Wednesday, February 1, 2023

Treatment For Gastric Ulcers In Adults

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How Are Peptic Ulcers Diagnosed

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Your healthcare provider will look at your past health and give you a physical exam. You may also have some tests.

Imaging tests used to diagnose ulcers include:

  • Upper GI series or barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe , stomach, and the first part of the small intestine . You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray.
  • Upper endoscopy or EGD . This test looks at the lining of your esophagus, stomach, and duodenum. It uses a thin lighted tube called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your health care provider can see the inside of these organs. A small tissue sample can be taken. This can be checked for H. pylori.

You may also have the following lab tests to see if you have an H. pylori infection:

What Tests Are There For A Stomach Ulcer

If your doctor thinks you may have a stomach ulcer, the initial tests will include some blood tests. These tests will help to check whether you have become anaemic because of any bleeding from the ulcer. The blood test will also check to see that your liver and pancreas are working properly.

The main tests that are then used to diagnose a stomach ulcer are as follows:

  • A test to detect the H. pylori germ is usually done if you have a stomach ulcer. The H. pylori bacterium can be detected in a sample of stool , or in a ‘breath test’, or from a blood test, or from a biopsy sample taken during a gastroscopy. See the separate leaflet called Helicobacter Pylori for more details.
  • Gastroscopy is the test that can confirm a stomach ulcer. Gastroscopy is usually done as an outpatient ‘day case’. You may be given a sedative to help you to relax. In this test, a doctor looks inside your stomach by passing a thin, flexible telescope down your gullet . The doctor will then be able to see any inflammation or ulcers in your stomach.
  • Small samples are usually taken of the tissue in and around the ulcer during gastroscopy. These are sent to the laboratory to be looked at under the microscope. This is important because some ulcers are caused by stomach cancer. However, most stomach ulcers are not caused by cancer.

How Can I Prevent A Stomach Ulcer From Occurring Or Returning

  • Reduce NSAID use, if possible. Consider whether acetaminophen might substitute. If you take NSAIDs for medical reasons, talk to your doctor about reducing your dosage or switching your medication. Your doctor may also prescribe another medicine to take with NSAIDs to protect your stomach lining.
  • Reduce other irritants that may contribute to too much stomach acid or erode your stomach lining, including smoking and alcohol use.
  • Take an H. pylori breath test to find out if you have an overgrowth of the bacteria.

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Causes And Risk Factors

  • In most cases, peptic ulcers are caused by a bacterial infection with Helicobacter pylori , and not by stress or spicy foods. Between 10% and 20% of those infected with H pylori will have a peptic ulcer during their lifetime.
  • Long-term use of nonsteroidal anti-inflammatory drugs is the second most common cause of ulcers. Women and older adults seem to be more susceptible.
  • Compared to other NSAIDs, COX-2 inhibitors may pose less risk for bleeding, but still increase the risk of bleeding compared with no NSAID use at all.
  • Alcohol and smoking are also common risk factors for peptic ulcer.

How Do Doctors Treat An Nsaid

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If NSAIDs are causing your peptic ulcer and you dont have an H. pylori infection, your doctor may tell you to

  • stop taking the NSAID
  • reduce how much of the NSAID you take
  • switch to another medicine that wont cause a peptic ulcer

Your doctor may also prescribe medicines to reduce stomach acid and coat and protect your peptic ulcer. Proton pump inhibitors , histamine receptor blockers, and protectants can help relieve pain and help your ulcer heal.

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Alternative And Complementary Therapies

Certain lifestyle changes can help you recover from an ulcer.

  • Watch your diet. If you know that there are specific foods that make your ulcer feel worse, avoid them until your treatment is over. For many people, these include alcohol, caffeine, fatty foods, spicy foods, and chocolate.
  • Stop smoking. If you smoke, you are already at increased risk of getting an ulcer. The data also shows that ulcers take longer to heal in smokers and that the ulcer medication you are taking may be less effective. Scientists don’t know exactly why smoking has these negative effects.
  • Take pain medication carefully. NSAIDs, such as aspirin, ibuprofen, and many other commonly taken drugs, are taken for pain and fever, but can cause an ulcer if used too often. NSAIDs can also prevent an ulcer from healing as quickly as you would like, so talk to your doctor about what you can take for your other aches and pains while you are waiting for your ulcer to heal. Acetaminophen does not cause ulcers, so it may be an effective substitute. Also, be sure to read all drug labels some cough and cold liquids have NSAID ingredients in them, and you should avoid them, too.
  • Cut back on alcohol. Stop drinking alcohol if you want to completely reduce your risk of additional ulcers and help your body heal.

Diagnosing A Stomach Ulcer

To get a diagnosis of stomach ulcer, you need to visit your doctor. Your doctor will ask you to describe your symptoms, including how often you feel them and when they happen . To confirm if you have an ulcer, the type of ulcer, and its cause, your doctor will run further tests.

One of these tests is a barium swallow. You will need to drink liquid barium, which will coat the organs of your gut so they can be seen by an X-ray . Another test is an upper endoscopy. An endoscope with a camera is inserted in your mouth and is directed through your digestive tract to your duodenum to check for ulcers. A tissue sample can also be taken for a H. pylori lab test using this method.

