Overview
Peptic ulcers develop in the stomach’s inner lining and the small intestine’s upper portion. Peptic ulcers can lead to painful sores. A thick layer of mucus protects the stomach’s inner lining from the strong gastric acids and digestive juices.
If there is a reduction in the protective layer of the mucus, it can affect the stomach’s inner lining, which leads to peptic ulcers.
According to NCBI, peptic ulcer is characterised by the damage to the inner lining of the stomach’s protective mucus. The most commonly affected regions are the stomach and proximal duodenum; in rare cases, they can extend to the low oesophagus and jejunum.
People with peptic ulcers experience epigastric pain that occurs within 15-30 minutes after meal consumption. People with duodenal ulcer experience pain after 2-3 hours of meal consumption.
The NCBI research article titled “Peptic Ulcer Perforated” states that peptic ulcers have a 30% of mortality. The primary aim of the treatment will be to manage the aggression of the sepsis. People affected with peptic ulcers initially represent asymptomatic, and patients with perforated peptic ulcers may be symptomatic.
Additionally, the data represents that the lifetime prevalence of peptic ulcers is declining and is currently estimated to be 5-10%. And in developed countries, the number is even low.
Causes of Peptic Ulcer Disease
A peptic ulcer can be caused due to various reasons. People who are immunocompromised, young and old, can be prone to such ulcers. Peptic ulcers are commonly caused due to a bacterial infection and nonsteroidal or anti-inflammatory painkillers.
Bacteria
The bacteria that cause peptic ulcers is Helicobacter pylori, and it is a gram-negative bacillus bacteria found in the gastric epithelial cells. This bacterium infects your stomach and damages the gastrointestinal tissues. As a result, it leads to soreness and redness.
Helicobacter pylori usually infect and damages the mucus membrane, which leads to inflammation.
This inflammation can lead to increased stomach acid production, which in turn damages the stomach’s inner layer. The damage to the stomach’s protective layer happens over time.
If the Helicobacter pylori infection is left untreated, it can lead to peptic ulcers. According to NCBI, about 90% of duodenal ulcers and 70-90% of gastric ulcers are caused by this bacterium.
The infection is commonly acquired in childhood, and it can manifest as peptic ulcers later in adult life. However, peptic ulcers can occur only if the infection is left untreated.
The bacterium has a wide spectrum which allows it to adhere to the gastric mucosa. This can result in gastric ulceration.
Regular use of pain relievers
Another cause of peptic ulcers is the use of pain relievers and nonsteroidal anti-inflammatory drugs. These are the second most cause of peptic ulcers, next to bacterial infection.
The gastric mucosa is usually protected by prostaglandin. Prostaglandin is responsible for vasodilation and vasoconstriction in the vascular smooth muscles, activation or inhibition of platelet aggression, regulation of hormones and induction of labour.
When a nonsteroidal anti-inflammatory drug is taken often, it can block the synthesis of prostaglandin, which results in decreased production of gastric mucosa and bicarbonate.
Over-the-counter drugs can also interfere with the production of prostaglandin and lead to peptic ulcers. When these drugs are often administered, they can irritate, inflame and rupture the lining of the stomach and small intestine.
When the ruptured or inflamed stomach muscle is left untreated, it can lead to infection and cause major complications. In cases with a history of Helicobacter pylori, it can lead to peptic ulcers.
Some of the common medications that can lead to peptic ulcers are
- Ibuprofen,
- Naproxen sodium and
- Ketoprofen.
Medications
Apart from these nonsteroidal anti-inflammatory drugs, certain medications can cause peptic ulcers. Medications like corticosteroids, potassium chloride, bisphosphonates and fluorouracil have been implicated in the aetiology of peptic ulcers.
Symptoms of Peptic Ulcer Disease
The symptoms of peptic ulcers may differ from one person to another. In early cases, peptic ulcers may be asymptomatic, and when the ulcer reaches the advanced stages, there can be symptoms like stomach pain and discomfort.
In the early stages, the person can experience symptoms like
- Black-coloured stools.
- Anaemia symptoms like fatigue, exhaustion and shortness of breath.
- Blood in vomit.
In rare cases, peptic ulcers can lead to perforation of the stomach wall. This symptom occurs with sudden and sharp pain. The symptom can be life-threatening and requires immediate medical attention.
Burning stomach pain
The common symptom of peptic ulcer is burning stomach pain. This pain occurs especially after meals. There will be a sharp burning or gnawing pain in the abdomen. In most cases, stomach pain will be experienced during internal bleeding.
Some patients may experience indigestion. The pain will last for a few minutes to hours, depending on the food the patient ate. Patients tend to wake up at night due to severe pain.
Heartburn
Heartburn is also a common symptom of peptic ulcers. The underlying condition for heartburn may differ. The burning sensation will start from the oesophagus and spread to the small intestine.
Heartburns are mainly caused when the stomach acids flow back to the oesophagus. It can lead to discomfort and a sharp burning pain below your breastbone and upper belly.
The symptoms of GERD and peptic ulcers may be the same. When a person has GERD, the symptoms can be felt only in the oesophagus region, whereas patients with peptic ulcers will experience pain throughout the oesophagus and stomach.
GERD causes irritation in the tissue lining, whereas ulcers can wear away or damage the tissue lining. The other common symptom of peptic ulcers includes indigestion, dyspepsia, pain and discomfort.
