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Is it heartburn or an ulcer?

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December 31st, 2008

It used to be a diagnosis of an ulcer condemned you to a diet of bland foods, like milk and applesauce. Not anymore. "Foods, even spicy foods, don t cause ulcers. There s no specific diet recommended when you have one," says George Fantry, M.D., a gastroenterologist at the University of Maryland Medical Center in Baltimore, Md. Stress doesn t cause ulcers either. An ulcer isn t a hole in the stomach, as many people believe (except in rare cases which is when the term "perforated ulcer" applies). "It s a break in the lining of the stomach of about 3 to 5 mm in size, but that break doesn t actually go through the stomach wall," Fantry says. There are three different types of ulcers: peptic, gastric, and duodenal. A gastric ulcer affects the lining of the stomach; a duodenal ulcer affects the lining of the duodenum, the beginning of the small intestine. Peptic ulcer is the term used to describe ulcers in general. Most ulcers are caused by a bacterial infection called helicobacter pylori or, more commonly, h. pylori (H. Pie-LORE-ee). About half the people with a peptic ulcer from this cause are over age 60. The bacterial cause of ulcers That doesn t mean having h. pylori automatically leads to ulcers. "Many people can live with this infection and it will never bother them," says Mary Norman, M.D. "The other major cause of ulcers is extensive use of NSAIDs anti-inflammatory drugs like aspirin and ibuprofen," Norman says. "That s especially true among adults age 70 and older, since they tend to use NSAIDs regularly to fight problems like arthritis." The NSAID factor If you re not only taking NSAIDs but also steroids or blood thinners, you re at greater risk for ulcers. "If someone age 70 has never had stomach problems, suddenly notices their stool has turned black and is taking NSAIDs regularly, the odds are pretty good they have an ulcer," Fantry says. Diagnosing ulcers can be tricky because many adults think they re fighting heartburn. "Only 20% of people with heartburn have an ulcer," Fantry says. Reading the signs correctly "Heartburn tends to be higher up in your chest and literally feels like a burning. An ulcer is more of a dull, gnawing ache between your navel and upper abdomen. Pain may also radiate toward your back," Norman says. Other signals of an ulcer:

  • It occurs two or three hours after eating (when the stomach is empty).

  • Pain usually comes and goes.

  • The discomfort is sometimes relieved by eating.

"A blood or stool test can check for h. pylori but won t tell if an ulcer has actually developed," Fantry says. The best way to determine an ulcer is an endoscopy, an exam in which the doctor inserts a tube down your throat and looks into your stomach. If there are other symptoms like weight loss, other tests may be needed to check for more serious problems. Since NSAIDs play a major role in developing ulcers, anyone taking them regularly, even the over-the-counter drugs, should talk with their doctor about their true necessity. "Don t assume because it s a nonprescription medicine it can t hurt you," Norman says. Settling your stomach If an NSAID is necessary, ask your doctor:

  • Is this the lowest dosage that will help me?

  • What can I take to protect my stomach?

The treatment for h. pylori is a triple drug therapy. "You take an acid-fighting drug known as a proton pump inhibitor (PPI), like Prilosec or Prevacid, plus two antibiotics twice a day for two weeks," Fantry says. "The cure rate is 85% to 90% if you take these drugs for the full two weeks. Then you need to maintain your PPI for 8 to 12 weeks to be fairly confident the problem s been resolved."

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