She knew she wasn’t feeling perfectly fit, but Sonali Kocchar, 36, a Delhi-based physician with an NGO, didn’t think it was serious enough to complain about. Kocchar ignored the mild pain in her chest, the occasional heartburn after a meal, and focused on work instead. She often worked late and never kept track of the cups of coffee she had. She travelled frequently, all over the world.
Kocchar should have known better, in retrospect. With time, the pain grew more and more acute. She started feeling nauseous, and when it started keeping her awake at night, she knew it was serious enough to get herself checked up.
It was, as she suspected, a peptic ulcer—a sore in the lining of the stomach or intestine —one of the most common and uncomfortable health problems anywhere. Though exact figures for India are not available, according to the US National Institutes of Health, it affects one in 10 Americans. In the UK, up to 13% of men, and 5% of women, get such ulcers. In a globalized world, where jetting around the world, eating and drinking at odd hours, and stress, have become a part of everyday life, symptoms of ulcers are getting increasingly common.
“Indeed, factors such as stress or tea and coffee, are triggers. They make the situation worse,” says S. Chatterjee, an internal medicine specialist at Delhi’s Indraprastha Apollo Hospital. He explains: “Every time we eat, our stomach produces acids to digest this food. Normally, a mucous coating on our stomach protects it against these acids. But, in certain situations, this protection is stripped off and acids affect the stomach, lining resulting in painful ulcers.”
Cause and effect
Lifestyle factors can aggravate the problem, but do not actually cause ulcers. Having tea or coffee frequently is more likely to cause acid reflux, where the food, along with the stomach acids, gets regurgitated up the oesophagus (the tube that connects the mouth to the stomach), says Paramvir Singh, a consultant gastroenterologist at Artemis Health Institute, Gurgaon. Among the known offenders are common drugs such as aspirin and ibuprofen, called non-steroidal anti-inflammatory drugs, which have been known to strip the stomach of its mucous coating and cause ulcers; so can excessive alcohol consumption and smoking. What took the medical profession by storm, however, was the discovery in the 1980s that a spiral-shaped bacteria called Helicobacter pylori that settles in the stomach, is more often the culprit. It weakens the mucous coating, and along with the acid, irritates the stomach lining till a sore forms. Nobody knows how it acts and why. Being infected with this bacteria does not necessarily mean you will get an ulcer. It only increases your chances of getting it. Nobody is quite sure how it is transmitted, although it is thought to be through food and water.
Blame it on bacteria
The discovery of Helicobacter pylori and its role in ulcers turned traditional medical concepts on ulcers on its head, and also won its discoverers the Nobel Prize in medicine. Till then, the traditional treatment for ulcers was rest and a bland diet along with antacids. Now, with a bacteria being proved responsible in some cases, good old antibiotics could do the trick, just like any other bacterial disease.
“At first, when I decided to get myself checked, very few doctors had heard of Helicobacter pylori,” says Kocchar. “So, when I didn’t get better for a year, I decided to do a little bit of research on the subject on my own, and then spoke to the doctor about this possibility.”
Kocchar was right—a test proved that she did indeed have that bacterial infection, and a course of two antibiotics along with certain drugs helped her recover completely.
That doesn’t work for everyone, though. Ranju Nair, a 50-year-old Delhi-based senior executive, frequent traveller and a food lover, got an ulcer without any bacterial infection. The pain below her chest came and went after meals. She had once loved experimenting with food, but her physical situation soon robbed her of her passion for exotic cuisine. Antacids became almost a regular part of her diet. Eventually, she disciplined her lifestyle, cut down on travel, and has got the discomfort somewhat under control.
Generally, for someone with common symptoms of pain and nausea, doctors will confirm the presence of an ulcer through a gastrointestinal series, i.e., x-rays of the affected parts of the digestive tract, or an endoscopy. In this, a tube-like instrument is passed through the mouth into the stomach of a sedated patient to enable the doctor to see the stomach lining or even take a sample for testing. This is the only way to confirm the presence of an ulcer.
The next step is to determine whether it is the bacteria or drugs that are responsible. A blood, stool or even a breath test can provide this information. If it is indeed Helicobacter pylori, then a course of two antibiotics, and another strong medicine called a proton pump inhibitor, which can stop acid production, usually do the trick, and the ulcer heals for good.
If the cause is something else, apart from the proton pump inhibitors, which are for more severe cases, another group of medicines—called H2 blockers—are available. These include well-known drugs such as ranitidine and cimetidine, which are effective for most people, and can be obtained over the counter. The ulcer could, however, recur once the medicines are stopped.
There are other, far less common, factors that cause ulcers. “Rarely, it is due to a virus, or Crohn’s disease. Or, it could be a sign of gastric cancer, though that is less than 5% of the cases,” says Dr Singh. “It could also be Zollinger-Ellison Syndrome, a very rare disorder.” Here, a tumour in the pancreas secretes a hormone which stimulates the stomach to produce more acid, thereby leading to ulcers.
So far, no one has figured out how to stop an ulcer from developing. But its impact can be minimized by certain simple precautions. The most obvious is to stop smoking and drinking as these could well be the cause of an ulcer. Avoiding aspirin in such situations is also a good idea. “Eating at regular intervals goes a long way towards this,” says Dr Chatterjee. So does cutting down on tea, coffee, colas and other carbonated drinks.
Losing weight is also a good preventive tactic, according to Dr Singh. “In obese people, abdominal obesity increases the pressure in that part of the body, and forces the oesophagus to open up, and this causes acid reflux,” he explains.
One of the best ways to keep an ulcer under control is particularly useful as summer approaches—drinking lots of water. “Water washes away the excess acid in the stomach,” Dr Chatterjee says. It’s one thing Kocchar sticks to, though she still has a hectic schedule. As she puts it: “It’s best to be careful, I never want to go through that agony again.”
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