Ask Dr Roach: Ulcers Are Less Common | Way of life
DEAR DR. ROACH: When I was growing up, people would discuss their ulcers and complain about ulcer pain. You never hear that word again. Why is that?
Dear reader: Ulcers have indeed become less common in the United States and Canada in recent decades. But I think a big part of the reason people don’t talk about ulcers is that most upset stomachs attributed to ulcers are now more correctly diagnosed as acid reflux. It’s also called GERD, for gastroesophageal reflux disease, a term I don’t remember hearing much when I was growing up.
Most ulcers, both in the stomach and duodenum, are due to an infection called Helicobacter pylori, discovered in the 1980s. Until then, stress and spicy foods were thought to be the main causes. ulcers. Drs. Barry Marshall and Robin Warren won the 2005 Nobel Prize in Medicine for their work on H. pylori.
The ulcers are now treated with antibiotics and drugs to stop the secretion of acid. People who have ulcers and do not have H. pylori infection have usually taken drugs that led to their ulcers, such as anti-inflammatory drugs, and treatment is to stop these drugs in addition to prescribing antacid treatment. Stopping smoking also helps heal and prevent ulcers.
People have been living with GERD for years; treated ulcers only show symptoms for weeks. This is the main reason why you don’t hear so many people complaining about ulcers anymore.
DEAR DR. ROACH: My son is 23 years old and diagnosed with tics, but he was given blood pressure pills known to relieve tics. Do you have more information about this disorder?
Dear reader: Tourette’s syndrome is the most common cause of persistent tics. These tics can be vocal, like a simple sound like a growl or moan, or more complex, like a word or phrase. Although people with Tourette are often portrayed in the media as shouting obscenities, this happens less than 20% of the time. Tics can also be simple motor actions, such as blinking an eye or shrugging the shoulders, or even more complex, such as kicking, jumping, or taking an unusual step. Tourette is common (1 in 200 people) and is much more common in men than in women. It is most often diagnosed in childhood and must appear before the age of 18. Tourette’s syndrome usually occurs in association with attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Treating these in combination with Tourette can be critical.
Treatment can include behavioral and pharmacological options. Behavioral approaches, such as habit reversal training and comprehensive behavioral intervention for tics, have value in reducing the severity of tics without side effects from medication, but it is very important to remember that person with Tourette’s syndrome does not choose to have tics and cannot simply stop them. These therapies take months to learn, are not effective for everyone, and are not readily available to many. They can be expensive and are usually not covered by insurance.
Drug treatment may include clonidine, a blood pressure medication, which is safe if used with caution and under supervision. Antipsychotic drugs such as haloperidol and aripiprazole are approved for use in Tourette, but have the potential to cause long-term side effects, such as movement disorder tardive dyskinesia. This serious illness can be permanent if it is not recognized quickly and the medication is stopped. New options such as tetrabenazine are being used by experts. All of these can reduce the frequency and severity of tics.
I recommend the Tourette Association of America website at Tourette.org for more information.
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