Ulcers--Identifying, Treating, and Avoiding Them in Challenging Times

Technically speaking, an ulcer is an open sore where the skin or lining has been worn away gradually (in contrast to an abrasion, which happens suddenly).  However, most often when we are speaking of an ulcer, we are referring to the lining of the esophagus, stomach, or duodenum that has become compromised for any number of reasons and is causing pain.

The reasons why excessive acid production has compromised the intestinal mucosa lining are varied and will be covered later.  The first objective is to determine whether the pain a person is complaining of is, in fact, attributable to an ulcer.  It's important to make that determination quickly because the pain can also be confused with angina and other heart issues.  While very little can be done for heart issues, calming down a patient's pain due to excess acid production will make a difference and prevent further pain.  

Diagnosis.  Without laboratory tests and endoscopy, a diagnosis can tentatively be suggested based on the patient's symptoms.   

Occasional pain in the stomach is associated with heartburn, especially if the pain is worse after eating a large meal or after lying down.  If it occurs more than twice a week, or other symptoms are involved, other causes should be considered.

Pain due to ulcers often is felt in the pit of the stomach, on the left or in the upper-mid abdomen and radiating toward the breastbone up to the esophagus.  It's usually a chronic, dull pain, but it may become sharp at times.   The pain may occur right after eating (which suggests a gastric--stomach--ulcer) or several hours later (which suggests a duodenal ulcer).  It's also described as being somewhat like hunger pangs or indigestion and can be confused with angina. To differentiate ulcer pain from angina, have the patient drink some milk (the higher the fat, the better) or take an antacid.  These will alleviate the pain if it is due to an ulcer or acid reflux.   They will do nothing for angina.(1)  Frequent and lasting pain suggests an ulcer.  Pain that lessens when food is eaten or a lot of water is consumed, pain that worsens at night or after eating, or with alcohol or spicy or fatty foods also points toward an ulcer.

A severe ulcer may cause vomiting, with either fresh blood or partially digested blood.  Stools with blood from an ulcer are usually black.  And some ulcers are painless and the first sign is blood in the vomit and black, sticky stools.  This is a medical emergency and care must be sought quickly.  The patient may be bleeding to death.(2)

Causes.  Most causes of ulcers will be reduced or eliminated with societal collapse.  There will be less alcohol consumption, less smoking, and less overeating, especially of fatty foods.  Ibuprofen and aspirin use, other agents that can cause ulcers, will continue until those supplies are exhausted.  Some ulcers are actually caused by a bacterial infection and require antibiotic treatment.  Stress levels may increase, and chronic stress will increase stomach acid production. 

Prevention.  The best prevention is to avoid alcohol, tobacco, overeating, and stress. 

Treatment.   To prevent pain and allow the ulcer to heal:

• Don't overeat. Eat small meals and healthy snacks in between meals.  Focus on foods that soothe and calm.  

• Avoid foods that cause pain, including:

• alcohol

• coffee and tea

• soda

• spicy foods, including pepper

• fatty foods

• chocolate

• milk.  While milk calms the pain, it actually increases stomach acid production, so it should be avoided.

• Avoid Alka-Seltzer, Tums, and similar products.  These also quickly calm the pain, but should only be used for occasional indigestion, not ulcers.

• If the pain is worse at night, prop the upper body with pillows for sleeping.

• Drink a lot of water, at least a pint before and after each meal and in between meals as well.  Drink even if there is no pain. 

• Do not eat within four hours of going to bed.

• Do not lie down after eating.(3)

There are several over-the-counter treatment options.  Omeprazole (Prilosec) and ranitidine (Zantac) are two of the most common and inexpensive, and therefore, easily stockpiled. Dosages are provided on the packages.  Most packages are for a single course of treatment, usually about two weeks.  However, in some cases, treatment will take longer.  Also, what is sold over-the-counter is about half the prescription strength, which a physician will recommend in some cases. 

Omeprazole dosages physicians commonly prescribe for individuals 16+ years of age:(4)

• Active duodenal ulcer--20-40 mg per day for 4-8 weeks, either all at bedtime or in divided doses.

• Duodenal ulcer with H. pylori infection--20 mg twice per day for 10 days, plus one of the following:

• 1.  amoxicillin, 1000 mg twice per day, and clarithromycin (500 mg twice per day) OR metronidazole (400-500 mg, 3-4 times per day)  OR

•  2.  metronidazole (400-500 mg, 3-4 times per day) and tetracycline (500 mg twice per day) OR clarithromycin (500 mg twice per day).(5)

• If the patient isn't substantially improved within ten days, discontinue treatment.  Persistent symptoms in a middle-aged or older patient may be due to stomach cancer. 

• Gastric ulcer--40 mg once per day at bedtime for 4-8 weeks. 

• GERD--20 mg once per day up to 4-6 weeks.  Smaller, more frequent doses help curb acid production.

Again, these are not prescriptions or recommendations.  The information provided herein is a guideline for what quantities you may wish to procure for your family.  There is actually a wide range in both the dosages and durations that physicians recommend.  Proton-pump inhibitors and acid blockers are often recommended for preventing ulcers; however, such usage increases the patient's risk of other infections, including Clostridium difficile and some kinds of food poisoning.

It may be worth noting that omeprazole (Prilosec) has been shown to be more effective than famotidine (Pepcid).(6) 

Honey, one tablespoon per day, has been shown to be of help.(7)

 

Fresh cabbage juice, twice per day, has been scientifically proven to help heal ulcers.  See the article on the medicinal uses of cabbage for more information.

Links to related posts:
Honey
Antacids
Amoxicillin
Tetracycline
Metronidazole

The Medicinal Uses of Cabbage

For further reading:
(1) Joseph Alton, et al., The Survival Medicine Handbook, 386.
(2) David Werner, Where There Is No Doctor, 128.
(3)  Ibid, 129.
(4)  G. Massimo Claar, et al., "Omeprazole 20 or 40 mg Daily for Healing Gastroduodenal Ulcer in Patients Receiving Non-Steroidal Anti-Inflammatory Agents,"  Alimentary Pharmacology and Therapeutics, August 1993, 7(4), https://pubmed.ncbi.nlm.nih.gov/9663727-omeprazole-20-or-40-mg-daily-for-healing-gastroduodenal-ulcers-in-patients-receiving-non-steroidal-anti-inflammatory-drugs/  (accessed 2 March 2020).
(5) G. Treiber, et al., "Amoxicillin/Metronidazole/Omeprazole/Clarithromycin:  A New, Short, Quadruple Therapy for Helicobacter pylori Eradication," Helicobacter, March 1998, 3(1)  https://pubmed.ncbi.nlm.nih.gov/9546119-amoxicillinmetronidazoleomeprazoleclarithromycin-a-new-short-quadruple-therapy-for-helicobacter-pylori-eradication /?from_term=omeprazole+amoxicillin+helicobacter+pylori+metronidazole&from_page=2&from_pos=9 (accessed 2 March 2020).
(6) S. C. Misra, et al., "Omeprazole Versus Famotidine in the Healing and Relapse of Duodenal Ulcer," Alimentary Pharmacology and Therapeutics, May 1998, 12(5),  https://pubmed.ncbi.nlm.nih.gov/8218758-omeprazole-versus-famotidine-in-the-healing-and-relapse-of-duodenal-ulcer/?from_term=omeprazole+duodenal+ulcer&from_pos=9 (accessed 2 March 2020).
(7) Survival and Austere Medicine, 3rd Edition, 166.

 20 May 2020