“Heartburn” is a general term for a burning pain that is usually related to a stomach condition. Heartburn is most often felt as a burning or clawing pain behind the sternum, .jpg)
and may be related to meals. One particular cause of heartburn-like pain is an ulcer or ulcers, either in the stomach (gastric ulcers) or in the duodenum (duodenal ulcers), which is the first part of the small intestine. If you have heartburn, it is important for your doctor to diagnose the cause, and if the cause is ulcers, to address and hopefully “cure” the problem, as untreated ulcers may result in hemorrhage, scarring of the stomach or intestine, inflammation of the pancreas, and even death. The two most common causes of both gastric and duodenal ulcers are Helicobacter Pylori, and the use of Non-steroidal anti-inflammatory medications.
Helicobacter Pylori (H. pylori)
Helicobacter Pylori is a bacteria that causes 70% of gastric ulcers1 and 85–95% of duodenal ulcers.2 It is important to treat and remove this bacteria from your body in order for an ulcer to heal and to prevent further ulcers from forming. H. pylori is also a risk factor for gastric cancer. 1 The urease breath test is a very sensitive test for this bacteria, and will pick up evidence of the organism 90–95% of the time. 2 Treatment to eradicate this bacteria is simple and effective and usually involves taking three different antibiotics for up to 2 weeks.2
Non-Steroidal Anti-inflammatory medications (NSAIDS)
These include aspirin, ibuprofen, naproxen, and indomethacin. People taking these medications include athletes, patients with arthritis, women with menstrual cramps and people with headaches. 25% of gastric ulcers1 and 4–10% of duodenal ulcers. 2 Older people, and those with chronic disease are more likely to develop ulcers due to use of NSAIDS. 2 If stopping this medication is not an option due to concurrent disease, there are newer NSAIDS that can be used for arthritis and sports injuries. These newer agents are known as COX-2 inhibitors, and may reduce the risk of ulcers and ulcer bleeding in patients who must take anti-inflammatories. 2
Don’t bother
The link between ulcers and stress, smoking, alcohol use, and spicy foods has not been conclusively proven.2 If these factors make heartburn or ulcer pain worse, by all means modify or discontinue them. But remember the top two above as the most important causes of ulcers and the most important factors to treat.
A final word on decreasing acid production
There are several classes of drugs on the market that act to decrease stomach acid production, neutralize stomach acid, or protect the stomach lining from acid. While these medications are important in the initial treatment of ulcers, long-term treatment with these medications is usually not required if the underlying causes of ulcers are addressed, ie. The use of NSAIDS or the presence of H. pylori.1, 2
The three basic categories of these drugs are:
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Proton pump inhibitors: Within this category is omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). These medications are given for 4 weeks and will heal 80-100% of gastric ulcers if H. pylori has been eradicated. 1
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H2 blockers: These include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). Given over a period of 8 weeks these medications have a healing rate of higher than 70% when H. pylori is eradicated. 1 Mucosal protectants, such as bismuth and sucralfate, are not as effective as H2 blockers or proton pump inhibitors. 1
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Antacids: Although taken by the general population for pain interpreted as “heartburn” these medications will not significantly promote healing of an ulcer, and are not recommended by physicians for ulcer treatment. 1, 2
References:
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Shrestha S, et al. Gastric Ulcers. From: Emedicine. Downloaded November 8, 2008 from: http://www.emedicine.com/med/TOPIC849.HTM
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Leung YP, et al. Duodenal Ulcers. Downloaded November 8, 2008 from: http://www.emedicine.com/med/TOPIC591.HTM
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