Health Q&A: a duodenal ulcer and a pimply scalp

Dr David Roche / 10 March 2014

Saga Magazine's Dr Roche answers a question about the possible cause of a duodenal ulcer and explains what could be causing a pimply scalp.

Duodenal ulcer and irritable bowel syndrome

During a gastroscopy I was found to have a small duodenal ulcer, but no H. Pylori was detected. I want to know why I might have got this ulcer, if it will heal completely and whether I will have to take Omeprazole and stick to a bland diet for the rest of my life? If I take the medicine every day, the ulcer is fine, but after 3-4 days my IBS becomes unmanageable and I have to stop.

Answer: The vast majority (about 19 out of 20) of duodenal ulcers are caused by a stomach infection with the bacteria Helicobacter Pylori. It sounds as though you are one of the exceptions. The only other common cause is the anti-inflammatory group of drugs (includes aspirin, ibuprofen, diclofenac and others). These drugs can all cause stomach ulcers particularly in long term use. Apart from these causes, others are rare although stress, smoking and high alcohol intakes can all contribute to their development.

The ulcer should heal easily if you can take a drug like omeprazole for long enough. It is usually possible to withdraw the drug once the ulcer is healed, unless you are considered to be at risk of developing further ulcers, from long term use of anti-inflammatory drugs for example.

If you are experiencing side effects from omeprazole then there is an alternative group of drugs, called the H2 blockers, the commonest of which is ranitidine. This drug is much less likely to interfere with your irritable bowel syndrome (IBS). If you have not tried this drug or if your ulcer symptoms are persisting, then you should discuss the situation with your GP, as this is a very treatable condition.

Pimply scalp

For years I have suffered from an irritated scalp, which is now covered with little pimples. I’ve tried many different shampoos without success. Would a special diet help or can you recommend a special shampoo?

There are several possible diagnoses here so the first recommendation is to see your GP if you have not done that yet.

Infections can occur in the scalp, often located in the base of the hairs where it is referred to as folliculitis. It can be treated with oral antibiotics and kept away with regular use of an antiseptic shampoo, which your doctor or pharmacist can recommend. If the problem is of a longer term then it could be a variation of acne which would need the long term use of topical agents or oral antibiotics. In acne it is the grease glands in the scalp which get blocked and then infected.

Some patients develop a low grade persistent fungal infection of the scalp, caused by pityrosporum ovale. This can appear to be just bad dandruff but responds well to an antifungal shampoo such as Nizoral. Seborrhoeic dermatitis is a type of eczema which affects oily areas of skin such as the scalp, in this condition it is common to find certain parts of the scalp more badly affected than others. There are unique treatments for all of these common conditions but first of all you need a diagnosis.

The opinions expressed are those of the author and are not held by Saga unless specifically stated.

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