Case of the Week: Peptic Ulcer Disease

This has been the week of peptic ulcer disease (PUD).  It is a very common diagnosis here in Ghana and in clinic we give out Omeprazole, a drug to treat PUD like it is candy.  I believe that it is a diet rich in spicy food, high use of alcohol, and the incorrect use of over the counter Motrin that can be bought at local chemical stores that is to blame for the high rate of PUD. 

This week I had three cases of perforated gastric ulcers that needed emergent surgery, all under the age of thirty.  In addition, I operated on a thirteen year old boy with a gastric outlet obstruction.  At surgery, I found scarring at his pyloris (the area that empties the stomach) creating the obstruction.  I did not have a good reason for this to have occurred in such a young patient, but after talking the case over with a Ghanaian doctor he was not surprised at the findings cited PUD as a very common cause even in the very young in Ghana.

It was probably fitting that this week I saw a lot of these cases because over the last few weeks, I have had increased sympathy for patients with PUD.  I officially know the pain they go through after just getting over an esophageal ulcer caused by Doxycycline, which I am taking for my malaria prophylaxis.  When I thought I was going to die in Ghana because of the chest pain, I reached out to a trusted gastroenterology consultant (aka my father) who said this was most commonly seen in pimple faced teenagers on tetracycline, but he supposed it could happen to me also!  After taking Omeprazole and drinking “Gastrome,” our version of Pepto-Bismol and stopping the doxy for a few weeks I am now feeling much better.  I think that it is humbling and good for physicians to be sick once in awhile so we can always continue to relate with our patients’ suffering.  Now, I have just been praying that I will not have the opportunity to relate to the malaria patients since I’ve been off my prophylaxis!