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Managing Peptic Ulcers: A Comprehensive Guide

Managing Peptic Ulcers: A Comprehensive Guide

For individuals with chronic pain conditions, what are the risks of developing peptic ulcers?

Managing Peptic Ulcers: A Comprehensive Guide

NSAIDs and Peptic Ulcers

A peptic ulcer is a sore in the lining of the stomach or duodenum, the first area of the small intestine. The most common symptom is a burning stomach pain that may come and go for several days or weeks. Other symptoms include:

  • Feeling full
  • Feeling bloated
  • Belching
  • Heartburn
  • Nausea
  • Stress and spicy foods can worsen ulcers but do not cause them.

A peptic ulcer is a sore that occurs in the mucosal lining of the stomach, small intestine, or esophagus. It is caused by stomach acids or other digestive juices damaging the stomach or duodenum lining. When the ulcer is in the stomach, it might also be called a gastric ulcer. The acid can create a painful open sore that may bleed. The most common cause of a peptic ulcer is a type of bacteria called Helicobacter pylori (H. pylori). A second, less common cause of peptic ulcers is the use of non-steroidal anti-inflammatory medications or NSAIDs like aspirin, ibuprofen, and naproxen. (Fashner J. & Gitu A. C. 2015) Using over-the-counter NSAIDs for the occasional headache or achy back won’t cause a peptic ulcer. Rather, peptic ulcer disease is something that can occur with longer-term use, especially at high doses, such as for chronic pain associated with arthritis or other inflammatory conditions. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

NSAIDs and Ulcer Development

NSAIDs can cause ulcers because they can interfere with the stomach’s ability to protect itself from gastric acids as they slow the production of protective mucus in the stomach and change its structure. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) While these acids are vital to the digestive process, they can compromise the stomach’s protective barriers. The stomach has three protections against gastric acid:

  • Foveolar cells that line the stomach produce a protective mucus.
  • Bicarbonate is produced by the foveolar cells, which help neutralize stomach acid.
  • Blood circulation aids in repairing and renewing cells in the stomach’s mucosal layer.

Specific lipids called prostaglandins, which the body makes, affect pain receptors. NSAIDs work to reduce pain by blocking enzymes involved in the production of certain prostaglandins. Prostaglandins also protect the stomach’s mucosal layer, which can be broken when depleted. Suppressing the body’s natural defenses against gastric acids can lead to inflammation in the stomach lining. Over time, this can cause a capillary blood vessel to rupture, causing bleeding and the development of an open, ulcerative sore. (Bjarnason I. et al., 2018)

Symptoms

A peptic ulcer may cause symptoms in the digestive tract, but some individuals may have no symptoms. The most common symptom is upper abdominal pain, which can feel dull or burning. The pain can range in severity, with some experiencing mild discomfort and others having severe pain. Most of the time, the pain will occur after a meal, but it might also happen at night for some. It could go on from a few minutes to a few hours. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)  Other symptoms are less common but can include:

  • Bloating
  • Burping
  • Gas
  • Nausea
  • Vomiting
  • Loss of appetite
  • Weight loss
  • Feeling sick in the stomach.
  • Feeling full after even a small meal.

In rare cases, individuals with peptic ulcers may see blood in their stool or have black stools because blood is present. Blood coming from one or more peptic ulcers could also be visible in vomit. Call a healthcare provider right away if there is blood in stool or vomit, as this can be a sign of excessive bleeding or other serious problems. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

Diagnosis

When peptic ulcer symptoms occur, a healthcare provider may order several tests to determine the cause. For individuals who are receiving NSAIDs for chronic pain, a healthcare provider may already have a high suspicion that the medication is the cause or is contributing to peptic ulcer disease. Because infection with H. pylori is the most common cause, it is normally ruled out through a breath, blood, or stool test. (National Institute of Diabetes and Digestive and Kidney Diseases, 2022) Tests to look for ulcers inside the upper digestive tract can include:

Upper GI Series

  • Patients drink a barium substance to help the internal organs appear on imaging.
  • A series of X-rays are taken.

