Ulcers

Ulcers

Taming the Fire Within

If you have an ulcer, think twice before casting the blame on the usual suspects. Many of the one in ten people who have or will develop one think that ulcers are the result of either too much pressure at work or too much spicy food.

But in reality, researchers say, those excuses may have bigger holes in them than the one that's formed in your belly. In fact, research shows that ulcers are more common among the unemployed. And there's no evidence that spicy food plays any role in their formation.

"It's often not what people think, but there are many causes of ulcers, and age seems to play a role in most of them," says Jorge Herrera, M.D., associate professor of medicine at the University of South Alabama College of Medicine in Mobile. That seems only fitting, since ulcers seem to age a woman before her time, causing pain that can hamper physical activity and command a lot of attention. Most women seem to handle ulcers by treating their jobs and pressures with kid gloves and by adopting Grandma's diet of applesauce, cottage cheese and other bland foods.

How We Set Ourselves Up

Ulcers form when digestive juices--acids, really--start burning through the delicate pink lining of your digestive organs. This is usually the result of a deterioration in a protective layer that covers the lining of the stomach and duodenum, the top part of the small intestine.

There are two major types: Gastric ulcers, which show up more frequently in women and usually after age 50, occur in the stomach, and symptoms include a burning or "hungry" feeling in the stomach or under the breastbone, a vague uneasiness of the stomach and even chronic nausea. Duodenal ulcers, which are more common among men and tend to strike between ages 20 and 40, hit lower, in the upper portion of the small intestine. With duodenal ulcers, pain is often relieved after eating; with gastric ulcers, it's not. Either type of ulcer can lead to stools that are black or maroon and foul-smelling and to vomiting what appears to be coffee-ground material.

"The biggest cause of gastric ulcers is taking certain medications," says Dr. Herrera. "These ulcers are more common in women, particularly as they get older, because many of these medications are for conditions that usually occur as you age, such as arthritis drugs and other painkillers."

But even young women may be setting themselves up for gastric ulcers. "Probably the worst offenders, simply because they're the most frequently used, are aspirin and other nonsteroidal anti-inflammatory drugs available over the counter," says Dr. Herrera. "If you take any of these drugs for more than three months at a time, as many women do, you increase your risk of ulcers significantly."

These drugs do their dirty work by inhibiting the production of mucus and protective acid-neutralizing agents; aspirin can also weaken the stomach lining and cause bleeding. "In fact, many patients don't even realize they have ulcers because of the painkillers in the drugs they take," he adds. "Sometimes they come into the office for problems with bleeding or their stools, and only then do they realize they have ulcers."

Duodenal ulcers often result from smoking, which causes the production of excessive amounts of digestive acids. But studies show that at least 95 percent of patients with duodenal ulcers also harbor common bacteria called Helicobacter pylori, says William B. Ruderman, M.D., chairman of the Department of Gastroenterology at the Cleveland Clinic Florida in Fort Lauderdale. The bacteria are spread from person to person, like other infectious diseases, and can be cured with antibiotics. "These bacteria are more common as you age," says Dr. Ruderman. "For one thing, exposure to these bacteria increases over time. And your body's defenses may get impaired over time." In fact, as many as one in five people with these bacteria comes down with duodenal ulcers.

How We Can Escape the Trap

If you think you have an ulcer, see your doctor. A doctor can prescribe drugs that reduce acid secretions and ease pain as well as antibiotics for H. pylori. In the meantime, here's what you can do to prevent ulcers or to lessen their severity.

Choose Tylenol. For headaches and other minor aches and pains, take acetaminophen, which is in products such as Tylenol, rather than ibuprofen, commonly sold as Advil and Nuprin. Ibuprofen is an anti-inflammatory, and products containing it can cause ulcers, says Dr. Herrera. "Sure, they have painkilling ingredients, but so do other medications that won't lead to ulcers. So if you have a headache or other minor problem that requires a painkiller, take Tylenol." And stay away from aspirin, since it can do even more damage than ibuprofen. Aspirin can weaken the stomach lining and cause bleeding.

Stop smoking. Cigarettes do double damage to the ulcer-prone. "Smoking can lead to ulcers because it increases acid production several-fold, especially if you smoke after dinner or before bed," says Dr. Herrera. "That's because acid production is usually worse at night."

Once you have ulcers, the acid created by smoking makes it hard to get rid of them. "It keeps ulcers from healing and makes it more likely that they will come back," adds Mark H. Ebell, M.D., assistant professor in the Department of Family Medicine at Wayne State University in Detroit.

Mellow out. People who view their lives as being too stressful are up to three times more likely to develop ulcers than those who learn to roll with life's punches, says Robert Anda, M.D., of the National Center for Chronic Disease Prevention and Health Promotion in Atlanta. But since we're all under stress, why do some of us get ulcers and others don't?

"It's how you interpret stress," says Dr. Anda. When you feel the weight of the world is on your shoulders and perceive stressful events as negative, you're a prime candidate for ulcers, because this perception results in the production of more stomach acids. On the other hand, women who acknowledge they have stress but view it as a fact of everyday life and don't let it overwhelm them are less likely to get ulcers.

Many women who react negatively to stress find it helps to talk about their problems with good friends, to do regular meditation or relaxation exercises or even to start regular exercise programs, says Howard Mertz, M.D., assistant professor of medicine at the University of California, Los Angeles, UCLA School of Medicine.

Reassess your bland diet. While there's no proof that eating a bland diet will help, there is evidence that drinking one may hurt. In fact, the old remedy of drinking milk for an ulcer may actually do more harm than good, says Richard W. McCallum, M.D., professor of medicine and chief of gastroenterology at the University of Virginia School of Medicine in Charlottesville. That's because while milk may initially have a neutralizing effect on these acids, after 30 minutes or so, you get a "rebound effect" in which the calcium and protein from the milk actually stimulate acid production.