Nausea
Peptic ulcers lead to inflammation of the gastrointestinal tract, which can block the passage of food. This can give you a feeling of fullness, nausea and loss of appetite. The stomach is the organ that processes the foods we eat. So, if there is any inflammation in the stomach, it can impact the eating habit.
Ulcers can trigger a response. So, the person will have the feeling of nausea. Patients with peptic ulcers will have difficulty consuming foods. In rare cases, they will experience aversion towards food.
Diagnosis of Peptic Ulcer Disease
The diagnosis of the peptic ulcer will require a physical examination and invasive or non-invasive medical examination.
The doctor will also enquire about the patient about their medical history. Medical history is to confirm the risk of peptic ulcer. The person’s symptoms also will be enquired about.
Patients with peptic ulcers experience pain after consuming meals, whereas those affected with duodenum ulcers will experience weight gain. However, patients affected with duodenum ulcers will have reduced appetite and still gain weight.
Some of the common diagnostic methods are discussed below.
Esophagogastroduodenoscopy (EGD)
According to NCBI, EGD is considered the most accurate and gold standard method of diagnosis, with a sensitivity and specificity of 90%, especially in duodenum and peptic ulcers.
Patients above the age of 50 years and with alarming symptoms can get diagnosed with the help of an EGD. The procedure will require a long flexible catheter with a camera. This will be inserted into the throat through the mouth of the patient. Then it will be slowly pushed down towards the stomach and duodenum.
The camera will help capture the inner cells of the stomach. It can also collect a sample of the stomach cells.
Barium swallow
The barium swallow will help to view the inner organs of the stomach. The test will make use of a specialised type of X-ray called fluoroscopy. A chalk-taste liquid will be given to drink, which will help to view the internal organs clearly under the x-ray.
Complete blood test
A complete blood test will help to determine liver function and check for the levels of amylase and lipase.
Helicobacter pylori testing
Serologic testing
Serological testing techniques can have high specificity. This diagnostic method is used to confirm the infection of H.pylori.
Antibodies
Antibodies will be used to detect the presence of H.pylori.
Computerised tomography (CT scan)
During the initial diagnosis, a CT scan will not be used. However, in perforated peptic ulcers, a CT scan may be used.
Treatment of Peptic Ulcer Disease
The treatment of peptic ulcers will depend on their cause. If peptic ulcers are caused due to bacterial infection, medication will be given to kill the bacteria.
The healthcare professional will administer a combination of antibiotics to kill H.pylori. Some of the common antibiotics used are
- Amoxicillin,
- Clarithromycin,
- Metronidazole,
- Tinidazole,
- Tetracycline and
- Levofloxacin.
The antibiotics will be administered for two weeks once. In some cases, the bacteria can become resistant to the medication. So additional medication will be given with a combination of other medications.
Medication to block acid production
Proton pump inhibitors will be given to stop the acid production by blocking the cells that produce the gastric acids. Medications to slow down the production of acids will also be administered.
Antacids
Antacids will help neutralise the stomach acids and provides immediate relief. Some patients may experience certain side effects like constipation or diarrhoea.
Medication to protect the inner lining of the stomach
Cytoprotective agents are medications used to protect the inner lining of stomach tissues.
Prevention of Peptic Ulcer Disease
Peptic ulcers can be prevented with certain prevention strategies.
Protect yourself from infections
Safeguard yourself from infections. The infection method of H.pylori is still not clear. Certain evidence states it can transmit from one person to another through food and water.
Do not overuse pain relievers.
Do not overuse painkillers. These painkillers can increase the risk of peptic ulcers. Consult your doctor before taking any painkillers.
Risk factors of Peptic Ulcer Disease
Smoking
Smoking can increase the risk of peptic ulcers in patients infected with H.pylori bacteria.
Alcohol consumption
Alcohol consumption can irritate the stomach’s inner lining. This can also lead to thinning of the stomach’s inner lining.
Spicy foods
Consumption of spicy food can also increase the risk of peptic ulcers.
Stress
Stress can also be a reason for peptic ulcers.
Complications of Peptic Ulcer Disease
Common complications of peptic ulcers are listed below.
Internal bleeding
Internal bleeding can occur slowly without the patient noticing it. It can occur slowly, which leads to anaemia, which might require hospitalisation. If a person vomits blood, it can be due to internal bleeding.
Gastric cancer
The risk of gastric cancer can increase for a person with a previous history of H.pylori.
Conclusion
Peptic ulcers will not be caused overnight. In most cases, bacterial infection can majorly cause peptic ulcers. Stress and the foods we eat do not directly cause peptic ulcers. However, they can aggravate peptic ulcers.
People who take painkillers often have an increased risk of peptic ulcers. Do not take any medications on your own. If you have any symptoms related to peptic ulcers, consult your doctor. Sharp pain or discomfort after meals can indicate that a person has peptic ulcers. Early diagnosis and treatment can heal peptic ulcers within a few weeks.
FAQs
How to prevent peptic ulcer?
1· Avoid smoking and alcohol consumption.
2· Do not overuse antibiotics.
3· Safeguard yourself from infections like H.pylori and
4· Do not ignore your symptoms.
5· Stress can trigger peptic ulcers. So, try to lead a stress-free life.
6· Avoid overconsumption of spicy foods.
What are the 3 main causes of ulcers?
1. Bacterial infections like Helicobacter pylori.
2. Regular use of nonsteroidal anti-inflammatory drugs (NSAID).
3. Medications like steroids, anticoagulants and selective serotonin reuptake inhibitors (SSRI)
