Q: My husband has been on treatment for stomach ulcers for the past 10 years. He has been taking his medication on and off (usually when his symptoms flare up). He has also changed his eating habits and removed all foods that give him heartburn from his diet. Recently, he was admitted with severe abdominal pain and after investigation, he was found to have a perforated stomach ulcer. He then went on to have emergency surgery. I feel that his regular physician did not treat the ulcers appropriately. Had he done so, my husband would not have had this complication. The surgeon told us that my husband’s smoking and constant use of painkillers for his back problems contributed to his predicament. Is this true? What are the complications of stomach ulcers and how can we prevent him from getting another perforation?
Peptic ulcer disease (ulcers of the stomach and small intestines) is a relatively common health problem in Kenya. Contrary to popular belief, it is not caused by stress or eating spicy food. There are several factors that have been found to be related to formation of peptic ulcers. These include
Infection: There is a bacterium known as Helicobacter pylori (H. pylori) which has been found in a large number of patients with gastric ulcers.
Painkillers: A group of painkillers known as NSAIDs (non-steroidal anti-inflammatory drugs) has been known to cause peptic ulcers. NSAIDs include aspirin, ibuprofen, diclofenac etc. Usually, taking a short-course of these pills is not a problem; however, use of large doses of these drugs can be harmful to your health. (People using these drugs for long periods of time include those with arthritis or long-standing back pain).
Smoking:This habit is detrimental to all tissues in the body, including the stomach and intestines and has been associated with ulcers.
Stomach cancer:Certain forms of stomach cancer present as a non-healing ulcer. These types of cancer can perforate just like a non-cancerous ulcer.
How can you tell if you have ulcers?
Usually, peptic ulcers present with recurrent heartburn and constant pain above the belly button. This pain is either relieved or worsened by eating (depending on the location of the ulcer). Some people also report sensation of fullness despite not eating much and some bloating.
Your doctor should be able to confirm the presence of peptic ulcers by performing a test known as an endoscopy. During this test, your doctor inserts a special tube with a camera down your throat and into your stomach/intestines. He/she can visualise any ulcers and take samples from the ulcers for further assessment in the laboratory (biopsy).
Possible complications of peptic ulcers
There are three common complications of peptic ulcers.
Perforation:Most ulcers are superficial; however, if they ‘eat’ into all the layers of the stomach, it gets a hole that allows for stomach content to spill into the abdomen (what happened in your husband’s case). This is usually an emergency and requires surgery to treat.
Bleeding:Sometimes, the ulcer can eat into the stomach or intestinal lining and reach a blood vessel, which can result in significant bleeding. This can present as either vomiting blood or passing black stools. If the blood loss is significant, then emergency counter measures must be instituted. Usually this involves endoscopy and using various methods to control the bleeding from the inside of the stomach/intestine. If this is unsuccessful, then emergency surgery may be necessary.
Obstruction (‘blocked stomach’):The ulcer can, sometimes, cause such severe scarring on the stomach wall that it blocks the opening that allows food to leave the stomach and get into the intestine. This causes one to vomit and experience satiety even after eating small volumes of food, all of which can result in weight loss. This usually requires surgery to correct.
Get rid of all risk factors
Your husband must get rid of all risk factors that contributed to the development of the peptic ulcers in the first place. In your husband’s case, he should switch to stomach friendly painkillers and must stop smoking.
Eradicate H. pylori
This bacterium can be removed from your stomach by administering a course of antibiotics. These are usually prescribed for one or two weeks. If need be, treatment can be repeated.
Control of stomach acid
Usually, most people with peptic ulcers require long-term use of acid reducing drugs. Currently, the drugs most popularly used are known as PPIs (Protein pump inhibitors) such as omeprazole, lansoprazole or pantoprazole.
What if the ulcer does not heal?
If your husband’s ulcer recurs despite proper treatment, then your doctor will need to carry out several tests that will assess for other digestive tract diseases such as inflammatory bowel disease, stomach cancer and conditions that trigger excess stomach acid production.