TREATMENT OF ULCERS: ANTACIDS

Q. At long last, let’s get on to the standby therapy of the past fifty years or more — antacids. What is their current status in ulcer treatment?

A. I’m glad you mentioned them, for the current reaction to them is a mixed one. For many years they have been the sheet anchor of therapy, but mainly by default rather than because of their intrinsic worth.

There is little doubt that they will reduce ulcer pain. However, as far as healing is concerned, evidence indicates that very large doses are required. According to a leading Sydney gastro-enterologist who has treated ulcers for many years, “when given in high dosage (equivalent to 30 ml double strength aluminium hydroxide gel one hour before and after each meal and also before retiring), antacids have also been shown to be effective in treating peptic ulcers. Liquid antacids are generally more effective than tablet formulations, but are less convenient for the working person.”

Q. Could taking all that medication each day in itself produce unpleasant side effects?

A. It seems this is possible and many patients on high doses may develop diarrhoea or constipation. Also, long term, a condition called ‘hypophosphataemia’ with anorexia (loss of appetite), muscular weakness, and a bone condition called osteomalacia may take place, if used in high doses over prolonged periods of time. Other side effects are also possible, depending on the type of antacid used. One case was recently reported in the medical journals of a patient with very large bladder stones which had developed after many years of taking a calcium antacid.

However, there is little doubt that used with discretion, and under proper supervision, antacids can bring a good deal of symptom relief. They are cheap, readily available and, in smaller doses, may do little harm, even if they are not as dramatically beneficial as some of the newer forms of medication. The antacids are available in many forms, as mixtures, tablets, powders. Many patients will continue using them, especially if there is occasional abdominal discomfort. What’s more, they often help in simple cases of dyspepsia, a feeling of fullness, bloat, and the unpleasant sensation which commonly follows from ‘dietetic indiscretions’, as the doctors succinctly put it.

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DIAGNOSIS OF PEPTIC ULCERS

Q. Now comes the important question of diagnosis. What is the story here?

A. The first essential point is that any person with any of the tell-tale symptoms which indicate a gastrointestinal disorder should seek medical attention. It is fruitless self-medicating, such as throwing down some antacid pills or mixture or powders in the hope that ‘it might go away’. Certainly, if there have been dietetic indiscretions — in short, plain stupidity in one’s eating habits, such as eating the kind of food that history has shown produces a tummy upset, then the penalty is usually patently obvious for anyone to see. Some self-medication for a day or so will often help, and eliminate the grotty stomach. But with ongoing symptoms, attending the doctor is advisable.

Q. What happens when the patient visits the doctor?

A. Usually the physician will take a fairly detailed medical history. He will try and elicit a sequential description of the symptoms suffered, how long they have been present, their intensity, and so forth.

Q. Does he examine the patient?

A. The physical examination follows the history taking routine. The answers to his questions will give him a clue what to seek next. He will concentrate mainly on the abdomen, for this is the spot where symptoms are worst. He will note your reaction to his feelings and proddings (or palpation as the medics say). Always give reliable answers to his queries; it is pointless giving false ones, for the only person to suffer from this is you, the patient. If there is pain with pressure, say so. Do not try and be brave, this is foolish in the business of diagnosis. Often from the history and examination the doctor will have a pretty good idea of the diagnosis.

I might add that these days most doctors will also give the other systems of the body a quick once over — such as checking blood pressure, the heart, the urine, and other systems. Occasionally other disorders may be picked up at the same time, and this is always fruitful.

Q. What comes next?

A. If the physician suspects an ulcer, he will then proceed with the next step to confirm it. Here, there are two options open.

Q. What special examinations are carried out?

A. The first is called a barium meal x-ray of the stomach and duodenum. The second is called an endoscopic examination of the same organs.

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