TREATMENT OF ULCERS: FORMS OF MEDICATION
Q. What about other forms of medication? Over the years we have heard about a great many. Are these still in use?
A. In some cases, yes, and on other cases, not altogether. For some time a drug called carbenoxolone sodium appeared to have a beneficial effect on gastric ulcers. It seemed to relieve ulcers in the stomach more than duodenal ones where it was rapidly destroyed. A time-release capsule was developed, but never became popular. What is more, it produced side effects which many doctors thought made the risks of use, as the first-line attack drug, not really worthwhile.
Although modestly effective, it produced fluid retention (called oedema), elevated blood pressure, and sometimes it caused the body to retain potassium to seriously high levels. Although it was possible to give other drugs to counteract these adverse effects, it was soon overtaken by the development of newer, more effective drugs. So today, whilst it is available, it is not used very often, in contrast to the newer drugs which act more rapidly and have fewer adverse side effects.
Q. What about the so-called anti-cholinergics? These once held pride of place in the prescribing habits of many doctors.
A. Certainly they did; for several years they were extremely popular. They probably reduced acid production and so relieved pain. Some believe that in cases resistant to the histamine H2-receptor antagonists, the added use of the anticholinergics may be useful.
The drugs were removed from the general prescribing list in Australia in 1976, the same year as cimetidine became available in Britain for general prescribing. ‘Tagamet’ became available in Australia soon after, so that as one drug vanished, another better one rose to fill its place.
Q. What about belladonna preparations? These seemed to be pre-eminent once.
A. They had their day also. Belladonna was often used as an additive to ulcer therapy. But, like the anticholinergics, it gradually lost out to the newcomers. Some doctors may still use it but in the main it has almost become lost in antiquity! Zinc, in small amounts in capsule form, was also used by a small number of doctors. This appeared to have some healing quality and improve healing rate but it has never taken off in a big way and it does not seem likely to.
Q. What is the current view on simple, old fashioned rest for an ulcer patient?
A. It is well known that a certain number of ulcers will heal irrespective of what line of treatment is involved. Rest has long been known to be part of this. At present many doctors still recommend it. In fact, sending an ulcer patient to hospital, whether he rests there or not, is also believed to be effective treatment.
It may be the ‘placebo’ effect — the belief that as something active is being done, this gives a high chance of a good result. One might call it mind over matter but doctors believe the placebo effect is significant, especially if the individual has faith in his treatment and believes a cure is forthcoming. For centuries the scriptures have been saying ‘as a man thinketh in his mind, so is he.’ It is salutary food for thought.
Q. What about the use of vitamins and minerals?
A. Although many western doctors have a disparaging attitude towards vitamin supplements and minerals, claiming that a good all round general diet will supply all the necessary ones, many others, specially those researching in American centres, have different views. They believe that the body, specially in the depleted state (common with ulcer patients), benefits substantially from additional vitamins and minerals. These should be tailor made for the individual, but in general will include increased daily doses of the vitamin B complex and vitamin C. Some advocate up to 100 mg of the main components of the vitamin B complex, and anywhere from 1,000 to 3,000 mg a day of vitamin C, preferably in the readily absorbable calcium ascorbate form. Added minerals covering zinc, magnesium, chromium, molybdenum, calcium, manganese and others are often suggested. These minerals are often in the orotate or chelate form which makes them more readily absorbed by the blood stream from the intestinal system. Various commercial compounds are available which contain these ingredients in suitable amounts.
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