Causes of ulcers

Treatment for a Patient With a Duodenal Ulcer

Until relatively recently, stress and spicy foods were deemed to be the likely causes of ulcers. That has changed, however, with the discovery of the causal link between H. pylori and duodenal ulcers. "Infection with Helicobacter pylori (commonly just called H. pylori) is the cause in about 19 in 20 cases of duodenal ulcer" (Kenny 2012). For some people who are infected, the bacteria causes no symptoms while for others it causes a disruption of the mucus barrier and an increase in the amount of digestive acid in the lining of the stomach, resulting in inflammation and discomfort, ultimately cumulating in an ulcer (Kenny 2012).

This revelation about the causation of ulcers has caused a dramatic shift in how they are treated. Instead of prescribing surgery, a 4-8-week course of acid-suppressing medication is used. The intention is to allow the ulcer to heal. A "one-week course of two antibiotics plus an acid-suppressing medicine will usually clear the H. pylori infection. This usually prevents the ulcer from coming back" (Kenny 2012). Surgery is still occasionally prescribed but only as a last resort after other options have been exhausted. A bland diet, formerly prescribed for sufferers, is no longer thought to be effective. In the case of this particular patient, because of her physical frailty, surgery would likely not be prescribed until multiple other options had failed.

In the case of this patient, it is noteworthy that she was on a course of anti-inflammatory medicines when the ulcer manifested itself: she was taking ibuprofen and aspirin, both of which are associated with triggering ulcers. "Anti-inflammatory medicines used to treat conditions such as arthritis sometimes cause duodenal ulcers" (Kenny 2012). Ideally, the use of the medication should be discontinued but if the patient must continue to take such anti-inflammatory medicines for pain relief, then he or she may need to take long-term acid-suppressing medication with the suggested anti-inflammatories instead. "In many cases the anti-inflammatory medicine is needed to ease symptoms of arthritis or other painful conditions, or aspirin is needed to protect against blood clots. In these situations, one option is to take an acid-suppressing medicine each day indefinitely. This reduces the amount of acid made by the stomach, and greatly reduces the chance of an ulcer forming again" (Kenny 2012).

Symptoms of duodenal ulcers are very specific, compared with other types of ulcers:

"Pain is absent when the patient awakens but appears in mid-morning, is relieved by food, but recurs 2 to 3 h after a meal. Pain that awakens a patient at night is common and is highly suggestive of duodenal ulcer. In neonates, perforation and hemorrhage may be the first manifestation of duodenal ulcer" (DiMarino 2014). This discomfort level means that treatment is a necessity. The first step in treating the patient would be blood, breath, and stomach tissue testing to confirm H. pylori infection. "Although some of the tests for H. pylori may occasionally give false-positive results, or may give false-negative results in people who have recently taken antibiotics, omeprazole, or bismuth, research shows these tests can be helpful in detecting the bacteria and guiding treatment" ("Stomach and Duodenal Ulcers (Peptic Ulcers)," 2014).