Skipping Meals, Stress,
Can Lead to
STOMACH ULCERS

Skipping Meals, Stress,
Can Lead to STOMACH ULCERS

Those suffering from peptic ulcer disease should quit smoking and drinking, have regular mealtimes and modify their lifestyles to reduce stress

 

 

When I first saw Ms Lee, 43, in the emergency department, she already had all the symptoms and signs of peptic ulcer disease (PUD), which is characterised by painful sores in the lining of the stomach or duodenum.


She was suffering from severe abdominal pain and had gone into septic shock, a life-threatening condition that occurs when blood pressure drops to a dangerously low level after an infection.

Her upper abdomen was rigid and hard, and tests suggested that she had a perforated peptic ulcer or a hole in the stomach.

This means the bacteria in the stomach and intestinal contents can leak into the abdominal cavity, and then get into the blood stream, which will result in a severe infection that can be fatal if left untreated. She needed immediate surgery to save her life.

Ms Lee is among a steadily growing group of people suffering from the same “urbanite chronic condition” – aka peptic ulcer disease, though her case is an extreme one as PUD cases rarely come with complications of bleeding and perforation.

Many of the patients I see have non-specific symptoms such as upper abdominal discomfort, bloating or belching. Although it can occur to anyone, those who are middle-aged, like Ms Lee, tend to be more susceptible to getting peptic ulcers as they tend to neglect their health due to their many commitments.

Those who get recurring symptoms such as upper abdominal pain, bloating and belching should get an endoscopic assessment of their upper gastro-intestinal tract to check for a bacterium called Helicobacter Pylori. This bacterium is linked to PUD and stomach cancers. However, about 80 per cent of the individuals infected with it do not have any symptoms.

Dr Sujith Wijerathne

Ms Lee, a stay-at-home mother of three young school-going children and wife to a jet-setting husband, is a clear example.

She fussed over her three children, was particular about how the housework was done and worried about almost anything and everything under the sun. This, plus her anxious nature and perfectionist streak, left her highly tense and paranoid. She is what some would term a “kancheong spider”.

And, she often skipped meals when she was short of time.

The hints of her condition were there as she frequently had gastric pain, including several episodes of intense upper abdominal discomfort. Each time, she would self-medicate with painkillers such as Non-Steroid Anti- Inflammatory Drugs (NSAIDs) like Ibuprofen, but the pain remained.

However, as she has a high threshold for pain and discomfort, she chose to put her family first and her own health last.

I am seeing more young working adults, some with young children, putting work, family or family commitments before their health. They skip meals or eat irregularly, and do not always eat enough.

Some of them also hit the gym on an empty stomach to stay slim and look good. Others drink and smoke to cope with stress.

These compounded sacrifices are not worth it because over time, PUD may creep up on you and, if left untreated, it may lead to severe consequences.

The frequent use of painkillers such as NSAIDs does not treat the problem. In fact, they may even worsen the pain. The sharp pain always returns because these drugs treat only the symptoms, but not the cause.

Those who get recurring symptoms such as upper abdominal pain, bloating and belching should get an endoscopic assessment of their upper gastro-intestinal tract to check for a bacterium called Helicobacter Pylori. This bacterium is linked to PUD and stomach cancers. However, about 80 per cent of the individuals infected with it do not have any symptoms.

Ms Lee underwent a two-hour keyhole operation where I repaired a 1cm hole in her duodenum (the first part of the small intestine). There were a lot of pus and stomach contents coming out of the ulcer.

After the surgery, she was put on a liquid diet (she returned to a normal diet after three days) and a course of antibiotics to treat the bacteria responsible for PUD.

At the follow-up check-up, I explained to Ms Lee that she would need to modify her lifestyle as there was a possibility the condition may recur.

Stress is an oft-cited anecdotal cause of gastritis and ulcers. The stress due to anxiety and related disorders may contribute to PUD. I thus referred Ms Lee to a psychologist at Alexandra Hospital.

She has since adjusted her routine and is recovering well. When I saw her recently at my clinic, she also looked much happier.

My advice for PUD patients is to quit smoking and drinking, and have regular mealtimes as skipping meals can worsen the condition.

Go for balanced, healthy food that is lower in fat, acidity and spiciness. Avoid foods that may irritate the stomach, such as fried and spicy food, caffeine, carbonated beverages, citrus fruit juices and alcohol.

Dr Sujith Wijerathne is an associate consultant at the general surgery services of Alexandra Hospital and the minimally invasive surgical centre of National University Hospital.