Peptic Ulcer

Peptic ulcers are quite common, although the exact number of affected people is unknown. Studies have shown that as many as 1 in 10 people may be affected by peptic ulcers at some point in their lives. Peptic ulcers tend to affect people over 60 years of age more than other age groups, though they can affect anyone, including children. Men are thought to be generally more prone to this condition as compared to women.

What Is a Peptic Ulcer?

Peptic Ulcer is an open blister or sore that develops on the inside of the stomach wall or the first part of the small intestine called the duodenum. Sometimes, an ulcer may also develop on the lower part of the food pipe (oesophagus) where it meets the beginning of the stomach. This kind of peptic ulcer is called the oesophageal ulcer.

Peptic ulcers may be classified into two categories depending on where they occur:

• Gastric ulcers or stomach ulcers 
  Stomach ulcers or gastric ulcers occur on the inside of the stomach lining.
• Duodenal ulcers
  Duodenal ulcers occur in the duodenum. The duodenum is the upper portion of the small intestine that connects it to the stomach.

Some people may have ulcers in one or both the locations. Doctors generally differentiate between the two by a careful analysis of when and where the symptoms appear. The pain and discomfort associated with peptic ulcer may manifest in a location other than the actual site of the ulcer.

One of the most common symptoms of a peptic ulcer is a sensation of dull pain or a burning in the stomach. The pain generally occurs in the upper portion of your stomach that is, above the belly button. Other symptoms include bloating of the stomach, burping, feeling of sickness, vomiting, loss of weight due to no apparent reason and poor appetite. At times, people also experience heartburn and indigestion. (Read more - Stomach pain causes and treatment)

The burning feeling in the stomach is generally associated with the following features:

• It stops for some time if you take antacids or eat something.
• It mostly occurs on an empty stomach, such as during the interval in between meals and at night.
• It may last from a few minutes to several hours.
• It occurs periodically for several days or weeks or months.

Peptic ulcer should be taken seriously, and it is essential to consult a doctor even if your symptoms are mild. This is because if left untreated, peptic ulcers can get more severe and result in various complications.

Causes

The stomach and the small intestine are protected from the strong acids produced in the stomach by a protective lining. However, when this protective lining breaks down due to various reasons, peptic ulcers can form. Some factors that can contribute towards the formation of peptic ulcers include:

• Medications
  Certain medicines that belong to the category of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen may lead to peptic ulcers. Many people can safely take NSAIDs without any problems, but long-term consumption of these medicines at high doses may result in the formation of peptic ulcers.
• Bacterial infection
  The bacteria Helicobacter pylori (H. pylori) may cause a disease in the stomach or duodenum, which leads to the development of peptic ulcers. Usually, the bacteria survive in the stomach lining without causing any problems.
• Zollinger-Ellison syndrome
  These ulcers may also arise due to the presence of certain cancerous and non-cancerous tumours in the stomach known as Zollinger-Ellison syndrome.

At times, peptic ulcers are formed due to both- NSAIDs and the Helicobacter pylori infection.

Risk Factors

Certain factors are known to increase the risk of developing peptic ulcers. These include:

• Use of NSAIDs
  People who take NSAIDs every day or many times during a week are at a higher risk of developing peptic ulcers as compared to those who do not take these medicines regularly. The risk for NSAID induced peptic ulcer also increases if the person is elderly or a female, has had peptic ulcers before, taking or has taken more than two kinds of NSAIDs, drinks or smokes on a regular basis or has more than two long-term medical conditions.
• Bacterial infection
  The presence of an H. Pylori infection increases the chances of getting a peptic ulcer as the bacteria can damage the protective lining of the stomach and the duodenum.

There are no fixed steps that a person can take to prevent the development of peptic ulcers. However, maintaining good hygiene may protect people from ulcers formed due to bacterial infection. People who need to take NSAIDs regularly should talk to their doctor regarding their concern. They may be advised to stop or limit smoking and drinking as these have been associated with peptic ulcers.

Diagnosis of peptic ulcers is based on a combination of your symptoms and your use of non-steroidal anti-inflammatory drugs.  

