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The way that you can prevent yourself from getting an ulcer is number one, avoiding the medications that can lead to ulcers, such as taking a significant amount of NSAIDs. Other things that you can do is make sure that your diet is compliant with a non ulcer producing diet, which means something that decreases the production of acid in your stomach. Also not putting yourself in an environment where you’re under a significant amount of stress or lack of sleep or lack of nutrition. These can all lead to changes in the Mucosa and changes which can lead to ulcer disease.
There are multiple different studies being conducted right now for both the endoscopic treatment of ulcer disease, different types of tools that we’re testing to see if a patient has an active bleed or a large ulcerations of how we can treat that endoscopically without the patient requiring surgery. Many medications are in the pipeline for the treatment of gastritis and inflammation of the stomach, which can then lead to ulcer disease. So there’s many studies going on that will help change the future of ulcer disease.
Insurance definitely treats majority of ulcer-type disorders because of the fact that the risk of it progressing and becoming much more dangerous. Insurance companies cover multiple different regiments of anti acid medications and endoscopic treatments in order to treat patients with ulcer disease.
There are multiple different medications that a person can take to treat symptoms of ulcer disease. Antacids are the most common over the counter medications that patients take. After Antacids, you can take medications like H2 blockers that help decrease the acid production of the stomach. Very common medications are Proton pump inhibitors that doctors can prescribe in order to, once again, reduce the acidity of the stomach and allow for healing of the lining of the Mucosa. There’s multiple different types of coding medications as well that will help coat the lining of the Mucosa and the stomach and the small bowel, in order to allow for healing. So there’s def definitely multiple different modalities of treatment. If your ulcer disease is secondary to a bacteria like H. Pylori, then antibiotics will be warranted. The risk for ulcer formation can increase depending on many different conditions and many different medications. A lot of patients that are on Aspirin or non-steroidal anti inflammatory drugs such as Advil, Motrin, Naprosyn, Aleve, any of these kinds of medications can increase your risk of ulceration. One of the most common causes of peptic ulcer disease is H. Pylori. It’s a bacteria that’s relatively endemic and a majority of patients walking out on the streets can have it. And when you have that bacteria, you run the risk of forming ulcers, which then can bleed as well. Certain types of medications and foods such as caffeine or highly acidic or highly spicy foods, can also lead to damage to the lining of the stomach and the Mucosa and can lead to ulcer formation.
The condition is usually confirmed for by an endoscopy in which we’re able to see what the actual causes. Certain types of imaging tests such as an upper GI study where you drink contrast and they take x-rays of your stomach can also be used to look for an ulcer. Both of these modalities are effective. An endoscopy is a little bit more effective because if they do see anything, we can take biopsies, which is a sampling of the tissue to figure out the exact etiology to the ulceration and we can treat them if we see them. Endoscopy is an endoscopic type of surgery, a surgical intervention in which a portion of the stomach is cut or a portion of the small bowel is cut and it is done intra-abdominally which means that the patient is completely sedated and they do a full surgical procedure. That’s more of an invasive procedure. In terms of physical treatments, most of those treatments are done through an endoscope, which means we take a camera, it’s about the width of my finger. We go down through the mouth and into the stomach. And if we see an ulcer, we can use different modalities such as injections, hemoclipping which means the titanium clips that help close off the ulcers and allow them to heal, or burning of the ulceration and injecting medication to allow it to heal better.
One of the most common complications of peptic ulcer disease is bleeding. You know, when the ulcer gets deep enough to where it erodes into a vessel such as a vein or more likely an artery, you get a subsequent very severe bleed, which needs endoscopic treatment. And what I mean by that is a doctor needs to take a camera and go down into the stomach and find the area that’s bleeding and then we’re able to treat it in multiple different ways by injecting medication, or putting clips, or burning the area. One of the most severe complications of ulcer disease is what we call a perforation. If that ulcer gets too deep and it causes a burrowing hole into the tissue, then you get bile acids and stomach content going into the abdominal cavity, and at that point, that becomes a surgical emergency.
Peptic ulcer disease can absolutely change your quality of life. Patients with ulcer disease have chronic pain, nausea, they have difficulty eating because when they eat then, sometimes the pain gets worse. They don’t have good quality sleep because they sometimes get woken in the middle of the night due to the pain. So it’s something that can be very debilitating. Patients with severe ulcer disease also go in and out of hospitals because of recurrent bleeding. So it’s something that can definitely take a toll on your life. And the sooner you get help and the sooner you get it evaluated and treated, the less chance you’ll have any other long-term complications.
Ulcer disease is one of those disorders that definitely has a high recurrance rate. Depending on the etiology to your ulceration, if someone’s ulcerations were secondary to NSAID use, and if the patient once again, goes back to using a significant amount of NSAIDs, you run the risk of having a recurrence of your ulcers as well. That’s why lifestyle changes in these patients are lifelong in order to maintain them, in order to reduce the risk of recurrance.
