Peptic ulcers, open sores in the stomach or small intestine, are usually caused by a bacterial infection from Helicobacter pylori, or H. pylori, or by the continued use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen. Typically, ulcers respond very well to treatment and heal, never to be seen again.
“If treated, ulcers will heal and symptoms resolve,” says Carrie Folse, MD, a gastroenterologist at Saint Vincent’s Hospital in Birmingham, Ala. Alexander Salomon, MD, a doctor of internal medicine in Crozet, Va., agrees: If the ulcer is caused by H. pylori, the “cure rate is 90 to 95 percent.”
However, ulcers can recur; these recurrences are known as ulcer flares. If you have a loved one who has ulcer flares, you know how painful they can be. But did you know that lifestyle changes can diminish the risk of ulcer flares and may even prevent them?
Ulcer Flares: What Causes Them?
Ulcers flares typically occur for one of the following reasons:
- An incompletely healed ulcer
- Continued use of NSAIDs, if that was the original cause
- Other lifestyle factors that contribute to the recurrence of the ulcer
- Genetic factors resulting in higher acid production
- Other medical conditions
Ulcer Flares: Noticing the Symptoms
Medications are now very effective in controlling ulcer symptoms and in curing ulcers completely. If your loved one is prone to ulcer flares, be aware of symptoms and notify the doctor immediately if you notice them. Prompt medical treatment may be able to prevent the ulcer from fully developing.
Symptoms of a recurrent ulcer are the same as those of a first-time ulcer and include:
- Recurrent episodes of pain in the upper abdomen, particularly at night or when the stomach is empty
- Nausea and vomiting
- Fullness after eating
- Decreased appetite
Keith Benkov, MD, chief of pediatric gastroenterology at Mount Sinai School of Medicine in New York City, says that the reason ulcers do not occur as often as they used to is that medications are very effective. “If someone is developing ulcer symptoms, they get treated very quickly before the ulcer develops. No one has a chance to develop an ulcer,” says Dr. Benkov.
As a caregiver, you can help head off the ulcer flare by helping your loved one recognize these symptoms and getting him to a doctor quickly so that treatment can begin. And encourage him to take the entire course of medication his doctor prescribes. His ulcer could recur if he stops taking the medications early, especially if H. pylori bacteria are the cause.
Over-the-counter medications such as famotidine (Pepcid AC), ranitidine (Zantac 75), or cimitidine (Tagamet HB), and even antacids such as Tums may help relieve symptoms until your loved one can see his doctor. But don’t wait too long, even if his symptoms improve, because stronger medications and even antibiotics will be needed to cure the ulcer and to prevent another flare.
Ulcer Flares: Other Risk Factors
There are additional risk factors and lifestyle choices that can aggravate an ulcer or even bring on symptoms, including:
- Alcohol use
- Chronic pain treated by NSAIDs
Ulcer Flares: Prevention
Although the risk factors will not usually cause an ulcer by themselves, they can increase the risk of the ulcer not healing completely or of another ulcer might develop. The best way to help a loved one with ulcer flares is to encourage lifestyle changes to address the risk factors and help prevent future recurrences:
- Smoking. Smoking has been shown to exacerbate an existing ulcer — which slows recovery — and increase the chances that another ulcer will occur. If your loved one smokes, help him with strategies to quit, and join him if you smoke, too. It will be much easier for him to stop if you are not still smoking.
- Alcohol consumption. Alcohol can aggravate the stomach’s protective mucous layer, which can make it more likely to be injured, Dr. Folse says. It can also cause inflammation of the stomach lining, which could make your loved one more susceptible to the damage from NSAIDs or H. pylori, she notes.
- Drinking caffeinated beverages. Caffeine can increase acid production and therefore irritate the lining of the stomach, so your loved one should avoid caffeine during the flare and limit intake to one cup of coffee or tea per day afterward to help avoid another flare.
- Taking NSAIDs. These will make the ulcer worse during the flare and can cause a new ulcer once the flare has healed. Your doctor can recommend alternative medicines to deal with any chronic pain. Relaxation exercises, such as tai chi and yoga, may also help with pain relief.
If your loved one has made all of these lifestyle changes and is still experiencing ulcer flares, contact your doctor. It may be a sign of another underlying condition, such as acid reflux, non- ulcer dyspepsia (indigestion-like pain), or even a tumor.
With a little encouragement and a few important healthy lifestyle changes, your loved one may be able to say goodbye to ulcer flares, which will make you both feel better. Consult your loved one’s doctor for strategies to get him started — the sooner the better.