Ever had to complain about this abdominal pain that comes on, particularly when you consume carbonated drinks/caffeine, at night or when you have not eaten, or probably early satisfaction during eating? Sometimes, this pain can radiate towards your chest region with discomforting heartburn which can be accompanied by nausea or vomiting. Oftentimes, in a community pharmacy setting, we see people walk in with just the option of self-medicating with over-the-counter acid-suppressing medications without proper diagnosis and knowledge about the condition called PEPTIC ULCER DISEASE (PUD). Although commonly called ULCER, Peptic Ulcer Disease is a type of ‘Ulcer.’ Peptic Ulcer Disease is a common condition, where lesions are found in the stomach and duodenum, and these lesions are acid-induced.1
RISK FACTORS
H. pylori (a microorganism) and the use of NSAIDs (Non-Steroidal Anti-inflammatory Drugs, a class of pain relivers) are the main risk factors for PUD, it is worthy of note, that not all individuals infected with H. pylori or taking NSAIDs develop PUD. Asides from these risk factors, PUD can be encouraged by several actions called triggers. These are;
- The use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Examples of are Diclofenac, Ibuprofen, etc. These drugs are used to help relieve pain and inflammation (swelling); however, one of their side effects is PUD. They do this by inducing mucosal (the thin skin that covers the inside surface of parts of the body) injury in the digestive tract. NSAIDs account for over 90% of all ulcers and approximately 25% of NSAID users will develop peptic ulcer disease2
It becomes something of concern when one has been in and out of treatment for a long time, also, some are at the highest risk for NSAID-induced ulcers. These are;
- Patients with a history of peptic ulcers or hemorrhage,
- Those concomitantly using steroids or anticoagulants,
- Anyone over the age of 65 and
- Those taking high doses or combinations of more than one NSAID (including low dose aspirin)
For Patients that require long-term use of NSAIDS, what can be done?
They will be on treatment that will prevent them from coming down with PUD during NSAIDs use. This is where you will need the professional advice of a medical personnel.
Other triggers are;
- Use of Caffeine
- Alcohol consumption
- Smoking
- Spicy meals
- Carbonated drinks
- Stress, etc.
DIAGNOSIS
Diagnosis of PUD starts with:
1. An observation and differentiation of alarm symptoms from non-alarm symptoms. Alarm symptoms are;
- Bleeding of the digestive tract
- Weight loss
- Early satiety
- Difficulty to swallow or painful swallowing
- Family history of upper digestive tract malignancy
- Iron-deficiency anemia
- New upper digestive tract symptoms in patients older than 553
2. Test: The test can be invasive or non-invasive. Examples of tests done are Culture tests, Stool antigen tests, Histology, Urea breath test, Serology, and Rapid Urea test. However, the result of some of these tests can be influenced by the administration of antibiotics and the class of drugs called Proton pump inhibitors.
TREATMENT
Treatment is usually followed through after the test results. This is advisable especially due to increasing antibiotic resistance resulting in a fall in the efficacy of triple therapy of PUD below 70% in many countries. Due to this increase in antibiotic resistance, there has been recorded reoccurrence in PUD among patients. It has resulted in a need for reexamination, about four weeks after the end of therapy, in H. pylori-associated PUD.
MANAGEMENT
To prevent/manage PUD, you can;
- Take NSAIDs with meals.
- Take medications that will prevent them from coming down with PUD before the commencement of long-term NSAID use.
- Avoid the ingestion of carbonated drinks.
- Manage stress properly.
- Avoid consumption of caffeine.
- Enable a hygienic environment for living and feeding.
- Complete antibiotic/triple therapy regimen.
- Insist on getting tested before commencing drug therapy.
- Seek the advice of a medical personnel (You can schedule an appointment with a pharmacist here).
- Do not self-diagnose/self-prescribe.
Your health needs all the attention!
REFERENCES
1. Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. Tenth edition. ed. Philadelphia, PA: Saunders/Elsevier, 2016: 2 volumes (xxxi, 2369, 2389 pages).
2. Lanza FL, Chan FK, Quigley EM, Practice Parameters Committee of the American College of G. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol 2009; 104:728-738.
3. Talley NJ, Vakil NB, Moayyedi P. American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology 2005; 129:1756-1780.
4. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infection-the Maastricht V/ Florence Consensus Report. Gut 2017; 66:6-30.