An ulcer, in general, is anytime you get a loss of the Mucosa of the lining of any type of tissue. It’s when you get any type of inflammation, irritation or mucosal damage, which then leads to a loss of the tissue that can lead to erosion into an artery or a vessel, which can lead to bleeding or pain. Ulcers are very common. We see them in all ranges of patients from young patients to older patients. There’s multiple different etiologies to what causes an ulcer. It could be from a bacteria called H. Pylori. It could be from certain types of medications, such as anti-inflammatory medications. It can be from certain types of stressful environments that a patient is in, which leads to increase acid in the stomach, which can lead to ulcers. There’s multiple different etiologies and multiple different treatments for ulcers.
A peptic ulcer is an area of tissue in your stomach, or in your small intestine in which the area has eroded. And there’s actually a loss of the Mucosa of the tissue, which leads to what we call an ulcer, which is a small indentation, or it could be large indentation, which then can lead to bleeding, infection, and pain in patients. Not treating an officer can lead to very severe complications. If the officer gets large or deep and it erodes into a vessel that can large to a very life-threatening bleed, and if it gets even larger and it subsequently leads to a perforation or a hole in the bowel, it could lead to significant complications and even death.
One of the most dangerous causes of an ulcer is obviously a cancer. Gastric cancers or gastric malignancies often show themselves as an ulcer and their symptoms can mimic just general peptic ulcer disease. So that is why if you have a patient that’s a more elderly, or if it’s a new onset of a ulcer disease or symptoms, it’s very important to do a thorough workup, including an endoscopy to make sure that there’s no malignancy involved.
So depending on where the ulcer is, the pain can be anywhere in the upper GI tract. You could have ulcerations in the esophagus. You could have ulcerations in the lining of your stomach. You could also have ulcerations in your small bowel. The pain can be associated with food or can get worse when you don’t eat food, depending on the location of the ulcer. And it could be exacerbated by multiple medications.
If a patient comes to the office with symptoms that go along with a possible peptic ulcer disease, the first thing that a physician should do is get a very clear history of when the pain started, what medications the patient may have been on, if they’ve been ill or around anyone that’s been ill, if they’ve been out of the country. And then by delineating exactly the start time and the progression of the disease, the physician can then evaluate and see what the next step will be. Usually, blood tests are taken to see if there’s any evidence of any blood loss, especially if the patient is complaining of any dark stools or any blood in the stool. Patients can be placed on certain types of medications to help alleviate the patient’s symptoms. And if need be, then certain procedures such as an endoscopy may be warranted in order to help treat the ulcer or to make more diagnostic tests.
Anyone that has any significant acute abdominal pain, nausea, that progressively gets worse over a few days should be seen by a physician, because peptic ulcer disease is definitely something that’s on the differential. And if you wait too long, it can lead to a catastrophic event such as a internal hemorrhaging and bleeding and perforation and even death. The common symptoms of a peptic ulcer include pain, irritation, nausea, loss of appetite. Sometimes patients exhibit, you know, reflux symptoms. These are all things that should be evaluated by a physician if you do have them, because you could have an ulcer and if it’s not caught early, it could lead to further complications such as bleeding.
Patients that have a Type A personality that are very stressed and patients that don’t take care of themselves, and what I mean by that is they don’t sleep well, they don’t eat well, they don’t do exercises, obese patients, patients with poor nutritional status. These are all patients that have a higher risk of forming ulcerations. If you have any abdominal pain, irritation, reflux, or anything that’s out of the ordinary, that lasts for more than 24 hours, you should definitely consult your physician to see what the cause of that could be because it could progressively get worse very quickly.
If you feel like you do have a peptic ulcer or any of the complications associated with peptic ulcer disease, you should see a gastroenterologist because they’ll be able to do certain types of tests such as a breath test in order to evaluate for H. Pylori or stool tests, or if need be, we can do an endoscopy, which is a camera that takes a look inside of the throat and inside of the esophagus and the stomach, and it looks for any ulcerations, inflammation, or any bacteria that can lead to ulceration formation.
A majority of ulcers are able to be treated with either endoscopic or medical treatment. Very few ulcerations end up requiring surgery. Most ulcerations heal within four to six weeks. Peptic Ulcer disease can definitely be treated with medication and can be cured if the patient is compliant with their therapy.
There are many remedies for ulcer disease that patients can do at home. Using more alkaline water rather than acidic water can definitely help with improving the acidity level in your stomach and allowing for healing. Many patients like to drink milk or yogurt because of the fact that it helps coat the stomach and decreases the acidity level in the stomach. Obviously avoiding things that can cause increased acid production, such as avoiding caffeine, chocolate, stressful environments, and acidic and spicy foods. Any of these things can definitely lead to improvement in symptoms and healing of the ulceration.
If a patient has a cause to their ulceration secondary to a bacterial infection then antibiotics are the treatment of choice. The antibiotics are very important. It’s very important that the antibiotics that you take are taken through the entire course, so that you don’t form resistance. We have significant bacterial resistance now, and second and third lines of bacterial treatments are needed to be conducted in many patients at this time. There’s many patients that have resistant forms of bacterial infections that can cause a peptic ulcer disease. Therefore, it’s very important that you take the medication and have good follow-up and test to make sure that the bacteria is gone after your treatment course.
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