Ulcers

Ulcers are caused by damage to the lining of the esophagus, stomach or duodenum.  It was thought for a very long time that ulcers were due to excess acid production, stress, and weakening of the lining of the stomach, esophagus, or duodenum. Over the past 20 years, a bacterium, H. Pylori, has been blamed as the cause of ulcers.  We do not feel that the answer is that simple, and have done extensive community based clinical studies that do not support the notion that H. Pylori is the main culprit.  We believe it is due to a combination of excess acid, stress, aspirin products, arthritis medications, and in some cases (mostly foreign born patients) H. Pylori presence.

Symptoms might include burning in the mid-abdomen, sharp pain, nausea, fullness after eating, belching, and weight loss.  The burning can occur when the the stomach is empty and may awaken one from sleep during the night.

Diagnosis is best made by endoscopy, an out-patient evaluation.  If bacteria are found with the ulcer (around 30% of the time), antibiotics are given.  Otherwise, suppression of acid is begun with either H2 blockers (Tagamet, Zantac, Pepcid, Axid) or proton pump inhibitors (Prilosec, Nexium, Prevacid, Protonix or Aciphex).  All treatments can heal ulcers.  Biopsies may be taken to ensure that the ulcers are benign.  Ulcers in the stomach rarely are malignant, but those in the duodenum are almost always benign.

The other major cause of ulcers today is aspirin and arthritis medications (nonsteroidal anti-inflammatory medications).  The treatment includes stopping these medicines and using the same medications listed above.

To avoid ulcers:

1. Don’t take aspirin/arthritis medications on an empty stomach.
2. Decrease stressful circumstances as much as possible.
3. Do not drink alcohol in excess.
4. Seek medical advice if symptoms occur and are not easily resolved.
5. Avoid spicy and fried foods if you are already having symptoms.
6. Stop smoking.

Remember:
Ulcers can heal completely, and most patients will not have ulcers repeatedly, if the measures listed above are followed.