Excess of acids is the major factor that causes sour eructations, stomach upset and indigestion or heartburn and we try to mollify such symptoms by taking antacids which are considered to rectify and prevent sour eructations. Infact, hydrochloric acid is a natural constituent of stomach secretions, and helps the digestive enzymes to activate. Recurrent bouts of excessive acidity permeate in the form of peptic ulcer which is a condition of localised destruction of mucosa of stomach or inner wall of the stomach, (gastric ulcer).
When upper part of small intestine gets infected, it gives rise to duodenal ulcer, or we can say that it is a wound inside the stomach or duodenum. Persons, who have 6 to 8 times more acid than is normally required, do suffer from peptic ulcers but there are many exceptions also, hence this is not a standard criterion. There are cases which have low-grade acidity but, even then, they have peptic ulcers.
Excessive use of spices, condiments, alcohol, tobacco, coffee, tea etc. is held to be the basic cause of peptic ulcer. In addition, there are drug-induced peptic ulcers which are caused by indiscreet/overuse of resperine, caffeine, corticosteroids, indomethacin, brufen, aspirin etc.
Symptoms:
– Pain in upper part of the abdominal region usually aggravated by food.
– Pain is sharp, penetrating, and of burning type.
– In gastric ulcers pain increases soon after or immediately after taking meals but, in case of duodenal ulcers, it (pain) it may occur 2-3 hours after taking meals. These are variable timings of occurrence which clearly distinguish pain, in one ulcer from another.
– Type of ulcer can be finally determined after barium meal test, examination of stomach and its contents.
The problem gets complicated when there is bleeding/perforation at the site of ulcer, in which case surgery becomes necessary but, in all other situations, specified drugs and general measures will resolve the problem.
Generally cold and toned milk mollifies the problem but a bland diet also solves the problem. Milk may be served to the patient even after 15 minutes or even 2 hours, depending on severity/intensity of the case. Milk counteracts acidity and also delays emptying time of stomach, thus allowing the dmg to act for much longer period.
Treatment
(1) Non absorbable antacids are preferred due to their delayed absorption. Aluminium I lydroxide (brand name: Aludrox) is the drug of choice for treatment of peptic ulcers which might cause constiption. But constipation can be removed by combining Magnesium with Aluminium. Usual dose is 200-600 mg every hour when there is acute stage, but dosage and frequency may be reduced as the symptoms show a downward trend. As complete cure takes much longer time, the medicines should be continued for a month or more, even when symp-toms have subsided. In addition Calcium Carbonate, various Magnesium salts are available in ‘Digene Gel’ ‘Acigon’ ‘Gelusil’.
(2) Rantitidine/Zinetac/Xanitidinc/Raniten block histamine H2 receptors. Dosage is 150 mg twice daily or a single dose of 300 mg at bed time.. In order to prevent recurrence of gastric/ duedenal ulcers a 150 mg dose at bed time would suffice, but has to be continued for some time.
(3) Another drug is ‘Cimetidine’ (800-1200 mg) to heal an ulcer take 400 mg at bed-time to prevent the recurrence of peptic ulcers but it has been ably replaced by Ranitidine which has less side effects.
(4) Famotidine (brand names : Famtac, Famotin, Acipin, Fudone, Zactane) is 20 times stronger than Cimetidine and 7 1/2 times stronger than Rantidine. Its usual dose is 40 mg at bed time and has hardly much side effects.
As for side-effects, drug reactions and drug interactions, read the relevant literature or consult your doctor. These drugs must not be given up suddenly (unless there is some serious adverse effect), rather their dose should be tapered in a phased manner. Once relieved, doesn’t and shouldn’t mean a total immunity as there could be recurrence at any time. Cimetidine must be used with utmost care as it may decrease W.B.C.s. cause sexual dysfunction in males, swelling in the breasts (gynaecomastia) of females. Do not take any other drug while taking Cimetidine. Rest of the drugs, not men-tioned, should also not be taken with proper medical advice.
Unless dietary regimen is scruplously followed and all precipitatory factor/items omitted form diet altogether, no medicine can show any favourable and salutary results. Selfrestraint and self-management, self-descipline, self-control are the well known traits for speeding up quicker recovery.
Omeprazole is reported to provide 100% relief after use of four weeks but in the absence of much clinical evidence, this success rate cannot be fully relied upon but other drugs, of course with requisite safeguards & cautions, may be tried with lesser side-effects, even if their success rate ranges from 75 to 85%, so to say.