out holiday candy at the office. Soon there will be cookies and other treats to enjoy, unless you have belly pain - the kind that wakes you up in the middle of the night or can occur before or after a meal.

While the stress, food and belly pain might make you think you have an ulcer, it's the belly pain that should be leading you to a visit with your doctor.

Long believed to be the cause of peptic ulcers, stress and food - even spicy food - are not the culprits. The troublemakers can be a common bacteria, a reaction to nonsteroidal anti-inflammatories or consumption of a great deal of alcohol that can lead to ulcers, local doctors say.

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There could be a lot of other reasons, including stress, for that belly pain. That's why it's important to check with your doctor.

Taking over-the-counter medications to alleviate the pain only delays the diagnosis, which could be worse than an ulcer, as well as the treatment, says Dr. Nelson Ferreira, a gastroenterologist with Digestive Disorders Consultants at Robinwood Medical Center east of Hagerstown.

The classic symptoms are gnawing pain in the upper abdomen between the breastbone and the naval, and black stools, says Dr. Jan Kletter, a general surgeon with University Health Medical and Surgical Associates in Ranson, W.Va. Digesting iron supplements or taking Pepto-Bismol also can cause that dark coloration.

Other symptoms can be significant bleeding from the rectum, vomiting blood, belching, bloating and a persistent lack of appetite.

Diagnosis

The most common way to diagnose an ulcer is an endoscopic procedure because it allows the doctor to look at the stomach lining and see the ulcer or perhaps another problem, doctors say.

These ulcers occur in the stomach or duodenal lining in the uppermost portion of the small intestine, Ferreira says.

The patient is usually sedated during this procedure, which takes about three to six minutes, Ferreira says.

A soft, flexible tube about 9 mm in diameter with a tiny camera on the end is slipped down the throat into the stomach. The fiber-optic camera projects images on a monitor.

Another diagnosis option is drinking barium, a milky white chalky fluid, and having X-rays taken of the stomach, esophagus and duodenum, Kletter says. The barium makes the digestive tract more visible for X-rays. The advantage for the patient is there is no sedation, but the X-rays are not as accurate as the endoscopy. X-rays can miss small ulcers, he says.

Blood tests might help a diagnosis if there is a bacterial infection, but they're not as accurate as an endoscopy, Ferreira says.

An endoscopy might still be needed to confirm an ulcer and ensure the ulcer is not malignant, says Kletter, who has performed these endoscopies. The tube used in an endoscopy also can be used to slip tools through so a biopsy can be taken.

Treatment

First, the cause of the ulcer is removed.

The majority of peptic ulcers are caused by an infection of the H. pylori bacteria or the use of nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin, Ferreira and Kletter say.

Ruth Glaser, 79, of Maugansville, says she had taken just three pills of a nonsteroidal anti-inflammatory medication for a pulled muscle about a year ago when she noticed blood in her stool. She had not taken the medicine before.

If anti-inflammatories are the cause, consumption of such drugs is stopped, Ferreira says. Most people who take anti-inflammatories don't develop an ulcer.

Stop drinking alcohol if that was the cause. Generally it takes a lot of alcohol - more than a glass of wine a day - to burn the stomach lining and develop an ulcer, Kletter says.

The patient would be given a medicine, such as Prilosec, Nexium, Protonix, Aciphex or Prevacid, that blocks acid production in the stomach, doctors say. This allows the ulcer to heal.

If the ulcer was caused by the bacteria, antibiotics are prescribed, Ferreira says.

Most ulcers are benign and typically heal in four to six weeks, he says. If an ulcer doesn't heal within that time, it could be cancerous.

Surgery is rarely needed for ulcers these days; usually reserved for life-threatening complications such as a perforated stomach or significant bleeding that cannot be stopped otherwise.

Twenty to 30 years ago surgery was more common, used to stop bleeding from an ulcer, but now medications can control the bleeding, Ferreira says.

In some cases, an endoscopic procedure is needed to stop bleeding.

Tools are inserted into the stomach through the tube to inject epinephrine around the ulcer to coagulate the blood, and a heat probe cauterizes the ulcer to stop the bleeding, the doctors say.

Smoking doesn't cause ulcers, though it can retard the healing process, Ferreira says.

Prevention

Ulcers aren't very discriminating.

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