Peptic Ulcer

Peptic Ulcer Disease: Causes, Symptoms, and Treatment

Peptic Ulcer Disease (PUD) refers to open sores that develop on the inner lining of the stomach, upper part of the small intestine (duodenum), or sometimes the esophagus. These ulcers can cause significant discomfort and lead to complications if untreated.

Definition of Peptic Ulcer Disease

Peptic ulcers are sores caused by the erosion of the mucosal lining due to the corrosive action of stomach acid and digestive enzymes. They typically occur in the stomach (gastric ulcers) or the first portion of the small intestine (duodenal ulcers).

Types of Peptic Ulcers

1. Gastric Ulcers: Occur in the stomach lining and are associated with pain soon after eating.
2. Duodenal Ulcers: Develop in the duodenum (the first part of the small intestine) and are characterized by pain that improves with eating but worsens a few hours later.
3. Esophageal Ulcers: Less common, these form in the esophagus due to acid reflux.

Etiopathogenesis of Peptic Ulcers

Peptic ulcers occur when the balance between protective and harmful factors in the gastrointestinal (GI) tract is disrupted. Some of the main contributing factors include:

• Helicobacter pylori (H. pylori) infection: This bacterium weakens the protective mucosal lining, making the stomach more susceptible to acid damage.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen and aspirin can reduce the production of the stomach's protective mucus.
• Excessive acid production: Conditions like Zollinger-Ellison syndrome can lead to overproduction of stomach acid, increasing the risk of ulcer formation.
• Lifestyle factors: Smoking, alcohol consumption, and stress can aggravate ulcer risk by impairing mucosal defense or increasing acid production.

Manifestations of Peptic Ulcer Disease

Common symptoms of PUD include:

• Burning stomach pain: Often felt between meals or during the night.
• Bloating and belching: A feeling of fullness or discomfort in the abdomen.
• Nausea or vomiting: Especially in more severe cases.
• Weight loss: Due to reduced appetite or food aversion caused by pain.
• Vomiting blood or dark, tarry stools: These are signs of bleeding ulcers and require immediate medical attention.

Diagnosis of Peptic Ulcers

Several diagnostic tests help confirm PUD:

• Endoscopy: A thin, flexible tube with a camera is used to view the stomach lining and check for ulcers.
• H. pylori testing: A breath test, stool test, or biopsy during endoscopy can detect the presence of H. pylori bacteria.
• Barium X-ray: A special drink highlights the stomach lining on an X-ray, helping identify ulcers.

Treatment of Peptic Ulcers

Treating peptic ulcers involves addressing the underlying cause and promoting healing.

Non-Pharmacological Treatment:

1. Dietary adjustments: Avoid spicy, acidic, or fatty foods that may irritate the stomach lining. Eating smaller, more frequent meals can help reduce acid production.
2. Avoid NSAIDs: If possible, switch to safer pain-relief alternatives to protect the stomach lining.
3. Lifestyle changes: Quit smoking, reduce alcohol consumption, and manage stress, as these factors can exacerbate ulcers.

Pharmacological Treatment:

1. Antibiotics: If H. pylori infection is present, a combination of antibiotics (e.g., amoxicillin, clarithromycin) is prescribed to eradicate the bacteria.
2. Proton pump inhibitors (PPIs): Reduce stomach acid and promote healing of the ulcer (e.g., omeprazole, lansoprazole).
3. H2 receptor antagonists: Decrease acid production, though less potent than PPIs (e.g., ranitidine, famotidine).
4. Antacids: Provide quick symptom relief by neutralizing stomach acid.
5. Cytoprotective agents: These medications help protect the stomach lining (e.g., sucralfate).

Tips for Maintaining Digestive Health

• Eat a balanced diet: Focus on foods rich in fiber, such as whole grains, fruits, and vegetables, to promote a healthy gut.
• Avoid smoking and excessive alcohol: Both weaken the stomach lining and increase acid production, raising the risk of ulcers.
• Stay hydrated: Drinking enough water aids digestion and maintains mucosal health.
• Manage stress: Chronic stress can trigger the release of excess stomach acid, so adopting relaxation techniques can be beneficial.
• Limit NSAID use: Opt for alternative pain management methods or use protective medications like PPIs when NSAIDs are necessary.

 

FAQs on Peptic Ulcer

1. What is a peptic ulcer?
A peptic ulcer is a sore that forms on the lining of the stomach, the upper part of the small intestine (duodenum), or the esophagus due to the corrosive effects of stomach acid and digestive juices.

2. What causes peptic ulcers?
The primary causes of peptic ulcers are:

• Helicobacter pylori (H. pylori) infection: A bacterial infection that damages the protective lining of the stomach and intestines.
• Long-term use of NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen and aspirin can erode the stomach lining over time. Other factors include excessive alcohol use, smoking, and stress.

3. What are the symptoms of a peptic ulcer?
Common symptoms include:

• Burning stomach pain, usually between meals or at night
• Bloating or fullness
• Nausea or vomiting
• Indigestion
• Dark, tarry stools (a sign of bleeding) Severe cases may cause sudden, sharp abdominal pain, indicating a perforated ulcer.

4. How is a peptic ulcer diagnosed?
Diagnosis usually involves:

• Endoscopy: A camera is inserted through the throat to view the stomach and intestines.
• Upper GI series: X-rays are taken after drinking a barium solution to highlight ulcers.
• Testing for H. pylori: This can be done through blood, breath, or stool tests.

5. How are peptic ulcers treated?
Treatment depends on the cause:

• H. pylori-related ulcers: Antibiotics are prescribed to eradicate the bacteria, along with proton pump inhibitors (PPIs) to reduce acid production.
• NSAID-related ulcers: Stopping the NSAID, along with PPIs or H2 blockers, helps heal the ulcer. Lifestyle changes, like reducing alcohol intake and quitting smoking, are also essential.

6. Can peptic ulcers be prevented?
Yes, peptic ulcers can be prevented by:

• Avoiding long-term use of NSAIDs or taking them with protective medications like PPIs.
• Limiting alcohol consumption and quitting smoking.
• Managing stress and eating a balanced diet.
• Treating H. pylori infections promptly.

7. What are the complications of untreated peptic ulcers?
If left untreated, peptic ulcers can lead to severe complications, including:

• Bleeding: Ulcers can erode blood vessels, causing internal bleeding.
• Perforation: An untreated ulcer may create a hole in the stomach or intestinal wall, leading to a medical emergency.
• Obstruction: Swelling or scarring from an ulcer can block the passage of food through the digestive tract.