Originally published in The Ottawa Citizen December 17, 2002
Original Title: Oh please, not another space shuttle endurance test!

Part 1

Last week’s column reviewed the principal causes of stomach and duodenal ulcers: the bacterium Helicobacter Pylori (H. Pylori) and non-steroidal anti-inflammatory medications (NSAIDS). What diagnostic tests are available to aid in the treatment and management of ulcers?

One of the first tests to do for patients with ulcer symptoms is an H. Pylori blood test. This test measures H. Pylori antibody levels. A positive indicates the immune system is actively fighting the microbe. Two other methods of H. Pylori detection, breath and stool tests, are less commonly done. The immune response cannot defeat H. Pylori by itself.

Patients with more disconcerting symptoms such as anemia (blood loss), difficulty swallowing, dark black tarry stools, weight loss and vomiting with small black pieces or blood need further investigation.

Gastroscopy is a common procedure used to visualize the stomach and duodenal lining. A narrow fibre-optic tube with a camera at its end passes through the mouth into the stomach. A small claw-like device within the tube is available to take tissue samples. The advantage to the gastroenterologist is that he/she can see the ulcers, identify areas suspicious for H. Pylori infection and control bleeding ulcers by either cauterization or injection of adrenaline.

Most patients dread this test. As a participant, I can tell you first hand that it is a necessary yet unpleasant experience particularly for those with a strong gag reflex. Despite abundant freezing of the throat to control the gag reflex, the tube’s descent into the stomach is akin to being sick on a roller coaster that never stops.

The barium swallow, an older test in which x-rays are taken as the patient drinks the solution is not as good at detecting ulcers and other stomach or duodenal problems.

Medical therapy is the standard approach to ulcer healing. About two to five percent of ulcer sufferers require surgery. The goal is to reduce stomach acid secretion and if present, eradicate H. Pylori infections.

The treatment plan is a mix of prevention and medical therapy. This is important to help prevent ulcer recurrence and to promote healing.

Patients should stop using aspirin containing compounds or NSAIDS. If unsure, your doctor or pharmacist can help identify these products for you.

Smokers should make every effort to quit because the chemicals from cigarettes directly injure the stomach lining and stimulate acid secretion.

Caffeine and alcohol also stimulate acid secretion. Avoid coffee, tea, caffeinated beverages and soft drinks and, as much as it pains me to say this, chocolate (for a while). Alcohol will impair ulcer healing. Although some people will identify other foods that cause stomach upset, there is little evidence that they prevent ulcer healing or cause recurrence.

The use of antacids can provide temporary relief from ulcer pain but should not be the sole treatment. Use them one hour before or two hours after taking medications since they can interfere with their absorption reducing their efficacy.

Alleviating stress can reduce acid secretion and will improve overall health. Herbal medications and supplements (such as licorice, marshmallow, and glutamine) probably have no role in the treatment of peptic ulcers since conventional medications have proven to be very effective and safe.

Treatment of H. Pylori involves taking several medications, usually two antibiotics along with a medication that reduces stomach acid, for seven to 14 days. These treatment plans can successfully cure infection in up to 90 percent of people. The most common cause of treatment failure is when patients do not take the medications as directed by the physician’s instructions.

There are two groups of acid-reducing medications: proton pump inhibitors (Losec, Pantaloc, Prevacid, Nexium, Pariet) and H2 blockers (Ranitidine (Zantac), cimetidine, Axid and Pepcid). Protons are the acidic hydrogen secreted by the stomach. The proton pump inhibitors are potent agents that stop the stomach’s secretion of acid. A six to eight week course of treatment will promote complete ulcer healing.

Most patients with uncomplicated successfully treated duodenal ulcers do not need follow-up testing unless symptoms recur or do not improve. Those with complications such as bleeding or perforation need repeat H. Pylori testing to ensure its complete eradication.

Patients with stomach ulcers usually require a repeat space shuttle endurance test, er, gastroscopy, to ensure healing and that the ulcer did not harbour any cancer. Duodenal ulcers do not develop into cancer.

Patients who have frequent recurrences or a history of ulcer complications usually remain on long-term acid suppression therapy. Those successfully treated for uncomplicated ulcers due to H. pylori usually do not require medical therapy.

One of the problems with over-the-counter (OTC) antacids and Zantac among others is their haphazard use. Although they provide symptom relief, they may not prevent ulcers. Indeed most people do not take OTC Zantac or Pepcid long enough to prevent or successfully treat ulcers. Further, these preparations are half the prescription dose strength. Take the time to see your doctor about your heartburn. The chocolate will taste even better afterward.

---

© Dr. Barry Dworkin 2002