Dear Readers,

J. Heron is a 26-year-old mother, housewife, and student who resides in Kingston 20. For several weeks she experienced a burning discomfort in her upper abdomen and behind her breast bone. The pain worsened after she took painkillers and became severe. She saw a private doctor who told her she had gastritis caused by the type of medication she was using. He gave her some Losec to take which helped alot. J. Heron asks LIFELINE what really is gastritis and how best to prevent it and treat it. Her private doctor has told her to avoid all medication similar to aspirin but she would like to know more about the disorder.

Although Ms. Heron has been treated for acute gastritis and has settled fairly well, in view of her long-standing abdominal discomfort, further investigations of her gastro-intestinal tract could be done to check for peptic ulcer disease.

A peptic ulcer refers to an ulcer which appears within the stomach or the upper part of the duodenum (small intestine). It is a bit worse than experiencing gastritis which refers to an inflammation of the lining of the same gastric tissues which are routinely bathed with hydrochloric acid.

In peptic ulcer disease (PUD), ulceration of the mucous membrane of the stomach or duodenum is caused by the combined effects of acid and pepsin which are secreted by the gastric mucosa. The organism (bacterium) Helicobater Pylori (H. Pylori) is thought to play a significant role in the onset of most gastric and duodenal ulcers and eradication of H. Pylori will benefit both the healing of the ulcers and preventing relapse. Adequate treatment will remove adverse symptoms, accelerate healing of the ulcer, prevent complications and hopefully cure the disease. H. Pylori and non-steroid anti-inflammatory drugs (NSAID's) disrupt the normal mucosa in the stomach and duodenum and leave the lining of these bowel areas more susceptible to acid attack. NSAID's cause both a direct irritant effect to the bowel mucosa as well as they inhibit prostaglandin synthesis. Prostaglandins prevent injure to the gastro-duodenal mucosa by stimulating mucous formation, bicarbonate secretion, promoting ulcer repair and inhibiting gastric acid secretion. NSAID inhibition of prostaglandin activity can in fact quickly result in, hyperacidity and ulcer formation, especially when the integrity of the bowel mucosa has already been breached. Risk factors for peptic ulcers include:

NSAID's

H. Pylori Infection

Cigarette smoking

Alcohol ingestion

Stress

Certain foods

Genetic predisposition

The most common symptoms of both gastritis and peptic ulcer disease are:

Epigastric (abdominal) pain

Nausea and vomiting

Abdominal cramps

Relief of pain after food and after antacids

A diagnosis of PUD can be confirmed by a barium meal or by endoscopic examination (endoscopic being more fool proof).

The goal of treatment is to relieve pain, heal the ulcers and inflammation, and to prevent recurrence. To this end the following drugs are available:

Antacids which neutralise gastric acid by raising the pH (e.g.) Dica, Maalox, Rioplus etc.

Histamine Z receptor antagonists which inhibit acid secretion (e.g.) Zantac, Ranitidine etc.

Proton pump inhibitors - which also inhibit acid secretion by up to 90 per cent and have a long duration of action. (e.g.) Losec, Lanzap, Pantecta, Nexiun and Pariet. These work faster than the Histamine Z receptor antagonists but are more expensive.

Sucralfate - which forms a protective coating over the stomach mucosa preventing the corrosive effect of the hydrochloric acid.

In addition to these medications H. Pylori must also be eradicated in most causes to prevent relapse. The bacteria is treated with antibiotics used in combination. Most commonly used are Amoxil, Flagyl and Clarithromicin.

If her symptoms recur, J. Heron should visit her doctor and request investigations be done. If PUD is confirmed then the above mentioned plan of treatment would help much to give a long lasting outcome.

- A.J.M.