August 11, 2005

Q: I will soon be 71 and am in reasonably good health. My working career ended 18 months ago. Three months ago, I began to get easily fatigued. Then my stool turned quite dark.

My doctor sent me to the ER, where a scope inspection of my stomach revealed two ulcers. I had no indications of them. Why do ulcers occur? How do I prevent them from coming back?

A: The two common sites for digestive-tract ulcers are the stomach and the duodenum. The duodenum is the first section of the small intestine. It hooks up to the stomach and receives the food that the stomach has partially digested and ground up.

Stomach ulcers and duodenal ulcers have some things in common and a few things special to themselves. With both kinds of ulcers, the digestive-tract lining has been scraped off, like skinned knees, and what’s left is an open sore, which can be shallow or deep. Deep ulcers erode blood vessels, and their bleeding turns stool black. Tarry stools like yours are a sign of bleeding ulcers.

Stomach acid plays a role in ulcer formation, more so in duodenal ulcers than in stomach ulcers. So does a germ called helicobacter, a recent discovery in ulcer pathology.

Duodenal ulcers are more common than stomach ulcers by a factor of four to one. They usually cause a gnawing or burning pain midway between the navel and the breastbone. The pain frequently comes on 90 minutes to three hours after eating and is relieved with antacids. It often wakes up people from sleep between midnight and three am.

Stomach ulcers can cause pain, but in up to 40 per cent of patients they are silent and are discovered only when something else brings patients to their doctors. That something else is often black stools.

Modern ulcer treatment is a regimen that includes antibiotics to get rid of helicobacter and medicines that suppress stomach-acid production. Concern about ulcer recurrence is not as great as it was in the recent past, now that elimination of helicobacter is part of treatment.

Medicines –– particularly anti-inflammatory ones –– are another big cause of ulcers.

Q: Would you please give some information on Still’s disease? My sister-in-law has it, and we cannot find much information on it. She is a retired person.

A: Still’s disease is the name given to juvenile rheumatoid arthritis. Up till 1971, it was believed that it happened only to children. Since then, it is recognized as happening to adults, and when it does, it’s called adult-onset Still’s disease.

Adult-onset Still’s disease is uncommon. It begins with spiking high temperatures and a salmon-coloured skin rash that breaks out on the trunk, upper arms and upper legs when the temperature reaches its peak. Any joint can become swollen and painful, but the wrists, hips and shoulders are favoured targets.

This arthritis is treated much like other kinds of arthritis: with anti-inflammatory drugs. Sometimes methotrexate, a rheumatoid-arthritis drug, is prescribed, and on a few occasions, cortisone drugs must be used.

I am sorry to say that the course Still’s disease takes is unpredictable. In about one-fifth of patients, the illness is over and done with in one year. Around a third will experience a remission of symptoms, but they can suffer relapses. The rest have an illness that requires chronic treatment.

Q: My friend went to see her doctor about her throat. He told her she had arthritis of the throat. Is that possible?

A: The larynx ––- the voice box –– does have joints. Rheumatoid arthritis, the less common kind of arthritis, can affect those joints. When it does, it causes hoarseness and pain upon swallowing.This is not a common happening, but it occurs.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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