By Nassaka Flavia
Herbalist and doctors give their views on a growing problem
So you have heartburn, bloating, vomiting and a gnawing or burning pain in the middle or upper section of your stomach, especially between meals or at night. According to Dr Lawrence Ekwaro, a medical specialist at Nsambya hospital, that could indicate that you have wounds in your stomach; the so-called peptic ulcers. You need a doctor to examine you to confirm that.
If ulcers are diagnosed and they are inside the stomach, they are termed as gastric ulcers. If they are located in the upper portion of the small intestine, they are called duodenal ulcers.
If they are at an advanced stage, you might also notice an onset of bleeding, having dark stool and severe pain in the upper abdomen. So what do you do next?
You could slope down to Katwe, the busy hub of herbalists just outside Kampala’s central business district. Here you might find Hajjat Nalwadda or one of the many herbalists who claim to cure ulcers easily. Hajjat Nalwadda stands out because she vends her concoctions over a megaphone to lure patients against the deafening din of welding machines and motor vehicle revs in repair shops near her outlet. But brace yourself. Nalwadda says her concoction is a carry-all cure – for ulcers and another twenty or so ailments. She shows you the label on the bottle to prove it. Scared or just sceptical? Then you could cross over to Dr Ekwaro’s practice at Nsambya hospital, across the city to the north. Here Dr Ekwaro will first attempt to establish what kind of ulcers you are suffering from because, he says, different ulcers have different kinds of treatment. If the cause is bacterial, he might recommend Proton-pump inhibitor drugs such as Prilosec and antibiotics such as amoxicillin or tetracycline with metronidazole, or omeprazole. “Over-the-counter antacids and acid blockers may relieve some or all of the pain, but the relief is always short-lived,” he says. According to him, one needs a doctor’s help to find relief from the ulcer pain and, possibly, a lifelong cure from the disease.
Dr Ekwaro recommends some unusual remedies of his own; eating raw cabbage or drinking juice made out of it.
He says drinking half a cup before each meal and at bed time helps because the vegetable is a huge source of vitamin U which translates into an enzyme called methylmethionine. This chemical is responsible for fluid balance in the stomach.
He advises patients to get into a habit of eating bananas at least two per day. These fruits contain an antibacterial substance that inhibits the growth of ulcer-causing H. pylori.
Apparently, studies show that animals fed on bananas have a thicker stomach wall and greater mucus production in the stomach, which helps build a barrier between digestive acids and the lining of the stomach.
Using honey is also recommended for it soothes and reduces inflammation of the lining of the stomach and is good for healing as well.
Taking two small cloves of crushed garlic either as a spice in food or as a fruit will sooth the stomach because garlic has anti-bacterial properties that will kill the ulcer causing bacteria.
But although such alternative therapies have been shown to aid in the relief of symptoms, doctors warn they should be used only as supplements to conventional treatment.
Dr Ekwaro’s view is backed by Dr Medard Karyoko who is a general practitioner at Mengo Hospital in about the same area of the city.
Dr Karyoko might be in about the same area of the city as Hajjat Nalwadda but he is totally against the concoctions the herbalists sell. “Their contents could worsen peptic ulcers since usually herbalists who administer the herbs don’t do any research and don’t carry out tests on the patients before giving the drugs,” he says.
Dr Karyoko also warns against another popular remedy recommended to ulcer patients; milk. He says although many pride in taking plenty of milk other than recommended treatments when they experience pain, it is wrong.
“In fact, milk can make an ulcer worse,” he says.
He explains that milk provides brief relief of ulcer pain because it coats the stomach lining but it can also stimulate the stomach to produce more acid and digestive juices, which can aggravate ulcers. He says patients need to avoid foods that irritate your stomach.
“If it upsets your stomach when you eat it, avoid it,” he says.
He says recurrent, severe cases that do not respond to medication, might require surgery. That is if the ulcer is bleeding. In that case, a surgeon will identify the source of the bleeding and repair it. Perforated ulcers; where there are holes in the entire stomach, can also be surgically closed.
But Dr Karyoko warns that peptic ulcer surgery should be done only in emergency situations. He says there are many potential complications associated with the procedure including ulcer recurrence, liver complications, and dumping syndrome which cause chronic abdominal pain, diarrhoea, vomiting, and even sweating after eating.
Ulcers on the increase
Doctors say ulcers are increasingly becoming a threat in Uganda and one in every 20 adults has complained of the disease. It’s estimated that 10% of adults globally are affected by peptic ulcers at least once in their lifetime.
They say no single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum that cause excess acid production from tumors of the acid producing cells of the stomach that increases acid output.
Doctors says 75% of gastric and 90% of duodenal ulcers result from chronic inflammation due to the presence of certain bacteria; H.plyori, that increase secretion of gastrin, which, in turn, stimulates the production of gastric acid.
Apart from bacteria, doctors say use of non-steroid anti-inflammatory drugs (NSAIDs) like aspirin and tobacco smoking, spices, and coffee contribute to the development of peptic ulcers.
“NSAIDs interrupt the production of mucous, which protects the lining of the stomach from gastric acid”, explains Dr Ekwaro.
Practices to heal or smooth ulcers
The doctor says one can live with ulcers with limited trouble when they are conscious on the following tips:
If you have an ulcer, be cautious when choosing over-the-counter pain relievers. Aspirin, diclofenac and ibuprofen may not only irritate the ulcer but also prevent a bleeding ulcer from healing.
Food supplements such as iron can be recommended for those with bleeding ulcers in order to avoid anemia but they should be used in small amounts to avoid irritation of the stomach lining.
While there’s no medical evidence that stress can cause ulcers, Dr Ekwaro says stressful and busy work schedule can at times make one loose appetite for food or even skip meals. So it’s important to practice relaxation techniques such physical fitness exercise, plenty of fluids, and taking a deep breath.
People at risk of getting the disease are smokers, those who drink alcohol regularly, those with other illnesses such as liver, kidney or lung disease, those from a family that has had ulcers and the aged of 50 years and older.