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If a patient has a cause to their ulceration secondary to a bacterial infection then antibiotics are the treatment of choice. The antibiotics are very important. It's very important that the antibiotics that you take are taken through the entire course, so that you don't form resistance. We have significant bacterial resistance now, and second and third lines of bacterial treatments are needed to be conducted in many patients at this time. There's many patients that have resistant forms of bacterial infections that can cause a peptic ulcer disease. Therefore, it's very important that you take the medication and have good follow-up and test to make sure that the bacteria is gone after your treatment course.
If a patient has a cause to their ulceration secondary to a bacterial infection then antibiotics are the treatment of choice. The antibiotics are very important. It's very important that the antibiotics that you take are taken through the entire course, so that you don't form resistance. We have significant bacterial resistance now, and second and third lines of bacterial treatments are needed to be conducted in many patients at this time. There's many patients that have resistant forms of bacterial infections that can cause a peptic ulcer disease. Therefore, it's very important that you take the medication and have good follow-up and test to make sure that the bacteria is gone after your treatment course.
There are multiple different medications that a person can take to treat symptoms of ulcer disease. Antacids are the most common over the counter medications that patients take. After Antacids, you can take medications like H2 blockers that help decrease the acid production of the stomach. Very common medications are Proton pump inhibitors that doctors can prescribe in order to, once again, reduce the acidity of the stomach and allow for healing of the lining of the Mucosa. There's multiple different types of coding medications as well that will help coat the lining of the Mucosa and the stomach and the small bowel, in order to allow for healing. So there's def definitely multiple different modalities of treatment. If your ulcer disease is secondary to a bacteria like H. Pylori, then antibiotics will be warranted. The risk for ulcer formation can increase depending on many different conditions and many different medications. A lot of patients that are on Aspirin or non-steroidal anti inflammatory drugs such as Advil, Motrin, Naprosyn, Aleve, any of these kinds of medications can increase your risk of ulceration. One of the most common causes of peptic ulcer disease is H. Pylori. It's a bacteria that's relatively endemic and a majority of patients walking out on the streets can have it. And when you have that bacteria, you run the risk of forming ulcers, which then can bleed as well. Certain types of medications and foods such as caffeine or highly acidic or highly spicy foods, can also lead to damage to the lining of the stomach and the Mucosa and can lead to ulcer formation.
A majority of ulcers are able to be treated with either endoscopic or medical treatment. Very few ulcerations end up requiring surgery. Most ulcerations heal within four to six weeks. Peptic Ulcer disease can definitely be treated with medication and can be cured if the patient is compliant with their therapy.
There are many remedies for ulcer disease that patients can do at home. Using more alkaline water rather than acidic water can definitely help with improving the acidity level in your stomach and allowing for healing. Many patients like to drink milk or yogurt because of the fact that it helps coat the stomach and decreases the acidity level in the stomach. Obviously avoiding things that can cause increased acid production, such as avoiding caffeine, chocolate, stressful environments, and acidic and spicy foods. Any of these things can definitely lead to improvement in symptoms and healing of the ulceration.
The management of ulcer disease all depends on the etiology of the ulcer. If it's secondary to a bacterial infection and you treat that, you should be cured and not have to worry about it in the future. If it has to do with your lifestyle that has to do with stress induced ulceration, those patients should definitely exercise more or try to find coping skills in order to reduce that stress. Dietary changes definitely help improve the long-term prognosis for ulcer disease. And obviously avoiding medications that put you at risk for ulcer disease is definitely the number one thing that a patient should do.
There are multiple different studies being conducted right now for both the endoscopic treatment of ulcer disease, different types of tools that we're testing to see if a patient has an active bleed or a large ulcerations of how we can treat that endoscopically without the patient requiring surgery. Many medications are in the pipeline for the treatment of gastritis and inflammation of the stomach, which can then lead to ulcer disease. So there's many studies going on that will help change the future of ulcer disease.
In reference to ulcers, the actual number of surgical procedures performed for ulcers in this country has, I would think dramatically decreased. Okay for garden variety else's compared to 20, 30 years ago, simply because of the advent of these very potent antacid medications and the recognition that the majority of ulcers are triggered by a bacterial infection, so you give antibiotics, you give the potent and acids. Usually these ulcers heal, they don't perforate and they don't bleed. In the case of the bleeding ulcer, sometimes when we do these endoscopic therapies where we actually visualize the ulcer with the scope pass through the mouth nonsurgical and we can either try to control the bleeding with injections or placing clips or burning the a bleeding vessel, if that doesn't work, then sometimes surgery is necessary to either oversew the ulcer. Or if there's a complication related to the presence of a chronic ulcer. In other words, the outlet from the stomach becomes very narrowed. Sometimes you have to relieve that outlet obstruction. Surgery may be necessary to do that. Or let's say if the ulcer that cut a sore in the lining of the stomach has perforated, so now there's a hole in the stomach, you need to seal that. And so surgery may be indicated for those types of reasons.
In the patient who has active upper GI bleed, upper gastrointestinal tract bleed from an ulcer, what we would do is stabilize a person, protect their airway, give them IV fluids and blood if necessary. Okay. Get them stabilized and then we would perform an endoscopy or use that fiberoptic scope, pass it down to the area of the ulceration, and then we'd probably either inject the chemical to constrict the blood vessels to slow down bleeding. We may pass clips through the scope to actually clip the vessel, or we could use the device and actually coagulate or burn the visible vessel to stop the bleeding. If that didn't work, then surgical intervention may be necessary. And/or sending the patient to Interventional radiology.
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