By Dr David Delvin

You've got a pain at the top of your tummy, just a couple of inches below the bottom of your breastbone.  Maybe it wakes you up at night .....

What the heck is going on?

Well, the likelihood is that you've got an ULCER!

For make no mistake: ulcers are really, really common - particularly in the over-45s.  Roughly one in TEN of the population will get an ulcer at some time or another.

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WHAT IS IT?

But what actually IS an ulcer?  People talk about them a lot, but often they're not too clear about what they really are.

Let me explain.  An ulcer is a RAW PLACE, inside your abdomen.  It's usually about the size of a small coin - say, a 20p piece.  And it hurts like blazes, particularly if you haven't eaten for a while.

But not all ulcers are the same ...

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TWO MAIN TYPES

It's important to realise that there's more than one type of ulcer.  Leaving out the rarer ones, we can say that there are TWO common types:

* GASTRIC ULCERS

These occur in the stomach itself - which is the little 'bag' that all your food goes into when you swallow it.

* DUODENAL ULCERS

These develop in the duodenum.  This is the narrow tube which carries food away from the stomach.  It's located a few inches about your navel.

In fact, both types of ulcer produce very similar types of pain,.  As I said at the start, the pain is usually in the top of your belly.  It's usually EASED by drinking some milk, or eating some food, or taking an antacid.  

And it's usually WORSENED by going without grub (which is why it may hit you in the middle of the night), or by worry and stress, or by smoking.  Aspirin and anti-rheumatism pills may also make it worse.

INTERNAL BLEEDING.  There's another very common symptom of ulcers, and it's this:  BLACK, 'TARRY' motions.  These are usually caused by BLEEDING from the ulcer.

So anyone who gets black motions should always report the symptom to the GP.  (It can also be caused by trivial things - like taking iron medication, or drinking red wine.)

If an ulcer bleeds, this can also cause VOMITING of blood.

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THE BAD OLD DAYS

Many readers who are aged over 45 will have nasty memories of the 'bad old days' when having an ulcer was a really SERIOUS business.

Back in the 1960s and 1970s, a lot of ulcer sufferers had the most frightful time - with pain that went on and on for many years.  Some of them were on special diets for decades.  And many others had to have very debilitating operations, such as one called 'gastrectomy' - in which most of the stomach was cut out.  

Thank heavens, those days are gone.  With modern methods of treatment, ulcers can very often be cured quite quickly.  Surgery is sometimes necessary, but it's usually very successful.

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WHAT CAUSES ULCERS?

OK, so what CAUSES ulcers?

Basically, it's too much acid.  You probably know that the juices in your stomach (the 'gastric juices') contain acid, the purpose of this acid is to digest your food.  But if you're producing a lot of the stuff, it's highly likely to start digesting YOU - in other words gnawing at the lining of your stomach or duodenum, and causing an ulcer.

Factors which help cause ulcers are:

SMOKING - because nicotine increases acid production

IRREGULAR MEALS - because your gastric juices have nothing to digest (except YOU!)

STRESS - because worry increases acid formation

USING ASPIRIN AND ANTI-RHEUMATIC (OR ANTI-ARTHRITIS) PILLS - because these irritate the delicate stomach lining

HAVING A PARTICULAR GERM IN YOUR TUMMY 

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THE HELICOBACTER GERM

Now that last point is tremendously important.  About 10 years ago, an Australian doctor started saying that ulcer sufferers often had a 'new' germ in their stomachs.

For a while, nobody paid him any attention.  After all, ulcers had been studied for over 100 years - and NO ONE had ever shown that they were anything to do with infection!

But the Aussie was right.  Yes, it is now accepted that nearly all duodenal ulcers and  most gastric ulcers are connected with the presence of a nasty little bug which goes by the strange name of HELICOBACTER PYLORI.

Very frequently, this germ gets in to the stomach during childhood.  Then - many years later - it helps to cause an ulcer.

Fortunately, in the last few years it has become quite simple to test for the germ - usually by doing a special 'breath test.'  And once it has been found, it's usually simple to wipe it out - using a combination of drugs (see below).

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WHAT TO DO IF YOU HAVE  ULCER SYMPTOMS

So if you've got the classic ulcer symptoms - pain in the top half of your tum which has persisted for more than a week - what do you do?

You go to your GP.  She'll ask you some questions about the pain, and will examine you.  She'll then tell you whether she thinks you do have an ulcer.

Until quite recently, suspected ulcer-sufferers were always sent by their GPs to a hospital consultant - who would arrange a 'barium meal' x-ray or 'telescope' inspection of the stomach (an endoscopy).

However, these days, the results of medication are so good that your GP may actually decide to kick off by giving anti-ulcer pills.  Sometimes, these work so well that the pain disappears almost at once, and never returns.  If that happens, there's usually little or no need for any further medication.

