Many a times you find our clinics and hospitals in Kenya flocking with people presenting with complains of burning upper abdominal pain, nausea, vomiting etc., all these are presentations of stomach ulcers also called peptic ulcer disease (PUD).
What are Stomach ulcers? These are open sores, or ulcers that develop in the lining of the esophagus, stomach or first part of the small intestine.
- This can occur when the stomach acid damages the lining of the digestive tract. Normally a thick mucus layer protects the stomach lining from the effect of its digestive juices but many things can reduce this protective layer allowing stomach acid to damage the tissue layer. Many cases of Stomach ulcer disease develop because a bacterial infection (H.Pylori infection) eats away the protective lining of the digestive system.
Stomach ulcers include:
- Gastric ulcers that occur on the inside of the stomach and are normally worsened by food.
- Duodenal ulcers that occur on the inside of the upper portion of your small intestine(duodenum) and are normally relieved by food.
Who is at risk of developing Stomach ulcer disease?
- NSAIDS Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common pain relievers that includes Ibuprofen, Diclofenac puts one at a risk of developing Stomach ulcers.
- A family history of ulcers an individual with a family history of ulcers is more likely to also develop Stomach ulcers
- Illness such as liver, kidney or lung disease puts one at an increased risk of developing Stomach ulcers.
- Regularly drinking alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
- Smoking increases the risk of developing Stomach ulcers.
- Having un addressed stress
- People who stay hungry for long hours.
What causes Stomach ulcers?
- Helicobacter pylori (H. pylori) bacteria.
- Pain-relieving NSAID medications.
H. pylori bacteria
H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori infection, often without any symptoms.
The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissues causing stomach ulcers.
Pain relievers
Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These medications have the potential to cause peptic ulcers to form, they include:
- Aspirin (even those with a special coating),APC,Mara Moja
- Ibuprofenac,Diclofenac,Aceclofenac
- Use of corticosteroids (drugs your doctor might prescribe for management of asthma and arthritis e.g. prednisolone, dexamethasone.
Paracetamol and Celecoxib too are pain relievers and would not damage the stomach lining, they are widely available in our Kenyan chemists, hospitals, pharmacies.
Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H. pylori infection is potentially the most dangerous. People who have H. pylori and who frequently use NSAIDs are more likely to have damage to the mucus layer, and their damage can be more severe.
Rare causes
Infrequently, other situations cause peptic ulcer disease. People may develop ulcers after:
- Being seriously ill from various infections or diseases.
- Having surgery.
Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of acid that damages stomach tissue.
What are some ulcer symptoms?
Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:
- Gnawing or burning pain in your middle or upper stomach between meals or at night.
- Pain that temporarily disappears if you eat something or take an antacid.
- Bloating.
- Heartburn.
- Nausea or vomiting.
- Indigestion.
- Loss of appetite.
In severe cases, symptoms can include:
- Dark or black stool (due to bleeding).
- Vomiting.
- Weight loss.
- Severe pain in your mid- to upper abdomen.
DIAGNOSIS AND TESTS
How are stomach ulcers diagnosed?
Your healthcare provider may be able to make the diagnosis just by talking with you about your symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H. pylori infection. The most common tests done in Kenya to confirm H.Pylori bacteria as well as stomach ulcers include:
H. Pylori tests
H. pylori antigen test is the most affordable and accessible diagnostic test in our Kenyan set up.
H.pylori antibody test, this test is used to check for h.pylori bacteria antibodies in the blood.
Endoscopy
If you have severe symptoms, your provider may recommend an upper endoscopy to determine if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with a tiny camera) through your throat and into your stomach to look for abnormalities.
Urea breath test is the easiest way to discover H. pylori, however this is not very common in our Kenyan set up due to accessibility and affordability.
Imaging tests
Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the imaging machines.
MANAGEMENT AND TREATMENT
Will ulcers heal on their own?
Though ulcers can sometimes heal on their own, you shouldn’t ignore the warning signs. Without the right treatment, ulcers can lead to serious health problems, including:
- Bleeding.
- Perforation (a hole through the wall of the stomach).
- Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the stomach to the small intestine.
What ulcer treatments are available?
You can reach out to us on our website https://hellodaktari.co.ke and book am appointment with us so that we are able to give you tailored advice on the management of peptic ulcer disease.
If your ulcer is bleeding, your doctor may treat it during an endoscopy procedure by injecting medications into it.
For most people, doctors treat ulcers with medications, including:
- Proton pump inhibitors (PPI): These drugs reduce acid, which allows the ulcer to heal. The most common PPIs in Kenya include: Omeprazole, Esomeprazole, Lansoprazole, and Rabeprazole.
- Antibiotics: These medications kill bacteria. Doctors use them to treat H. pylori infection. They include Amoxicillin, Clarithromycin, Metronidazole, Tinidazole.In Keya, they are normally used alongside the PPIs which is what we commonly refer to as triple therapy.
- Protective medications: Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further damage from digestive acids and enzymes. They can either be in the form of a suspension or tablets.
PREVENTION
How can I prevent ulcers?
You may be able to prevent ulcers from forming if you:
- Talk to your doctor about alternatives to NSAID medications (like Celecoxib, paracetamol, buscopan, myospaz which are readily available in Kenya) to relieve pain.
- Treat H.pylori infection as soon as it occurs.
- Discuss protective measures with your doctor, if you can’t stop taking an NSAID.
- Quit smoking.
- Drink alcohol in moderation, if at all you have to drink.
- Look for ways of managing stress.
- Avoid staying hungry for long hours.
At Hello Daktari Online Medical Consultations, we are able to answer all your questions through online consultations, we are also able to offer Home based care services in Nairobi and all its environs. All you need to do is to click on this website https://hellodaktari.co.ke and book an appointment with us at the comfort of your home or any other place.