More than worry can cause ulcers

Press, 1 September 1986, Page 6

More than worry can cause ulcers

From

Dr George Hanbury

for th® Royal New Zealand College of General Practitioners

“He has a stomach ulcer.” You hear it said often enough, but just what does it mean? First, understand that the stomach is the sack at the end of your gullet It lies up under the ribcage, on the left side mostly. The soft bit between your ribs and your thighs is often called the stomach (or the “tummy” ) but It is really the abdomen, and it contains a good

deal else besides the stomach.

The duodenum is the first short length of intestine that empties the stomach. The words “stomach ulcer” may be used to mean an ulcer of the stomach or of the

duodenum. An ulcer is an open sore.

When we eat, the walls of the stomach produce strong acid to help break down food. Its own walls are protected by a mucous layer, but when

there is a breakdown of that protection an area of wall may become raw and an ulcer form.

Once food is past the duodenum, alkali from the pancreas neutralises the stomach acid, so there is little risk of ulcer, but the duodenum itself is an susceptible as the stomach to acid.

What happens? Pain is the classic feature. Typically it is a gnawing or burning pain, centrally in the upper abdomen, related to eating, coming in bouts lasting from days to weeks, then going. It is relieved by antacids contained in tablets for relief or baking soda. Lesser types of indigestion (wind, fullness, vague pains unrelated to food) are not the usual symptoms of ulcer.

Who gets ulcers? Duodenal ulcers, are more common in men than women. The peak ages are 35 to 55. For stomach

ulcers men and women equally, and the peak age is 70 and above. A European or American has a one in seven chance of suffering an ulcer in a lifetime, but that risk is not so high for a New Zealander.

Why do they happen? We associate uclers with worry and indeed we know that worry makes the stomach produce more acid than usual. However the connection between anxiety and ulcers is really far from clear.

More clearly, they can be associated with other causes of high acid secretion — cigarette smoking, coffee and alcohol overconsumption.

We know too, that It is not only oversecretion of acid that leads to ulcers. The other factor is the mucuous layer that protects the stomach wall.

Recent research has quite clearly associated breakdown of this mucous layer with the presence of certain bacteria in the stomach. We are now beginning to see at least

some cases of ulcer as caused by infections. Diagnosis can be presumed la the person with classic symptoms, but can only be confirmed by Xray, with a “barium meal” that outlines the stomach and duodenum with opaque dye, or by endoscopy. With the use of fibroptic technology a flexible instrument is passed down the gullet and into the stomach and duodenum, so that the operator can examine the wall directly. Most ulcers heal by themselves but many need medical treatment. Of those, people whose symptoms are severe enough to reach the attention of doctors, 80 per cent will have more symptoms within a year. Eventually most will cease to suffer — a quarter will have only one attack, half have recur-

ring oouis, ana another quarter suffer severe and pesistent symptoms. Treatment has varied over the years. Pain is relieved by antacids but they do not neutralise the stomach acid — to do that the dose would have to be impossibly high. There are now several quite specific and effective medications for ulcers. Their modes of action are complex and in some cases still rather poorly understood but they are indubitably effective, at least for stomach ulcers. So much so that surgery is now more rarely necessary. Surgery is necessary though, if there are complications. Nobody dies from ulcers, but the complications can be fatal. The ulcer can bleed catastrophically into the gut — the sufferer is suddenly weak and pale, and his bowl motions black and tarry. Urgent hospitalisation is necessary. Or the ulcer can eat its way right through the stomach wall and into the abdominal cavity, causing acid peritonitis.

Family Doctor