In addition to getting tissue samples through endoscopy, the Mayo Clinic points out that stool and breath tests can be used to check for H. pylori infection. Stool tests are used to check for H. pylori or its antigen. To perform a breath test, you will swallow tagged carbon molecules — if these encounter H. pylori in your gut, it will cause carbon to be released into your body, which will then need to be breathed out. You will exhale into a bag, and a device will detect the amount of tagged carbon molecules your breath contains.

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How Is A Peptic Ulcer Diagnosed

Your doctor will ask about your symptoms, whether you take NSAIDs and other drugs, and medical history. Theyâll also check you for bloating in the belly and pain. That may be enough to make a diagnosis.

The only way your doctor can tell for sure if you have an ulcer is to look. They may use a series of X-rays or a test called an endoscopy. This test allows them to pass a thin, bendy tube down your throat and into your stomach and small intestine. The tube has a camera at the end so they can check the lining for ulcers. They may also take a small piece of the lining to test for H. pylori. Blood, breath, and stool sample tests also can screen for the bacteria.

What Causes Stomach Ulcers

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The two most common causes are:

  • H. pylori infection. This common bacterial infection affects up to half of people worldwide. It primarily lives in the stomach. In many people, it doesnt seem to cause problems. Their gut immune systems keep it in check. But a portion of those infected have H. pylori overgrowth. The bacteria continue to multiply, eating into the stomach lining and causing chronic inflammation and peptic ulcer disease. H. pylori infection is associated with about 60% of duodenal ulcers and 40% of gastric ulcers.
  • Overuse of NSAIDs. NSAID stands for non-steroidal anti-inflammatory drug.” These include common over-the-counter pain relief medications such as ibuprofen, naproxen and aspirin. NSAIDs contribute to ulcers in several ways. They irritate the stomach lining on contact and repress some of the chemicals that defend and repair the mucous lining. Up to 30% of people who take NSAIDs regularly develop peptic ulcers. Up to 50% of all peptic ulcers are caused by the overuse of NSAIDs.

Less common causes of stomach ulcers include:

  • Zollinger-Ellison Syndrome. This is a rare condition that causes your stomach to produce too much gastric acid.
  • Severe physiological stress. Severe illness, burns or injuries can produce stress ulcers in the stomach. Physiological stress changes your bodys PH balance, increasing stomach acid. Stress ulcers develop very quickly in response to stress, unlike normal stomach ulcers that develop gradually.

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Antibiotic And Combination Drug Regimens For The Treatment Of H Pylori

The established treatment for H pylori infection is a combination of antibiotics plus a PPI. Current standard therapy includes three medicines, two antibiotics plus a PPI, called triple therapy. Quadruple therapy refers to four medicines, in various combinations. For any of these regimens, the medicines may be taken in stages, one after another. This is called sequential therapy. Medicines may also be taken at the same time. This is called concomitant therapy. Due to the growing resistance to certain antibiotics and areas where standard therapy cure rates are somewhat low, various combinations and timing of medications are now under study.

Reported cure rates for H pylori range from 70% to 90% after triple therapy regimen treatment. Eradication rates are higher for when bismuth subsalicylate is added to the regimen. The standard treatment regimen uses two antibiotics and a PPI:

Patients typically take combination treatment for 10 to 14 days. A 7-day regimen is another option, but some research suggests that 14 days of therapy with antibiotics and PPIs is more effective at eradicating H pylori. When quadruple therapy is taken at the same time , cure rates appear similar to when the medicines are taken sequentially.

Combination products are available.

Follow-Up

Follow-up testing to check that the bacteria have been eliminated should be done no sooner than 4 weeks after therapy is completed. Test results before that time may not be accurate.

Failure

What Ulcer Treatments Are Available

If your ulcer is bleeding, your doctor may treat it during an endoscopy procedure by injecting medications into it. Your doctor could also use a clamp or cauterization to seal it off and stop the bleeding.

For most people, doctors treat ulcers with medications, including:

  • Proton pump inhibitors : These drugs reduce acid, which allows the ulcer to heal. PPIs include Prilosec®, Prevacid®, Aciphex®, Protonix® and Nexium®.
  • Histamine receptor blockers : These drugs also reduce acid production and include Tagamet®, Pepcid®, Zantac® and Axid®.
  • Antibiotics: These medications kill bacteria. Doctors use them to treat H. pylori.
  • Protective medications: Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further damage from digestive acids and enzymes. Doctors commonly recommend Carafate® or Pepto-Bismol®.