Upper Endoscopy

Risk Factors

All NSAIDs have the potential to cause indigestion, gastric bleeding, and ulcers. However, some individuals are more susceptible to developing peptic ulcer disease than others. Peptic ulcers caused by NSAIDs are more likely to occur in individuals who: (National Institute of Diabetes and Digestive and Kidney Diseases, 2022)

  • Are 70 or older
  • Have a history of ulcers
  • Take corticosteroids
  • Take high-dose NSAIDs
  • Take NSAIDs regularly for a long time
  • Take more than two types of NSAIDs
  • Use aspirin daily, including low-dose aspirin, for cardioprotective purposes.
  • Take blood thinners
  • Drink alcohol regularly
  • Smoke

Studies suggest that 25% of those who use NSAIDs long-term will develop an ulcer, but only a small percentage will go on to develop serious complications. (Lanza F. L. et al., 2009)

Treatment

NSAID-induced ulcers usually heal once the NSAID is stopped. Certain treatments may be recommended to expedite the healing process depending on the severity of the peptic ulcer. In severe cases, surgery may be recommended to repair the damage.

Medications

A healthcare provider may recommend taking one or more medications. Over-the-counter options may include:

Prescription Medications

These might be recommended and can include the following:

The bigger problem for individuals is how to manage pain when the medications are discontinued. For individuals with chronic pain, this may require the help of a physical therapy team, including a pain management healthcare provider. Certain medications called COX inhibitors could be used to control pain for some. COX inhibitors have been shown to work for pain relief and are associated with fewer digestive side effects than other types of NSAIDs. These meds have also been shown to have cardiovascular side effects, however, so it’s usually recommended they be used at the lowest dosage. (Scarpignato C. et al., 2015)

Lifestyle Adjustments

Lifestyle adjustments may be recommended to heal peptic ulcers, including:

  • Avoiding foods that worsen symptoms.
  • Avoiding caffeine
  • Avoiding alcohol
  • Quitting smoking

Surgery

In some cases, surgery may be recommended, but this is more often the case when there are complications as a result of the ulcer, such as:

Prevention

Avoiding long-term and high-dose use of NSAIDs or not using these medications can help protect and prevent peptic ulcers. For individuals who have to take an NSAID due to a condition they are trying to manage, a healthcare provider may prescribe one of the meds used to treat peptic ulcers to prevent them from occurring. Some believe that spicy food and stress cause ulcers, but that has been discredited. (Cleveland Clinic, 2022) Most individuals who take NSAIDs will not experience peptic ulcer disease. (Drini M. 2017) However, those who have chronic pain and who are receiving high doses should be aware of the potential.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who have any concerns about the use of NSAIDs and how the digestive system will be affected should ask a healthcare provider if there are ways to prevent ulcers and if those measures should be implemented while receiving high doses of NSAIDs. Left untreated, ulcers can lead to complications, which is why it is important to get a diagnosis and receive treatment. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign naturally.


Root Causes of Gut Dysfunction


References

Fashner, J., & Gitu, A. C. (2015). Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. American family physician, 91(4), 236–242.

National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Peptic ulcers (stomach ulcers). Retrieved from www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers

Bjarnason, I., Scarpignato, C., Holmgren, E., Olszewski, M., Rainsford, K. D., & Lanas, A. (2018). Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs. Gastroenterology, 154(3), 500–514. doi.org/10.1053/j.gastro.2017.10.049

Lanza, F. L., Chan, F. K., Quigley, E. M., & Practice Parameters Committee of the American College of Gastroenterology (2009). Guidelines for prevention of NSAID-related ulcer complications. The American journal of gastroenterology, 104(3), 728–738. doi.org/10.1038/ajg.2009.115

Begg, M., Tarhuni, M., N Fotso, M., Gonzalez, N. A., Sanivarapu, R. R., Osman, U., Latha Kumar, A., Sadagopan, A., Mahmoud, A., & Khan, S. (2023). Comparing the Safety and Efficacy of Proton Pump Inhibitors and Histamine-2 Receptor Antagonists in the Management of Patients With Peptic Ulcer Disease: A Systematic Review. Cureus, 15(8), e44341. doi.org/10.7759/cureus.44341

