Dear Doctor, how do I manage ulcers?

Dr Flo,

I am 27 years old and I have had this problem for a year now. My symptoms are nausea in the morning, dizziness, anxiety, loss of appetite and abdominal pain.

Four weeks ago, I went to hospital for a checkup and they told me that I have ulcers (gastritis). The doctor prescribed medicine which I took for two weeks, but I am yet to recover fully. What medicine and diet plan can help me manage my condition? My current diet is basically black tea in the morning, an orange, oily chapati, rice and beans.

Please advise me.

Concerned Patient

Dear Concerned Patient,

Gastritis refers to irritation or inflammation of the lining of the stomach, caused by erosion by stomach acid and digestive enzymes. The inflammation may be worsened by an infection in the stomach. If this continues, it can lead to a break in the lining of the stomach, forming a sore called an ulcer. This can also occur in the lower part of the oesophagus (the food pipe) or in the first part of the small intestines (duodenum).

This causes abdominal pain, chest pain, loss of appetite, nausea and vomiting, poor digestion, bloating, and when severe, it can lead to weight loss, dark or bloody stools, severe pain and vomiting blood.

If the problem keeps recurring, stool tests, barium tests and endoscopy can be done to get to the root of it. For treatment, you will be given medication to reduce the amount of acid your stomach makes, medicine to neutralise the acid, medicine to protect the lining of the stomach, and antibiotics if you have an infection. You may need to be on this medicine for a long time.

In some people, the disease may take long to treat, or it may keep coming back. This may be because your stomach continues to produce a lot of acid, either because of genetics, or because it is triggered by stress or anxiety. It may also be due to having other problems like inflammatory bowel disease, other infections, liver or kidney disease, or even stomach cancer.

To reduce or prevent the symptoms, avoid alcohol and smoking; avoid some painkillers like ibuprofen, aspirin, diclofenac and also long-term use of steroids. Do not skip any meals, avoid spicy foods, chilli, very fatty foods, sodas, black tea and coffee, or very concentrated tea and coffee, and other foods and drinks that are acidic.

Every person who has the disease has different foods that trigger the symptoms. You can keep a food diary and see if you can identify which foods and drinks trigger the symptoms. In the long run, the purpose of treatment is to relieve the symptoms, so that you can be able to eat what you like.

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Dr Flo,

for the past three days I have been having pain in my stomach and diarrhoea.

I don’t know what the problem is.

Please help!

Sharon

Dear Sharon,

Abdominal pain and diarrhoea mean that there is a problem with the intestines, interfering with the normal process of digestion, water absorption, and the formation and elimination of stool. This could be due to a variety of things including: indigestion, food allergies, sensitivity to certain foods e.g. milk or fat, intestinal infection, pre-menstrual syndrome (symptoms that occur just before, during or just after your periods), and even stress or anxiety. Many times, the symptoms clear on their own within four days.

If the pain and diarrhoea continue or worsen, you will need to see a doctor so that tests can be done to determine the cause of the problem and its treatment.

In the meantime, take a lot of fluids, like water, juice and soup and avoid coffee and alcohol. If you suspect milk may be the cause of the problem, avoid dairy products. With time, you can add simple mild foods. Avoid spicy and fatty foods. You can take yoghurt if you do not have a problem with milk. Yoghurt is a natural probiotic, it helps the internal environment of the intestines to go back to normal.Also maintain good hygiene in food handling and preparation, wash your hands frequently, clean kitchen surfaces, store food properly, and avoid eating food while travelling.

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Dr Flo,

I have had persistent hiccups for two days now.

I take water and eat to stop them, but they return after about 30 minutes.

I feel quite uncomfortable. What can I do to stop them once and for all?

Cheru

Dear Cheru,

Hiccups happen when the diaphragm (the thin sheet of muscle that separates the chest from the abdomen) contracts, followed by sudden closing of the vocal cords as air comes in quickly, and produces a sound.

Most of the time, there is no explanation for why people get hiccups, and they happen for only a short period of time. Sometimes they can be triggered by something specific like taking alcohol, eating very quickly or taking a large meal, spicy foods, carbonated drinks like sodas, chewing gum, which leads to swallowing a lot of air, or sudden change in temperature, like taking something hot, then immediately taking something very cold. Hiccups can also be caused by coughing or laughing and emotional stress or excitement.

If the hiccups last for more than 48 hours, or if they are so severe that they interfere with speech, eating, breathing or sleeping, then they may be caused by something more severe like hyperacidity, stomach problems, lung disease, kidney disease, nerve problems, diabetes or brain disease.

Some medicines can also trigger hiccups; these include steroid medications, some pain medicines, cancer medicines, some anxiety medicines and some medicines that treat epilepsy. You can also get hiccups after going through abdominal surgery.

Most hiccups resolve without treatment. A simple method to stop hiccups is to hold your breath for sometime, or breathe in and out into a paper bag for some time, without suffocating yourself.

There are many home remedies that may be advised, but none of them have been proven scientifically.

If the hiccups persist and there is a known cause, then treating the cause will usually be enough to treat the hiccups. Some medications can be used to treat hiccups; these include baclofen (a muscle relaxant), metoclopramide, some acid medication, gabapentin, chlopromazine and haloperidol.

These medicines are usually used to treat serious medical issues like epilepsy and mental illness, but they also help to stop persistent hiccups. They should be prescribed by a doctor and taken until the hiccups stop, and then the doses are reduced gradually to wean you off the medication.