ULCERS & INDIGESTION - Full extract (no story)

Indigestion means different things to different people. It can mean heartburn, bloating, burping, nausea or even pain in the abdomen. Sometimes it is due to reflux of acid secretions from the stomach. It may also be due to the stomach not emptying properly after a meal. Fortunately, medications are now available to relieve most indigestion symptoms. 

Any indigestion that persists requires further investigation. A peptic ulcer, or break in the lining of the upper food- tract, is the main condition to exclude. However, symptoms like weight loss, the sensation of food getting stuck, or the occurrence of bleeding all require prompt investigation, since there may be a more serious cause. 

Gastroscopy has gradually replaced the traditional barium- meal X-ray as the first-line investigation. After light sedation, a thin tube is passed down the throat into the oesophagus, the food pipe that empties into the stomach. The stomach is then examined and after that, the duodenum, the first piece of the small bowel that the stomach empties into. The lining can be directly examined for ulcers and areas of inflammation, and biopsies can be taken if necessary. It is a simple outpatient procedure that only takes 10 to 15 minutes. After resting for an hour or so, the person is able to be taken home. 

Ulcers in the lower end of the oesophagus before it enters the stomach are associated with reflux of acid from the stomach.

Drugs such as aspirin and anti-inflammatory medications can cause ulcers to form, especially in the stomach area. more recent Australian research has demonstrated that a species of bacteria called helicobacter is associated with most duodenal and stomach ulcers.

The main symptom of an ulcer is upper abdominal pain, which may come on with eating, or several hours later, and is often relieved with antacids. Bleeding may occur and cause the bowel motions to become dark or even black. With blood loss symptoms of anaemia can develop; the person may be tired, pale and lacking in energy. If major bleeding or perforation of an ulcer occurs, the person may collapse and require emergency treatment. Earlier diagnosis and vastly improved ulcer treatment has made these complications less likely to occur. However, 15% Australians will develop an ulcer at some stage and several hundred still die each year from ulcer disease. 

Although antacids often give temporary relief of ulcer symptoms there is a range of medications such as Zantac and pepcidine that actually cause ulcers to heal, mainly by reducing the amount of acid secretion in the stomach. In persistent cases, more potent medications such as Losec or Zoton may be required. Other medications have an extra role of enhancing the protective lining of the stomach and duodenum.

Unfortunately, the majority of ulcers tend to recur, and until recently long-term medication was often required. The discovery of the importance of helicobacter infection has dramatically altered the treatment of stomach and duodenal ulcers. Short courses of combination antibiotic and acid lowering medications are often advised. The cure rate with this approach is much improved and the likelihood of ulcer recurrence is markedly reduced.

Lifestyle factors like stopping smoking and avoiding any medications that could be contributing to the ulcer should also be discussed with your doctor. Surgery remains an option for ulcers that persist, or for those where major complications have occurred.

Health Tips:
* Indigestion that persists should raise the possibility of an ulcer. 

* If indigestion occurs while taking anti-inflammatory medications or aspirin, stop the medications immediately and see your doctor for advice.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001