Scarpignato, C., Lanas, A., Blandizzi, C., Lems, W. F., Hermann, M., Hunt, R. H., & International NSAID Consensus Group (2015). Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis–an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC medicine, 13, 55. doi.org/10.1186/s12916-015-0285-8

Lee, C. W., & Sarosi, G. A., Jr (2011). Emergency ulcer surgery. The Surgical clinics of North America, 91(5), 1001–1013. doi.org/10.1016/j.suc.2011.06.008

Cleveland Clinic. (2022). Can stress give you an ulcer? health.clevelandclinic.org/can-stress-give-you-an-ulcer

Drini M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian prescriber, 40(3), 91–93. doi.org/10.18773/austprescr.2017.037

Tired of Medication! Chiropractic Can Help!

Tired of Medication! Chiropractic Can Help!

Chiropractic Alternative to NSAIDs for Back Pain

Arlington, Va.–People suffering from back pain should consider first trying chiropractic services and other non-drug therapies in light of a new research review that found common over-the-counter and prescription pain medications have limited effectiveness for back pain and raise the risk of side-effects, according to the American Chiropractic Association (ACA).

The review, published this month in Annals of the Rheumatic Diseases, examined 35 randomized, placebo-controlled trials, encompassing 6,000 patients, to determine the effectiveness and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for spinal pain. The authors of the report found that NSAIDs provided �clinically unimportant effects� when compared with patients who received only a placebo. Meanwhile, those who used NSAIDs had a 2.5 times greater risk of experiencing gastrointestinal disorders.
�At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo,� the authors noted.

The news about NSAIDs follows reports last year that prescription opioids also have limited effectiveness for back pain�one of the most common causes of disability worldwide.

�The American Chiropractic Association urges people to try non-drug approaches to back pain relief first, before resorting to over the counter or prescription medications,� said ACA President David Herd, DC. �In addition to spinal manipulation, chiropractors can offer a range of non-drug therapies for back pain and recommend exercises and important lifestyle changes to help prevent future back pain and injury.�

According to a 2016 Gallup survey, more than 35 million people visit a chiropractor annually.

About the American Chiropractic Association
The American Chiropractic Association (ACA) is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org to find an ACA chiropractor near you.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

 

blog picture of thousands of capsules flying through the air

 

Every day, an estimated 30 million people worldwide take a non-steroidal anti-inflammatory medication, or NSAID.

These versatile medications, available in over-the-counter and prescription strength, treat both pain and inflammation. Inflammation is a contributing factor in most back pain conditions, so reducing inflammation is important to alleviate the pain.

See Lower Back Pain Symptoms and Causes and Causes of Upper Back Pain

NSAIDs are used to address acute (short term) as well as chronic back, neck, and muscle pain.

See Pain Management for Chronic Back Pain

Painkillers for Back Pain and More:

 

Common uses for NSAIDs include treatment for:

  • Mild or moderate back pain, tenderness, inflammation, and stiffness
  • Activity-related pain or discomfort (e.g. pain that follows sports or activities such as housework, shoveling snow, or other exertion)
  • Pain related to muscle strain in the low back and elsewhere
  • Neck stiffness related to muscle, ligament, or tendon strains or damage
  • Osteoarthritis joint pain
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • A number of other forms of arthritis pain

This article provides information on how non-steroidal anti-inflammatory medications can be helpful against back, neck, and other pain, as well as several potential risks and complications to be considered.

Most Common Types of NSAIDs:

 

NSAIDs comprise a large class of drugs that act by hampering body substances called prostaglandins, which trigger feelings of pain, giving NSAIDs fever-reducing, pain-relieving, and anti-inflammatory properties. There are many types of non-prescription (over-the-counter) and prescription NSAIDs. The four NSAIDs most often used to treat many types of back and neck pain are:

  • Aspirin (brand names include Bayer, Bufferin, and Ecotrin, St. Joseph)
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Anaprox DS, Naprosyn)
  • Celecoxib (Celebrex)

Other Forms of NSAIDs:

 

