THE DISABLING DISEASES: PEPTIC (GASTRIC AND DUODENAL) ULCER
This disease is commonly referred to as ulcers. An ulcer is simply a sore. Doctors add the word ‘peptic’ to indicate that the sore is in the stomach or the duodenum.
The cause of ulcers is not fully understood, but it is definitely associated with the presence of an excessive amount of acid gastric juices. These gastric juices, which are secreted by the stomach, are needed for digestion. In people with ulcers, there are excessive secretions, not only after eating, but also between meals and at night during sleep. We know that worry and anxiety can increase these secretions. For this reason, ulcers are considered to be a psychosomatic disease.
Symptoms
Pain and discomfort. The most common symptoms of an ulcer are pain, a burning sensation, or discomfort in the upper abdomen, usually felt about two or three hours after meals or in the middle of the night; sometimes the distress occurs sooner after meals. These socalled hunger pains generally subside promptly upon eating, drinking milk, or taking bicarbonate of soda or other antacids. Nausea and vomiting can also occur.
Bleeding. Untreated peptic ulcers can cause a slow seeping of blood, resulting in anaemia and the loss of health and strength.
The bleeding may be in the form of a sudden haemorrhage that threatens life itself. Blood is sometimes vomited and appears brownish because of the effect of the stomach acids. Blood in the bowel movements may be responsible for black or tarry stools. In the case of a massive haemorrhage, the person becomes weak, faint, and thirsty. He requires immediate medical attention and hospitalization. Full recovery often is a slow process.
Perforations. An ulcer may perforate through the wall of the stomach or duodenum. This causes excruciating pain in the upper abdomen. Patients have described it as ‘the worst pain of my life.’ They must be rushed to the hospital and operated upon immediately to prevent a fatal outcome.
In order to diagnose peptic ulcer, tests are made on the stomach acids. This is done by passing a tube through the mouth and oesophagus and taking a sample of the stomach contents. X-rays of the stomach and duodenum are also taken.
A gastroscopic examination, in which the doctor looks into the stomach by means of an instrument resembling a periscope, is especially important in many cases.
Anyone with symptoms suggesting a peptic ulcer should see a doctor promptly. An ulcer that has caused only mild discomfort can suddenly threaten life. Other potentially dangerous diseases can resemble a gastric ulcer; some of these require immediate treatment.
Treatment
Ulcers can be successfully treated and cured. But there is no quick and easy cure. Complete co-operation of the patient is necessary. The fundamentals of the treatment are a bland diet and medications to neutralize excess stomach acid.
An ulcer that has been healed by medical treatment may return if emotional tensions persist. Therefore, every effort is made to help the person relax and take things easy. Medicines such as barbiturates and other sedatives are sometimes given for this purpose.
Various operations have been attempted for the relief of ulcer. In one of them, the stomach contents are bypassed from the duodenum into the jejunum. This operation is called a gastroenterostomy. It is not as successful as some doctors once hoped it might be, because the ulcer may recur at the new opening between the stomach and intestine. This marginal, or jejunal, ulcer can be fully as troubling as the original one. In another operation, the acid-producing part of the stomach is cut away. This procedure is called subtotal gastrectomy. It is a drastic operation and must be performed by a specialist surgeon. Still another operation, vagotomy, cuts the vagus nerves leading to the stomach and thus reduces the acidity and motility of the stomach.
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