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Tips For Living With Ulcers

  • If you have an ulcer, be careful when choosing over-the-counter pain relievers. Aspirin and other nonsteroidal anti-inflammatory drugs like ibuprofen can irritate an ulcer and prevent a bleeding ulcer from healing. Avoid powdered headache medication, too. It usually contains powdered aspirin. Your best choice may be acetaminophen, which doesnât cause or worsen stomach ulcers.
  • Don’t overdose on iron supplements. You may need them if you have bleeding ulcers, but taking too much can irritate your stomach lining and the ulcer. Ask the doctor how much iron you need.
  • Learn how to manage stress. Relaxation techniques like deep breathing, guided imagery, and moderate exercise can help ease stress and promote healing.
  • Avoid foods that irritate your stomach. Use common sense: If it upsets your stomach when you eat it, avoid it. Everyone is different, but spicy foods, citrus fruits, and fatty foods are common irritants.
  • Stop smoking. Heavy smokers are more likely to get duodenal ulcers than nonsmokers.
  • Practice moderation. Drinking lots of alcohol has been shown to contribute to ulcers, so keep your intake to a minimum.

Causes And Treatments For Stomach Ulcers In Adults

Natural remedies for stomach ulcers.... (With images)

Disclaimer: Results are not guaranteed*** and may vary from person to person***.

Stomach ulcers in adults have a lot of possible causes, but one cause that is often overlooked is stress. Even if you are healthy and have no other health problem, simply being stressed out could be causing painful stomach ulcers to occur.

Stomach ulcers are sores in the lining of your stomach or small intestine. The stomach lining and small intestine have a layer of mucus which protects them from acidic digestive juices. If this mucus is reduced, our digestive juices can eat away at our stomach lining or small intestine, creating those pain-inducing stomach ulcers we want to avoid.

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What Tests Will Be Done To Diagnose A Peptic Ulcer

Endoscopy. An upper endoscopy exam is expedient because allows healthcare providers to see inside your digestive tract and also take a tissue sample to analyze in the lab. The test is done by passing a thin tube with a tiny camera attached down your throat and into your stomach and duodenum. Youll have medication to numb your throat and help you relax during the test. Your healthcare provider may use the endoscope to take a tissue sample to test for signs of mucous damage, anemia, H. pyloriinfection or malignancy. If they take a sample, you wont feel it.

Imaging tests. Imaging tests to look inside the stomach and small intestine include:

  • Upper GI series. An upper GI X-ray exam examines the stomach and duodenum through X-rays. Its less invasive than an endoscopy. For the X-ray, youll swallow a chalky fluid called barium, which will coat your esophagus, stomach and duodenum. The barium helps your digestive organs show up better in black and white images.
  • CT scan. Your healthcare provider might recommend a CT scan if they need to see your organs in more detail. A CT scan can show complications such as a perforation in the stomach or intestinal wall. For the test, youll lie on a table inside a scanner machine while X-rays are taken. You may drink or have an injection with contrast fluid to make your organs show up better in images.

Tests for H. pylori. Your healthcare provider might want to test you separately for H. pylori infection. Tests may include:

Who Is More Likely To Get Ulcers

One in 10 people develops an ulcer. Risk factors that make ulcers more likely include:

  • Frequent use of nonsteroidal anti-inflammatory drugs , a group of common pain relievers that includes ibuprofen .
  • A family history of ulcers.
  • Illness such as liver, kidney or lung disease.
  • Regularly drinking alcohol.

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What Can I Do To Prevent Stomach And Duodenal Ulcers In My Child

Preventing H. pylori can reduce your childs risk of ulcers. It isnt fully understood how this infection is spread. But these things may lower your childs risk of H. pylori:

  • Washing hands often

  • Not having close contact with someone who has H. pylori

  • Not eating or drinking contaminated food or water

Ask your child’s provider about alternatives to aspirin or NSAID pain relievers for your child.

Can Stomach Ulcers Just Go Away

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Some ulcers follow a chronic pattern of healing temporarily on their own and then returning. This might happen if the factors contributing to your ulcer, such as NSAID use, smoking and alcohol, are temporarily reduced and then resumed. You wont completely heal your ulcer until you eliminate the cause, whether that is chronic NSAID use, H. pylori infection or an overactive stomach. Even after successful treatment, you can get another ulcer.

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Eradication Of Helicobacter Pylori

Most peptic ulcers are caused by Helicobacter pylori infection. If a diagnosis of ulcer is probable, treatment to eradicate H. pylori should be considered if the patient has frequent attacks requiring repeated and/or prolonged treatments with antiulcer drugs over 8 weeks or in cases of complicated ulcers . Infection should be confirmed with a test where possible.

H. pylori resistance to antibiotics varies globally, follow national recommendations where available. If not, for information, administer a triple therapy for 7 days:omeprazole PO 20 mg 2 times daily + clarithromycin PO 500 mg 2 times daily + amoxicillin PO 1 g 2 times dailyaCitation a.In penicillin-allergic patients, amoxicillin PO can be substituted with metronidazole PO 500 mg 2 times daily..

In immunocompromised patients, consider mycobacterium avium complex infection or other nontuberculous mycobacterium infection prior to starting a clarithromycin-containing triple therapy.

If symptoms continue despite treatment, consider the differential diagnosis of gastric cancer. Refer for investigations if possible.

Notes:

  • Acetylsalicylic acid and NSAID are contra-indicated in patients suffering from or with a history of ulcers.
  • Omeprazole is as effective PO as IV.
  • In penicillin-allergic patients, amoxicillin PO can be substituted with metronidazole PO 500 mg 2 times daily.

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