In addition to the above, NSAIDs come in forms other than those taken by mouth. For example:

  • Ketorolac can be given as an intravenous, intramuscular, or intranasal drug, making it useful after surgery or if the patient cannot eat.
  • Diclofenac is available topically as a gel (Voltaren), patch (Flector), or solution (Pennsaid). The medication is applied directly to the area of pain. Topical forms reduce gastrointestinal and other potential side effects of NSAIDs.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

 

Common NSAIDs for Back Pain
Potential Risks and Complications of NSAIDs
Types of NSAIDs
Anti-Inflammatory Medications for Back Pain Relief Video

Effective Use of NSAIDs:

 

Taking NSAIDs continuously, rather than just at the onset of pain, helps build up the body�s anti-inflammatory blood level, resulting in a better healing environment in the affected area. The efficacy is markedly lower if NSAIDs are taken only when experiencing pain.

See Using Medication to Manage Pain and Reduce Sleep Problems

Other Points To Be Aware Of While Taking NSAIDs:

 

  • Checking with the doctor. Because NSAIDs have risks and complications, it is important to keep the doctor informed. People taking NSAIDs for long periods are advised to see the doctor regularly so any side effects can be monitored. In some cases, a change in medication may be required.
  • Using as little as possible. The U.S. Food and Drug Administration advises that the lowest effective dose of NSAIDs be used, and then for only as long as necessary.
  • Combining with acetaminophen. NSAIDs and the pain relief medication acetaminophen (e.g. brand name Tylenol) work differently, so sometimes doctors recommend taking both medications. This often offers better pain relief than taking one type of pain medication. Some people find it also helps lessen the pain as one dose wears off, alternating between the two�for example, taking a dose of ibuprofen, then 3 hours later taking a dose of acetaminophen.

Any adverse reactions from taking an NSAID, or any other medication, should be reported to the doctor without delay.

When NSAIDs Are Not Advised

 

People having a lumbar fusion surgery are typically advised not to take NSAIDs for at least 3 months after surgery due to concerns about the impact NSAIDs may have on bone healing.

Many doctors also tell patients to stop using NSAIDs prior to other types of surgery because the medication poses an increased risk of bleeding.

 

Low Vitamin D Linked to Increased Headache Risk

 

blog picture of vitamin d capsules

 

News Bite: Vitamin D may be a component factor in headache a new study demonstrates.

More research is adding to the literature of a link between vitamin D deficiency and headaches, at least for men living in colder climates.

Data from 2600 middle-aged men from Finland who participated in the Kuopio Ischemic Heart Disease (KIHD) Risk Factor Study showed that those with the lowest levels of serum 25-hydroxyvitamin D (25[OH]D) were more than twice as likely to report having chronic headaches as those who had the highest vitamin D levels. In addition, reports of chronic headache were significantly more frequent in months other than the summer months (June through September).

The investigators note that although past studies have examined the link between vitamin D and headaches, the results have been �inconclusive� because many included small sample populations. When the KIHD study originally started, men in this part of Finland had the highest prevalence of heart disease in the world, and it was looking at risk factors for cardiovascular disease.

During the baseline examinations, questionnaires asked the participants to report headache status during the previous 12 months. �Frequent headache� was defined as a daily or weekly occurrence � and was reported by 9.6% of the full group.

Also at baseline, fasting venous blood samples were collected during morning hours and 25(OH)D concentrations were measured.

Interestingly, the mean concentration of serum 25(OH)D for the study group was 43.4 nmol/L, which is below the 50-nmol/L threshold generally considered to be a marker of vitamin D deficiency. In fact, 67.9% of the group had levels that were less than 50 nmol/L.

Sourced through Scoop.it from: www.elpasochiropractorblog.com

Every day, an estimated 30 million people worldwide take a non-steroidal anti-inflammatory medication, or NSAID.
These versatile medications, available in over-the-counter and prescription strength, treat both pain and inflammation.��The American Chiropractic Association urges people to try non-drug approaches to back pain relief first, before resorting to over the counter or prescription medications.� For Answers to any questions you may have please call Dr. Jimenez at�915-850-0900

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