Advice on peptic ulcers for a young woman

[holidayinzimbabwe]

Hi there

I'm currently visiting Zimbabwe (name changed for this), and I've met a young 21 year old woman. She has shared with me that she was recently diagnosed with peptic ulcers and that she is in a lot of pain. The health system here is really bad, and she hasn't been given any meds. Even with a prescription, there is apparently doubt she'll be able to source meds or afford to take them. I told her I'd come online and try and find out if there was any 'DIY' advice I could find for her.

Does anyone have any ideas of how I can help in this context?

Are there home remedies for anti-acids,for example? Im at a loss but really want to help her.

Manu thanks

Difficult because she really needs to be tested for Helicobacter pylori and it might be difficult to access the test.

Antacids aren't going to help very much, but if that's all that's available then something containing sodium alginate as well (like Gaviscon) would be better than just aluminium hydroxide/magnesium trisilicate. If she can get hold of a proton pump inhibitor (omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole), that would be better. Otherwise, a histamine H2 receptor blocker like ranitidine or cimetidine: these are difficult to get hold of in the UK now but I'm not sure about elsewhere in the world. She needs to avoid non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

Sorry, I missed the bit about home remedies for antacids. Not sure whether youmean things you can make at home or off-the-shelf things like Pepto-Bismol (bismuth subsalicylate) or milk of magnesia (magnesium hydroxide).

At that age I wonder whether h. Pylori is going to be a factor? Would they give antibiotics and omeprazole even without the test? Could there be a parasite infection (eg hookworm or tapeworm) - so maybe treatment for these? Are there any medical charities in the country that could help?

does she get heartburn (acid reflux)? If she does, then eating at least 2 hours before bed and sleeping with head raised (eg 2 pillows) may help.

Avoid alcohol, ibuprofen/nsaids, coffee.

Difficult because she really needs to be tested for Helicobacter pylori and it might be difficult to access the test.

I'm going to write this out for her and ask her to raise it with a Doctor. Can you tell me more about Helicobacter** pylori? What is it? How is it treated?

Not sure whether youmean things you can make at home

I'm afraid I did. Money is a massive issue and I was hoping there were things she could do to help herself.

does she get heartburn (acid reflux)

I'll check with her about this. Thank you for suggesting it.

Thank you both for raising NSAIDS. I spoke to her mother and apparently she takes diclofenic for pain. I checked online and this is an NSAID so her mum will get her to stop. She also takes something called Adco-dol for period pain and backache. (She has a job where she stands all day).

Ado-dol is made up of 10 mg Codeine Phosphate, 5 mg Doxylamine Succinate, 450 mg Paracetamol, 45 mg Caffeine, sugar free. Is it safe for her to take this?

Many thanks for help so far.

Diclofenac carries less of a risk than other NSAIDs of increasing stomach acid production and inhibiting stomach & intestine mucus production (although it carries some risk of thrombosis, which is probably fairly small at her age), but until she's worked out what's causing the peptic ulcers any NSAID use must be assumed to be contributing.

Codeine (an opioid), Doxylamine (an anti-histamine) and paracetamol shouldn't affect stomach acid production. Caffeine might; 45 mg is about the amount in a cup of strong coffee.

Helicobacter pylori is a bacterium that colonises the stomach and increases acid secretion. It's the most common cause of peptic ulcer disease. About half the world's population is thought to be infected, and it's not clear why only some develop ulcers. It's treated with a combination of antibiotics (typically amoxicillin and clarithromycin) along with a proton pump inhibitor to suppress the acid secretion. I don't know what facilities might be available to test for it where she is.

www.nhs.uk/conditions/stomach-ulcer/causes/

Helicobacter pylori is a bacteria that can cause peptic ulcers (see website above). Peptic ulcers can also be caused by just NSAIDS (so stopping ibuprofen/diclofenac would be good). I believe they tend to put a camera down into the stomach to diagnose it here - but it may be too expensive over there - so she would have to see a dr to recommend the best course of action given her budget (eg if she tries proton pump inhibitor meds for a few weeks but no relief perhaps she could try the h pylori or worm treatment or whatever is the next most likely course?)

the ado-Dol medication is not ideal (apparently caffeine can increase gastric acid production). It is also a mixture of meds (notably codeine and paracetamol) - so it would be advisable to check with the doctor if it is compatible with any additional medications she is prescribed.

One of the things she should be careful of is not to take other paracetamol-containing meds at the same time as the ado-dol (as she would get too much paracetamol, which would not be good for the liver).