CLASSIFYING THE IRRITABLE BOWEL SYNDROME: TRYING THE COMMON-SENSE APPROACH – FIGHTING THE FLATULENCE MILD SYMPTOMSYou could try fennel or peppermint tea, an adult dose of baby’s gripe-water, half a teaspoonful or bicarbonate of soda in a glass of warm water, or a quarter of a teaspoonful of ginger in warm water. Fennel or caraway seeds after meals can help prevent wind; chew them very well. Charcoal biscuits, available from most pharmacies, are an old-fashioned remedy for wind. Sometimes eating a food such as garlic, onions, leeks or lentils which makes more wind and great rumblings (the strange medical name for noises in the gut is borborygmi) can serve to break up the stubborn wind and get things moving.More Severe SymptomsIf you are quite sure that your trouble is no more than wind, a warm water enema or two glycerine suppositories can often bring immediate relief. Other measures include placing a covered hot water bottleon your abdomen as you lie on your back with your knees bent and feet flat on the floor, or getting into a warm bed with a compress made from a couple of cotton tea towels which have been soaked in very hot water. Squeeze out excess water, test the temperature carefully on your arm, then hold the compress in place with a large towel and get into bed. If you steam away nicely and relax, stay there and if possible have a nap; if you feel chilled get up and move around. Try it another time.*13\326\8*
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.
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