However, people who have severe symptoms - or complications, such as internal bleeding - are invariably referred to a hospital specialist for assessment and tests.

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TREATMENT

Now here's a brief guide to the medications which are used in order to treat ulcers.  There are various groups of drugs:

ANTACIDS  These traditional remedies are good at easing pain.  Many of them are famous 'over-the-counter' indigestion remedies.  However, they can't HEAL an ulcer.

H2-RECEPTOR ANTAGONISTS  These are the wonderful drugs which came in during the 1980s.  They HEAL ulcers by reducing the amount of acid which you produce.

Famous examples are cimetidine (trade name Tagamet), and ranitidine (trade name Zantac).

PROTON-PUMP INHIBITORS  These newer drugs also work by preventing your stomach from producing excess acid.  Celebrated examples include - omeprazole (trade name Losec), lansoprazole (trade make Zoton), and pantoprazole (trade name Protium).

CHELATES AND COMPLEXES  These useful drugs help to protect the stomach and duodenum against acid.  They include the well-known DeNoltab.

PROSTAGLANDIN ANALOGUES  These drugs are also protective agents.  The best known is misoprostol (trade name Cytotec).

OTHERS  Still useful for ulcers is the long-established remedy carbenoxolone, a derivation of licorice.

ERADICATION OF GERMS  A combination of drugs is used to eradicate the dreaded Helicobacter pylori germ.  Usually, you have to take them for either one or two weeks.

The actual combination of anti-helicobacter drugs is a matter for your GP or hospital specialist to decide.  But a common choice is 'triple therapy' with:

*  A proton-pump inhibitor (see above);

*  The penicillin-type antibiotic called ampicillin;

*  The antibiotic metronidazole

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WARNING!  WARNING!  WARNING!

ALL the medications mentioned in this article can have side-effects.  So you need to discuss the drugs carefully with your GP or gastro-enterologist before you start on them

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FINAL ADVICE!

Although modern anti-ulcer drugs are pretty wonderful, they are NOT going to work if you do daft things.

So please follow these common-sense rules:

*  Don't smoke

*  Get regular meals

*  Try to avoid stress

*  Unless your doc says it's OK to take them, avoid aspirin tablets and other anti-rheumatic (or anti-arthritis) pills.

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      (re Ulcers)

Q  My wife, aged 59, has an ulcer.  But she also has rheumatism.  Does this mean she can never take anti-rheumatism pills again?  If so, life is going to be very difficult for her.

A  There are special anti-rheumatic pills which your doctor can prescribe - ones which are not supposed to cause much gastric irritation.  But I can't GUARANTEE that these won't have a bad effect on your wife's ulcer.  Please bear in mind that good old PARACETAMOL doesn't irritate the tum.  So it can be taken by ulcer-sufferers without any risk of aggravating the ulceration.  Also, anti-rheumatism SUPPOSITORIES work well, and don't irritate the tummy

Q  I have recently had BLACK, tarry bowel motions.  I appreciate that this probably means internal bleeding.  But can I safely assume that the bleeding is just due to a small ulcer?

A  No!  There are other possible causes of internal bleeding - and some of them are serious.  Please see your GP as soon as possible.

Q  What on earth is 'GORD'?  I've had a lot of pain in  my tummy recently, and the doctors have told me that this is the diagnosis.

A  'GORD' is extremely common.  It stands for 'Gastro-Oesophageal Reflux Disease.'  In plain words, this just means, 'acid coming up from the stomach into the gullet.'   GORD causes symptoms very similar to those of an ulcer (see above), but with HEARTBURN being a major feature.  Fortunately, it responds very well to medication - but surgery is occasionally necessary.

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Q  I'm 61, female, and on HRT.  In view of the recent alarming revelations about side-effects, is it safe for me to go on taking it?

A  We've learned a lot recently about the unsuspected drawbacks of HRT - such as an increased incidence of breast cancer.  Personally, I think you should stay on it if it is helping to keep away severe menopause symptoms - like disabling hot flushes.  Happily, any chemist will be delighted to advise you about HERBAL alternatives to HRT.  Some of them seem to be very good at easing the symptoms of 'the change', without causing nasty side-effects.

Q  I'm male, aged 68 - and still keen on the ladies.  But I do need a little 'help' these days.  I've heard of that Viagra of course.  But are there any other pills on the market?

A  There are various ways of treat Erectile Dysfunction (ED(), but pills are now the most popular.  In my own practice, I've found that they work for most men in your age group.

At present, there are FOUR brands available in the UK.  They are:

*  Viagra    *  Cialis    *  Levitra    *  Uprima      More details are available fro your GP

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