No not me, my mom has had a perforated duodenal ulcer. She had numerous terribly ‘inconvenient’ symptoms for many years – probably her whole life to a greater or lesser extent. Not to get too graphic but they included pain in the abdomen that increased after eating, inability to properly digest food, urgency for evacuation of the bowels after eating, malaise, fatigue, heartburn and irritability (go figure).
After work one day 9 months after my own stay in hospital, I found myself heading over to the Rockyview Hospital Emergency Room to meet up with my dad and mom. My dad’s a serious diabetic and needed to go home for dinner so I sent him home and stayed with my mom in the ER until she could be seen and as it turned out be admitted.
By 11:30pm, I had had quite enough of sitting on wooden and plastic chairs and felt that she was going to be cared for so I left. What I missed was an ugly aspect of determining if an ulcer is present and in need of surgery – they put a hose up her nose and into the stomach to drain the contents continually. Yikes! And she has a real thing about her nose too. Always very concerned that things are perfectly presentable if you know what I mean. So this was a nightmarish beginning for her 11-day stay in the hospital.
Turned out she had a perforated ulcer in the first portion of the small intestine just past the stomach. The cause of ulcers in up to 90% of cases is a bacterium called Helicobacter pylori. This concept (a bacterial cause) went against the grain of everyone’s understanding of ulcers. So much so that the people who finally convinced the scientific and medical community that H. pylori was the cause of ulcers were awarded a Nobel Prize in 2005. How did Dr. Warren finally convince everyone – through normal scientific studies? Nope! After years of study still no one believed him – so he drank a culture of H.pylori in public, developed an ulcer then cured it with antibiotics.
Why the extreme measures? No one believed that bacteria could live in the stomach – it’s like battery acid in there. But bacteria had been found by scientists – in 1875, in 1893 and an entire treatise to the subject was written in 1899 connecting stomach aliments to curved rod bacteria. Unfortunately for the world of science and medicine, it was written in Polish. Now we know more about these clever little buggers; they take urea which is made and found in the stomach and convert it to 2 useful (for them) end products – bicarbonate (to neutralize stomach acid) and ammonia (also neutralizing and directly damaging to stomach cells). These guys can also burrow into cells of the stomach (or in my mom’s case intestinal wall) using their curved shape and propelling flagella. They smartly do not attack cells that produce acid – there are specialized stomach cells that do this. They inject a protein into the stomach lining cells that disables the cells’ ability to stay attached to their neighbours (leaving gaps for stomach contents to leak out) which in turn causes an increase in the inflammatory response. The inflammatory response causes the stomach to not only make more acid but make more cells that make more acid. It’s like an exponential increase in acid production leading to more and more damage to the already damaged areas of the stomach (or intestine) where they have set up shop (i.e. colonized). And we think we’re survivors.
Unfortunately for my mom, it looks as though she will have to go through some version of the whole ugly process again – perhaps with surgery this time. The big risks include not just the surgery complications but also when an area of the body has experienced that much inflammation for that long there is a much greater risk of cancer. And how did this all begin – with a bacteria she probably picked up in her youth in Eastern Europe. It’s not a coincidence that the early scientists that found these stomach bacteria were from Germany and Poland – they’re more commonly found there in nature. Why don’t they just kill the bacteria off before reaching the water supply? No one wants those kinds of concentrations of antibiotics in the water and in short order it wouldn’t be effective against the bacteria anyway. And filtering bacteria would be prohibitively expensive – a less than .45micron (0.000018 in) filter would be needed. That would be the cleanest water ever in the world – well practically.
What’s the answer? I’m sure I don’t know – all I do know is that I want my mom to be OK.
If you’ve got more info on duodenal ulcers in particular – I’d love to hear it so that I can be a better resource for my understandably concerned family.
