At about 36hours to my primary examinations in one of the faculties of the West Africa College of Physicians, WACP, I wouldn’t have believed–if I were told earlier–that I would be lying on the hospital bed later that day. It was around 7pm on the 7th of Oct when I was rushed to the emergency unit of the same hospital, where I work. I remember, vividly, the voice of my suffering soul as it kept shouting in agony, it was as if the small hollow organ inside of me, called stomach, was being plucked out with a sharp knife, creating freezing or better still numby sensation through my extremities. Something in my head kept telling me I should endure (while I was being conveyed to the A&E), that the pain would go soon, ‘ haven’t you seen people suffer greater pain, common pull yourself together, it is just for a moment.’ The voice said, but into my deaf ears, all I kept screaming to Sam, my friend and also a colleague, was ‘please sedate me! Please take me out!’


This instance is just one out of many bizarre presentations of Acute Exacerbation of Peptic Ulcer Disease. In my own case, I never saw it coming, so as many typical cases. All in my history was: I’m a known Ulcer patient, I didn’t take any meaningful meal in the past 24 hours or there about while I have also been working my head out at the hospital, and at the same time preparing for my primary examinations. Well, these are super-sufficient histories for any doctor to make a tentative diagnosis. Did I forget to mention I have a strong family history of PUD? Only one person out of a family of seven is PUD-free. Gbam! And that was it. So after the damage, there was no other escape route other than admission. Not even my ‘liquid ulcer medicine’ could save me from the gigantic physiologic embarrassment that befell me that day.

Now, knowing that peptic ulcer could have serious consequences and even more severe complications than I experienced, the questions I would ask you are, do you know if you have Peptic Ulcer? If yes, how were you diagnosed? If no, how can you be too sure? Do you know Ulcer can heal completely? What are the Pros and cons of PUD?

In answering any of these questions, we need to carefully simplify the term PUD.

PUD? Abb. for Peptic Ucer Disease, which refers to any of the disorders of gut and gastric acid; affecting any of the lower oesophagus, stomach, and upper duodenum. In order not to confuse us with medical grammars, the commonest are the duodenal ulcers and stomach ulcers (gastric ulcers). Ulcer in it real sense means discontuation or breakage in body tissue lining, whether outside or inside. So let’s imagine this breakage in our stomach or duodenum, we need not to be told there would be pain once this ulcer gets in contact with any substance! Okay now, imagine pouring acid on this ulcer wound, well, I can hear you shout ‘yepa’, this is exactly what happens in PUD exacerbation. Perhaps you are thinking why acid? Where is it coming from? Gastric acids are routine Gastrointestinal secretions, they help in food digestion, hence they are secreted in appreciable quantities with other digestive enzymes when we are hungry, thinking we would eat anytime and in turn they would digest the meals. But in situation where we refuse to eat as at when due, they persist in the stomach. Now imagine this stomach with an underlying ulcer wound, ‘Army don jam MOPOL be that’! I want to believe this is quite straight forward, hence why we encourage ulcer patients (like me) not to wait until they get hungry before having something gulped or whacked!

How can you tell if you harbour an ulcer or more in your tummy?

It is important to know that the disease PUD doesn’t just develop in a day, even though one of the complications, an acute exacerbation may occur suddenly, the lining of our tummy ulcerates gradually ( I. e, insidious onset and slow progression). This explains why some PUD patients never had any serious complication. Like I said earlier, the pain occurs usually in the period of meals, for gastric ulcer, before and during meal, while duodenal ulcers usually after meal, say 2-3hour after meal, when acid would have passed into the duodenum. Pain of PUD may also occur when one takes peppery or dry foods, note that pepper and garri do not cause ulcer, such foods only exacerbate the disease symptoms. Another important point is that pain of PUD may be described as churning or dull, very sharp in acute exacerbation. It usually affects the upper left tummy (epigastric region) and the left back. In severe cases, there may be bleeding through the mouth or passage of dark coloured stool, which are evidences of bleeding ulcers. These clinical features may vary but a complete history and clinical examination would strongly give out PUD. The confirmatory diagnostic routine is an Upper G.I Endoscopy, well, I haven’t had one done myself because of the cost implication in this part of the world.


What not to do as an ulcer patient;


These are the risk factors that should be avoided or reduced.

Avoid hunger, peppery and dry foods.

Avoid smoking, smoking has been linked with G.I ulceration. See other facts about tobacco smoking and addiction here

Avoid alcohol, as for my case the smallest percentage of ethanol would exacerbate my symptoms.

As much as possible avoid carbonated drinks.

Avoid the use of Non-Steroidal Anti-inflammatory Drugs, examples are Diclofenac, Ibuprofen. Always inform your doctor of your ulcer each time he or she is about to prescribe any medication for you.


What to do as a known PUD;


These are possible lifestyle modifications that would help an ulcer patient.

Adequate food intake, if possible eat in between meals.

Take fruits and vegetables, they not only nourish the body but also promote ulcer healing.

Also, check out this simple illustration on how fruits&vegetables help build sound mind

Well, if physical stress cannot be avoided, please do not cheat your tummy of adequate meals.


What to do in mild to moderate Exacerbation;


In this case, the pain is there but still hasn’t prevented you from activities, so get an antacid i.e, acid neutralizer e.g Gestid, Gascol. You can also use any of the Proton inhibitors prescribed to you by your doctor. Stop work or activity that moment and calm down somewhere until pain subsides. You can then start with a light meal, say milk-rich light food. Then take a visit to your doctor for complete treatment course.

The place of milk alone in mild to moderate case is a little questionable, while it helps some patients, others say it doesn’t help.


In case of Emergency;

One is said to have an emergency once ulcer pain gets so severe that one could not do any other thing, or once there is bleeding through the mouth, in such case, do not rule out symptoms yourself, kindly call for help to be taken to the nearest hospital.

In summary, just like any injury sustained at any site on the body, PUDs can heal up completely with good management and stringent lifestyle modification, as I listed above. The irony is, it can re-occur at the same site or at any other site once the risks are back into play.

kindly leave your comments, questions and views in the comment box. Thanks for reading.


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