Diagnosis and treatment of peptic ulcers
BEGINNING THE WEEK OF AUG. 7, ASK THE DOCTOR WILL CHANGE TO FIVE DAYS A WEEK FROM SIX DAYS A WEEK. THE FORMAT WILL REMAIN UNCHANGED.
DEAR DR. DONOHUE: My husband was just discharged from the hospital for a peptic ulcer. I don't know what a peptic ulcer is, and I am too embarrassed to ask the doctor. Is it a stomach ulcer? Will it come back? -- R.S.
ANSWER: Peptic ulcers are either stomach or duodenal ulcers. The duodenum is the first part of the small intestine. It's directly attached to the stomach. You can, without any embarrassment, ask the doctor if your husband's ulcer was a gastric (stomach) ulcer or a duodenal ulcer. The treatment for both is much the same. Both kinds respond to a decreased production of stomach acid. One big difference between the two is that 3 percent to 5 percent of stomach ulcers are cancerous. Stomach ulcers, therefore, call for close follow-up.
A new twist has become part of the ulcer story. It's a bacterium called Helicobacter (HE-lick-oh-BACK-tur) pylori (pie-LORE-ee). This bacterium disrupts the protective covering of the stomach and duodenum, and allows stomach acid and digestive juices to gnaw on the walls of those structures. That's the beginning of a sore, an ulcer, which can bore through the walls of the stomach and duodenum.
Ulcer pain most often arises in the upper-middle portion of the abdomen. It can waken a person from sleep. Food or antacids promptly relieve ulcer pain -- temporarily. If either ulcer bleeds, stools turn tarry black.
Endoscopy -- a look into the stomach or duodenum with a flexible scope -- is the most popular way of making the ulcer diagnosis today. An upper-GI X-ray, one taken with both barium and air (a double-contrast X-ray) is still a good diagnostic tool for ulcer detection.
Ulcer treatment has undergone major changes. Medicines called proton pump inhibitors can effectively stop the production of stomach acid and allow the ulcer to heal. Prevacid (lansoprazole) is an often-chosen proton pump inhibitor. Antibiotics eradicate H. pylori. Amoxicillin and clarithromycin are the ones usually chosen. Getting rid of H. pylori greatly reduces the chances that the ulcer will return.
DEAR DR. DONOHUE: I'm a healthy 80-year-old who loves to travel. I take airplanes. When the aircraft descends, I've been experiencing extreme ear pain. I tried all the standard ways to combat it, including taking a decongestant. I'd hate to resort to a broom for my next trip. -- P.S.
ANSWER: The middle ear, right behind the eardrum, is a hollow chamber containing three small bones that transmit sound to the inner ear. The air in the middle ear should have the same air pressure as the outside air. When a plane descends, air pressure in the cabin increases. The air pressure in the middle ear takes longer to adapt to the increased pressure. As a result, the eardrum is pushed inward -- a painful event. I know you've tried the usual maneuvers to equalize air pressure, but let me mention them for others. Chewing gum and repetitive swallowing force air into the middle ear to equalize pressure. Pinching the nose between the index finger and the thumb while trying to exhale through a closed mouth is another way to force air into the middle ear.
Have you tried EarPlanes? They're plugs you insert into the ear canals an hour before takeoff or landing. They're found in drugstores. They work wonders for many people with your problem. Ditch the broom.
DEAR DR. DONOHUE: I've taken a multivitamin for five years. During this time, I've been dizzy and had three falls. I quit taking the vitamin four months ago. My dizziness went away. I tried half a pill. Again, I became dizzy. What are your thoughts on this? -- H.S.
ANSWER: Your successful experiment surprises me. I never heard of such sensitivity to multivitamins. Perhaps it comes from the fillers, substances in the pill that hold it together.
You've made your point with credible evidence.
I wonder if any other readers have had a similar experience. It's news to me.
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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.
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