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Heartburn and Ulcers

Heartburn is a common complaint for many people. 
In fact, 20 people out of every 100 will regularly suffer from heartburn.2

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What causes heartburn?

Pregnancy, certain foods, alcohol, and some medications can bring on heartburn.1

How does it occur? If the stomach is stretched a lot – for instance after a large meal – the sphincter (valve) at the top of the stomach might temporarily loosen. This sphincter may also sometimes open for no apparent reason. The acid in the stomach irritates the lining of the food pipe, and that is the pain felt as heartburn.2 

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Treatment

Together with lifestyle modifications, medications can help to relieve symptoms. If this doesn’t provide enough relief, surgery might be considered.2,4

There are various reasons why this sphincter becomes weak or relaxes; 

  • increased pressure on the abdomen from being overweight, obese, or pregnant 
    certain medicines, such as calcium channel blockers (treat high blood pressure);
  • antihistamines; some painkillers; sedatives and antidepressants 
  • smoking

Gas or stomach contents leak up into the food pipe through the sphincter causing the pain of heartburn.2

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Who is at risk of developing heartburn?

People who have the above conditions or use certain medications will be at a higher risk of developing heartburn.4

Frequent or severe heartburn with acid reflux, is known as ‘gastro-oesophageal reflux disease’ or GORD for short.2

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Symptoms of GORD

Other than heartburn, possible symptoms include a burning sensation in the throat, a bad taste in the mouth, and stomach noises. People often feel very full and may also feel nauseous. Other possible symptoms include a dry cough, asthma, toothache, and a husky or hoarse voice. These occur if the stomach juices get into the windpipe and irritate the airways or get into the mouth and attack the teeth.2

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Treatment

Together with lifestyle modifications, medications can help to relieve symptoms. If this doesn’t provide enough relief, surgery might be considered.2,4

Lifestyle modifications:

  • Do not overeat and avoid spicy foods
  • Lose weight if overweight or obese
  • Wear loose clothing and increase height of bed
  • Quit smoking and reduce alcohol

 

Know your triggers! Greasy or spicy foods and alcoholic drinks can cause heartburn.4

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Medications

Treating heartburn is important because over time, reversal of stomach contents up the food pipe can cause damage.1 All heartburn medicines work in different ways. A combination of medicines may be needed to control symptoms. Most medications are now available over-the-counter.4

Histamine blockers decrease the amount of acid released in the stomach.3 They provide short-term or on-demand relief of symptoms. They can also help heal the food pipe, although not as well as other medicines.4

Proton pump inhibitors (PPIs) decrease the amount of acid your stomach makes.3d They are the most effective therapy for treating heartburn and reflux. They also heal the food pipe and can be prescribed for long-term treatment.4

Antacids work temporarily to relieve heartburn by neutralising the stomach acid, and may be used after meals and at bed-time.3,4

 

A ‘burning stomach pain’ is the most common symptom of a stomach ulcer.5

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What is a stomach ulcer?

A stomach ulcer is a round or oval sore where the lining of the stomach has been eaten away by stomach acid and digestive juices.
Discomfort caused by ulcers comes and goes and tends to occur after meals because stomach acid is produced in response to eating.6

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What are the signs and symptoms?

Stomach pain is the most common symptom, the duration of which is variable – the pain can last for several days or even weeks.5 Less common symptoms may include:6

  • bloating
  • nausea
  • vomiting
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What causes an ulcer?

Stomach ulcers develop when the lining of the stomach is damaged by stomach acid.
The two most common causes of stomach ulcers are bacterial infection (known as Helicobacter pylori) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Smokers are also at more risk than non-smokers. Stress can also be a cause of stomach ulcers.6

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Treatment

Even if symptoms are mild, without treatment, a stomach ulcer can get worse.5
Antibiotics are used to treat the infection caused by a bacteria Helicobacter pylori. In most people, treatment with an acid-suppressing medicine will be needed for 4 to 8 weeks.6

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Types of ulcer-healing drugs

  • Antacids do not effectively heal ulcers but they do relieve symptoms of ulcers by neutralising stomach acid. They are typically used to relieve symptoms in the early stage of treatment.
  • A protectant (e.g. sucralfate) forms a protective coating in the base of an ulcer to promote healing and is a reasonable alternative to antacids
  • Histamine receptor blockers relieve symptoms and promote ulcer healing by reducing the production of stomach acid.
  • Proton pump inhibitors (PPIs) reduce stomach acid and protect the lining of the stomach, and in this way promote healing of ulcers. PPIs are the most potent drugs that can reduce acid production in the stomach.6

 

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Dietary health

Eating healthy and balanced amounts of different types of foods is good for your overall health. You can adapt your diet to avoid certain foods and drinks that make your symptoms worse.4,6

Maintain a healthy lifestyle by following these universal rules:7

  • EXERCISE: maintain at least 30 minutes a day of vigorous activity
  • WEIGHT: avoid excess weight
  • FIBRE: eat plenty of fibre in your diet, whole grains and less sugary, white flour foods
  • FRUIT & VEG: aim for 5 portions a day!
  • REDUCE FAT: moderate intake of animal fats (dairy and meat fats)
  • FISH: increase fish and beans as an alternative to meat
  • FLUIDS: drink plenty of water and reduce alcohol consumption
  • DON’T SMOKE!

 

 

Medical References

1. NHS Choices. Stomach ulcer. Available from: URL: https://www.nhs.uk/Conditions/Peptic-ulcer. Last accessed 30 October 2017. 2. Malfertheiner P, Chan FKL, McColl KEL. Peptic ulcer disease. Lancet 2009; Published Online August 14, 2009; DOI:10.1016/S0140-6736(09)60938-7. 3. Vakil N. Peptic Ulcer Disease. Merck Manual Consumer Version. Available from: URL: http://www.merckmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease. Last accessed 26 October 2017. 4. Go MF. Review article: natural history and epidemiology of Helicobacter pylori infection. Aliment Pharmacol Ther 2002;16(Suppl. 1):3-15. 5. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon ATR, Baxxoli R, et al. The European Helicobacter Study Group (EHSG). Management of Helicobacter pylori infection-the Maastricht IV/ Florence Consensus Report. Gut 2012;61:646-664. 6. Chan FKL, Chung SCS, Suen BY, Lee YT, Leung WK, Leung VKS, et al. Preventing Recurrent Upper Gastrointestinal Bleeding In Patients With Helicobacter Pylori Infection Who Are Taking Low-Dose Aspirin Or Naproxen. N Engl J Med 2001;344(13):967-973. 7. Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic Review of the Epidemiology of Complicated Peptic Ulcer Disease: Incidence, Recurrence, Risk Factors and Mortality. Digestion 2011;84:102-113. ZA/11/2017-2019/OMEZ/060. 33965 12/17

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