Q: Hello good day Dr. Please I have ulcer for years now and have been taking deferent types of drugs still no improvement and currently am using cimetidine please help me is there a permanent cure and also is there foods I need to be avoiding if I drink garri or eat beans I will be having so much pain especially on my chest and painful bowel movement each time I go to toilet is usually watering please help me

A: There are two conditions that may often be confused, one for the other: Peptic ulcer and Gastro-Esophageal Reflux Disease (GERD).

Gastric acid is secreted normally in the stomach to help the process of digestion. Peptic ulcer is a sore in the stomach, esophagus or duodenum and occurs when there is either over-production of this gastric acid in the stomach or reduction in the quantity of mucous that protects the stomach from the acid. Infection with an organism, Helicobacter pylori (H. pylori) has been found to be a cause of peptic ulcer.

GERD, on the other hand occurs when stomach acid backtracks into the esophagus causing heart burn.

In the past, it was thought that spicy foods caused peptic ulcers. However, there’s no evidence to support this, though spicy foods can certainly make the symptoms of ulcer worse  Smoking, stress and drinking alcohol are also likely to worsen the symptoms of peptic ulcer. Caffeinated and carbonated beverages may also be culprit.

Ulcers are also common in people who take certain pain relieving drugs known as Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) like Ibuprofen.

People with peptic ulcer usually complain of abdominal pain or even sometimes, chest pain as the pain can be anywhere from the breast bone to the navel…giving room for a wide range of descriptions. The pain is usually worse at night or when the stomach is empty.

People with ulcers may vomit blood or pass out fresh or altered blood in stool. For the latter, the stool looks tarry black. Complications of peptic ulcers include internal bleeding, leakage of the acid into the abdominal cavity etc

Treatment is targeted at reduction in acid production, neutralization of acid, treatment of Helicobacter infection, promotion of healing or protection of stomach lining. Cimetidine which blocks the production of acid by acid-producing cells is clearly useful here. Your doctor will determine the best option or combination(s) with your active participation, of course

Thus, prevention is targeted at switching pain relieving drugs (if you have an ulcer, please stay away from NSAIDs, reducing your level of stress, stopping smoking and reducing your alcohol intake. Maintaining a healthy diet filled with loads of fruits and veggies, which provide sufficient vitamins to aid healing, is also a good way to go. It is still not very clear how H. pylori infections spread but it is thought to be probably from person to person or from food and water. So, judicious and very frequent, hand washing will certainly help

Does milk help? Well, temporarily but it quickly makes it worse. Milk coats the surface of the stomach, reducing the pain but then stimulates more acid production. Sounds like you can’t win, aye?! ;D

For GERD, there are also conditions like pregnancy and obesity that make this condition worse and there are also foods that encourage this. Examples of these ‘foods’ are fatty foods, alcohol, orange juice, chocolate and coffee, onions, tomatoes, peppermint and spicy foods.

So for the person in the question, I suggest you keep a food diary over a period of time and try to figure out the trigger foods. If you suspect garri or beans, try to confirm this by having a ‘beans meal’ or drinking garri, and watching for heartburn and an unpleasant taste at the back of the mouth. If this is not the issue, perhaps it’s a weight issue or even over-eating.

Treatment is targeted at the acid and healing the esophagus. Remember that occasional heartburn is not regarded a problem but if it happens frequently, like two or more times every week, then it becomes a problem and is now referred to as Gastro-Esophageal Reflux Disease (GERD). So, drugs used can stop acid production (like Cimetidine), reduce acid production and cause healing of the esophagus or neutralize the effect of the acid.

Prevention involves trying to avoid your trigger foods (quite a number are actually healthy maintaining a healthy weight, avoiding heavy meals just before bedtime, try eating smaller meals and avoid tight clothes that may also put pressure on your abdomen.

So, see a doctor first to confirm the diagnosis….peptic ulcer or GERD and then he’ll advice on treatment.

Good news is, these ulcers can heal and so you may not have to take meds forever.

Have a fabulous evening and remember…no heavy meals before bedtime