Dear Readers,

L.J.T. is a legal secretary, mother, housewife and potential university student. She is 27 years old and feels that life is 'full', can be fun, but is also stressful.

She seems quite positive in her outlook on life. Nevertheless, a barium meal x-ray done by her physician recently confirmed that she has peptic ulcer disease. L.J.T. admits that her ulcer may well be related to her pressured lifestyle, but she has to work and she is already a mother and wife, and she can't afford not to get on with her studies in order to help to improve the standard of living for her family.

L.J.T. asks Lifeline for advice on how to really cope with an ulcer in what is a 'stressful', although interesting, world. As she puts it, "I live in the real world which means I've got to work! I can't just stay home and mind baby."

Peptic ulcer disease is a common chronic relapsing condition where ulceration of the mucosa of the stomach or the duodenum (upper bowel) occurs. The ulcer occurs because of the effect of hydrochloric acid and pepsin (anenzyme) which are secreted by the gastric mucosa on the gastric and duodenal mucosa. There is also strong evidence that the bacterium, helicobacte pylori (H. pylori) can infect the bowel mucosa and cause ulcer disease. H. pylori and drugs (nsaids) damage the mucosa lining the stomach and duodenum, resulting in a disruption of the normal mucosal defence and its ability to repair itself. The mucosa becomes much more susceptible to attack by the acid present.

Both the stomach and duodenum secrete a mucous which has lubricating properties, as well as antibiotic activity. The stomach and duodenal mucosa also secretes bicarbonate which tends to neutralise the acid present. Another product of the gastric mucosa as prostaglandin E (a harmone) which promotes ulcer repair, inhibits gastric acid secretion and prevents disruption of the gastric mucosal barrier. The stomach and duodenal tissues therefore are normally able to control and monitor acid production.

There are several risk factors for peptic Ulcer disease (P.U.D.):

These include:

Nsaids

H. pylori infection

Cigarette smoking

Acute alcohol ingestion

Some foods

Symptoms of P.U.D. include:

Upper abdominal pain

Nausea and vomiting

Pain relieved by eating foods or taking antacids

Pain corresponding to food intake

Cramping abdominal pain

The diagnosis of P.U.D. is best confirmed by endoscopy (direct visualisation of the gastric mucosa), although a barium meal is a useful test.

Treatment seeks to relieve pain, promote ulcer healing and to prevent both recurrences of ulcers and their complications.

Histamine 2 blockers such as Zantac, Tagamet and others reduce gastric acid output.

Proton pump inhibitors are highly effective and can reduce gastric acid secretion by up to 90 per cent as well as have a longer duration of action. These include drugs such as Lanzap, Pariet, Nexium, Omeprazole, etc.

Neither H2 receptor blockers nor proton pump inhibitions will work adequately to treat P.U.D. and keep it from recurring if the H. pylori bacterium which is likely present in the bowel. Treatment usually requires a combination of antibiotics. Cabinations of clarithromycin and amoxil or Amoxill and Netronidazole are usually used. Most treatments require maintenance. do not go beyond six weeks, although if bleeding complications occur, the H2 receptor blockers or proston pump inhibitors are used long term for many months, even years.

Over-the-counter antacids may provide temporary relief of symptoms but will not usually cure P.U.D. Pepto bismol and cytotec help to protect the mucosa of the stomach and duodenum also assists with healing and pain relief.

Lifestyle changes which can help to control peptic ulcer disease include:

Eat small meals frequently to avoid triggering excessive production of acid and to give the stomach acid material to work on outside of the stomach lining.

Drink a quart of cabbage juice daily (in divided amounts). Cabbage has been found to help heal ulcers (stomach).

Drink plenty of water to dilute stomach acid and flush it away.

Avoid milk which stimulates gastric acid production.

Avoid citrus, sugar, coffee, alcohol and hot spicy foods which irritate the stomach lining.

Do not smoke tobacco as smoking irritates the stomach lining and increases stomach acidity.

As much as you can, avoid stress. Manage stress with exercise, yoga, long walks, restful music, avoidance of confrontations, proper planning of life's events and being realistic about your work load. Stress increases production of stomach acid.

Write:

Lifeline

P.O. Box 1731

Kingston 8