INVESTIGATION AND TREATMENT OF ULCERS

Q. Let us spend a few moments in summing up the various forms of investigation and treatment currently available and see how it works out.

A. Why not. Symptoms lead to medical investigation. This may include a medical examination and history taking, then probably either a barium meal x-ray examination of the stomach and duodenum, an endoscopic examination of the same areas. A diagnosis of chronic peptic ulcer is made, being either in the stomach or duodenum. If in the stomach, a biopsy will indicate if it is only an ulcer or an ulcer plus cancer. Provided the diagnosis of an ulcer is confirmed there are four most likely courses available. The patient may be given antacids in large doses, or cimetidine, or colloidal bismuth or he or she may be admitted to hospital. Antacids may give symptomatic relief and hospital care may cause the ulcer to heal. With cimetidine and colloidal bismuth healing usually occurs rapidly. In 3 weeks, about 50% improvement; in 6 weeks, about 75%; in 9 weeks, about 90%.

Q. What if healing does not occur?

A. If healing is slow or absent (and the experts say that this occurs in about 10% of cases), then the diagnosis must be re-checked. Hopefully, the gastric ulcer will not turn out to be a cancer after all — but it is always a possibility which certainly warrants verification. Or it may be due to the patient surreptitiously taking some other form of medication, such as analgesics which are notorious for creating gastric bleeding and ulcers. If a peptic ulcer is still in evidence a variant to cimetidine may be tried, such as ranitidine, or the patient may be hospitalised for treatment there.

This is the current routine often recommended by gastroenterologists. Today, diagnosis and treatment of peptic ulcers have never been better. There is no reason why anyone with an ulcer should put up with the pain and discomfort that it entails. Adequate investigation and therapy are readily, and fairly cheaply, available to everybody in this country.

Q. Do some people complain of costs?

A. Some misguided individuals complain that medication is costly. These people are misguided in the extreme. At present the government in this country picks up the bulk of the tab for most of the forms of ulcer treatment. However, even if the patient had to pay the entire drug cost himself, this is minimal when the alternatives are considered.

In the bad old days a severe ulcer required up to three months’ absence from work plus, in many cases, the financial hardship that this entailed, plus the costs of hospitalisation, drugs, medical attention, etc. The economics were often mind-blowing and bank-busting.

But today, within a few days, with a relatively small drug bill, the patient may be back to work again, with symptoms gone and the ulcer well on the way to healing. The economics have taken a dramatic change for the better. I always tell my patients never to begrudge the small price they are paying for their medication. The very same persons who complain will think nothing of going out to dinner for the evening with friends and blowing twice the sum as it costs, for example, for the retail price for six weeks’ cimetidine treatment. If you are tempted to complain of costs, please remember the alternatives which in the past used to be dramatically expensive.