CONDITIONS
Stomach Ulcers (Peptic ulcer)
What are stomach ulcers or peptic ulcers?
Ulcers are open sores on the lining of the stomach or upper portion of the small intestine. Stomach ulcers are commonly known as peptic ulcers, with two distinct types: gastric ulcers located in the stomach and duodenal ulcers found in the small intestines. Duodenal ulcers are more common than stomach ulcers.
The food moves from the oesophagus to the stomach, which is a vital organ in the digestive system. Inside the stomach, the food is broken down further by acid and enzymes, which convert complex substances into simpler ones. A protective mucous lining protects the stomach’s inner wall from the damaging effects of acid and enzymes. However, when there is an imbalance between the digestive juices and the protective factors, the lining of the stomach or small intestine may break down, allowing acids to erode the inner surface, leading to the formation of an ulcer.
What are the types of peptic ulcers?
- Gastric ulcer: It occurs when a sore forms in the lining of the stomach.
- Duodenal ulcer: This happens when a sore develops in the upper part of the intestine.
- Oesophageal ulcer: This is when a sore forms in the lining of the oesophagus, which is the tube that carries food and liquid from the throat to the stomach.
What causes peptic ulcers?
The most common cause of peptic ulcers is infection of the stomach by bacteria called Helicobacter pylori (H pylori).
Other factors contribute to the risk of developing ulcers include:
- Excessive alcohol consumption
- Frequent use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Smoking cigarettes or chewing tobacco
- Undergoing radiation treatments
- Experiencing high levels of stress
- A rare condition known as Zollinger-Ellison syndrome results in excessive acid production by the stomach and subsequently leads to stomach and duodenal ulcers.
What are the symptoms of peptic ulcer?
The common symptom of peptic ulcers typically involves a burning sensation or discomfort located just below the ribcage, specifically in the epigastric or upper mid-abdomen region. This discomfort can persist for a few minutes to several hours, with intermittent occurrences over the course of days or even weeks.
Discomfort or pain associated with duodenal ulcers usually occurs between meals or during the night, while gastric ulcer pain may present shortly after eating.
Additional symptoms may include:
- A sensation of early fullness, bloating
- Burning or dull ache in the stomach
- Episodes of burping or belching
If ulcers are not treated for a long time, can lead to complications. Untreated ulcers can cause bleeding or erosion in the gastrointestinal tract, eventually resulting in the formation of a hole.
Signs indicating upper gastrointestinal bleeding may include:
- Blood in the stool
- Black and tar-like appearance of the stool
- Vomiting that resembles coffee ground
- Feeling dizzy or faint
- Pale skin
- Rapid heartbeat
On the other hand, symptoms that suggest a gastrointestinal perforation (hole) may include:
- Sudden, intense, and severe abdominal pain
- Abdominal swelling and tenderness on touch
- Presence of fever and chills
How is peptic ulcer diagnosed?
The diagnosis of peptic ulcer disease typically involves a combination of medical history, physical examination, and various tests.
Medical history: The doctor will ask about symptoms, including when they started, how severe they are, and if anything makes them better or worse. They will also inquire about medical history, including any previous gastrointestinal issues or treatments.
Physical examination: During the physical exam, the doctor may gently press on the abdomen to check for tenderness, which could indicate an ulcer. They may also listen to your abdomen with a stethoscope to detect any sounds that suggest increased intestinal activity.
Diagnostic Tests include:
Endoscopy: This is the most common test used to diagnose peptic ulcers. A thin, flexible tube with a camera (endoscope) is passed through the mouth and into the oesophagus, stomach, and duodenum. The doctor can visually inspect these organs for ulcers or any other abnormalities. They may also take tissue samples (biopsies) during the procedure to test for the presence of H. pylori bacteria or to check for signs of cancer.
Upper GI series: Also known as a barium swallow or barium meal, this test involves swallowing a chalky liquid containing barium, which coats the oesophagus, stomach, and duodenum. X-rays are then taken, which can reveal ulcers, inflammation, or other abnormalities.
Laboratory Tests: Blood, stool, or breath tests may be used to detect the presence of H. pylori bacteria, which is a common cause of peptic ulcers.
What are the treatment options for peptic ulcers?
Treatment for peptic ulcers typically involves a combination of medications and lifestyle changes, and, in some cases, surgery may be needed. Here are the main treatment options:
Medications
- Proton pump inhibitors (PPIs): These drugs reduce the production of stomach acid, allowing the ulcer to heal. Examples include omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid).
- H2 receptor blockers: These medications also reduce stomach acid production but work through a mechanism different from PPIs. Examples include ranitidine (Zantac), famotidine (Pepcid), and cimetidine (Tagamet).
- Antacids: These provide short-term relief by neutralizing stomach acid. They can be used in conjunction with other medications. Common antacids include magnesium hydroxide (Milk of Magnesia), and aluminium hydroxide (Gelusil).
- Antibiotics: If the ulcer is caused by an H. pylori infection, a course of antibiotics is prescribed to eradicate the bacteria. Common antibiotics used include amoxicillin, clarithromycin, metronidazole, and tetracycline.
Lifestyle changes
- Quitting smoking
- Drinking less alcohol and caffeine
- Staying away from foods which worsen the condition
If the ulcer does not improve with medication and lifestyle modifications, sometimes surgery may be necessary.
How one can reduce the risk of peptic ulcer?
- Avoid long-term use of painkillers
- Avoid excessive alcohol consumption
- Quit smoking
- Limit caffeine intake
- Avoid spicy, acidic, or fatty foods that can irritate the stomach
- Follow a healthy diet
In summary, peptic ulcer involves the formation of open sores in the lining of the stomach, small intestine, or oesophagus. Common symptoms include abdominal pain, bloating, nausea, and heartburn. The main causes include infection with H. pylori bacteria, long-term NSAID use, excessive alcohol consumption, and smoking. Diagnosis typically involves endoscopy and testing for H. pylori. Treatment often includes medications to reduce stomach acid, antibiotics to eradicate H. pylori, and lifestyle changes. With proper management, most ulcers can heal successfully, but early detection and intervention are essential to prevent complications.
References
- Cleveland Clinic. Peptic ulcer disease. Available from: https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease. Accessed on May 8th, 2024
- Understanding ulcers. Available from: https://www.webmd.com/digestive-disorders/understanding-ulcers-basic-information. Accessed on May 8th 2024
- Penn Medicine. Peptic ulcer disease. Available from: https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/peptic-ulcer-disease. Accessed on May 8th 2024