Testing for the presence of Helicobacter pylori (H. pylori) infection 
If your doctor suspects an H. pylori infection then he/she may prescribe the following tests:

• Blood test
  A sample of your blood is collected and tested for the presence of antibodies to the H. pylori bacteria.
• Breath test
  The person is given a special drink that contains a specific kind of chemical, which is broken down by the H. pylori bacteria. Your breath is then analysed to check for the presence of any infection.
• Stool antigen test
  A stool sample is collected and sent to the laboratory to check for the presence of the bacteria.
• Gastroscopy
  A gastroscopy may be advised by your doctor to confirm the diagnosis at times. It is an outpatient procedure that requires insertion of a thin flexible tube down your throat with a camera at one end. The images taken by the camera can confirm the diagnosis. At times a tissue sample may also be collected for analysis.

Peptic ulcers respond very well to treatment and start healing in about two months time. The treatment depends upon the cause of the ulcer. When the ulcers are formed due to regular use of medication such as NSAIDs, discontinuation of medicines is considered. Your doctor will review your case and may reduce dosage or suggest alternative medicines. Medications include:

• Proton Pump Inhibitors
  Usually, a medicine called a proton pump inhibitor (PPI) is prescribed. This medicine reduces the production of stomach acids and allows natural healing of the ulcers. PPIs are usually prescribed for 4 to 8 months. The commonly used PPIs include omeprazole, pantoprazole and lansoprazole.
• Antibiotics
  If a bacterial infection is the cause of the peptic ulcer then antibiotics are prescribed to kill the bacteria. Along with antibiotics, PPIs may also be prescribed at times. Once the bacteria are killed, the ulcer heals and does not usually return. Usually, a course of two or three antibiotics is prescribed, each of which is required to be taken twice a day for a week. When peptic ulcers are formed due to a combination of bacterial infection and NSAIDs medication, then the recommended treatment is also a combination of PPIs and antibiotics.
• H2 receptor antagonists
  H2 receptor antagonists are inhibitors that restrict the amount of acid produced by your stomach. One of the most widely used H2 receptors antagonists is Ranitidine.
• Antacids and alginates
  Antacids work by providing short-term relief against the symptoms of peptic ulcers by effectively neutralising the stomach acids. Some antacids contain a medicine called alginate. These produce a protective coating on the stomach lining which helps to provide relief. Antacids should be taken when one experiences the symptoms or expects the symptoms to occur such as at bedtime or after meals. Antacids containing alginates, however, are usually taken before meals.  

Do not begin or discontinue any medicines without consulting your doctor. Consult your doctor to detect the underlying cause of the condition and remember that taking or stopping any medication without his/her recommendation may lead to dangerous consequences.

90% of all peptic ulcers are a result of an infection caused by the H. pylori bacteria. Such infections can be easily cured by taking a course of antibiotics for the recommended time, which is usually two weeks.

Lifestyle management

It was previously believed that peptic ulcers are caused by certain lifestyle factors and dietary choices such as spicy foods, stress and alcohol intake. Today, however, spicy foods and anxiety are not known to cause ulcers by themselves, although they tend to make the symptoms worse.

Research regarding the role of diet and nutrition in the formation and prevention of peptic ulcers has not been conclusive, and researchers have not found any link between them.  

One of the most common home remedies for symptomatic relief has been the consumption of milk. However, milk consumption is ineffective in providing relief from the disease itself.

In addition, alcohol uptake and smoking have been linked to the formation of peptic ulcers and hence should be avoided.

Prognosis

If properly diagnosed and treated, peptic ulcers do not tend to return. However, it is crucial that you follow all the instructions given by your doctor and take all the prescribed medications on time. Complications usually arise if the condition is not diagnosed and proper treatment is not administered in time.

Complications

Complications due to peptic ulcers are rare but may occur especially if the diagnosis and treatment are delayed. These include:

• Bleeding
  A blood vessel in the stomach or the small intestine ruptures at times and causes bleeding. Internal bleeding is the most common complication of peptic ulcers. Slow, long-term internal bleeding leads to anaemia. Rapid bleeding may cause the stools to become black and sticky and may also cause the appearance of blood in vomit. (Read more - Blood in stool causes and treatment)
• Gastric outlet obstruction
  Sometimes inflamed ulcers can cause a blockage that stops the passage of the food through the digestive system. This condition is characterised by repeated vomiting of undigested food, a feeling of fullness or bloating and a reduction or loss of appetite.
• Perforation and Peritonitis
  Rarely, peptic ulcers may cause a small hole or an aperture in the stomach or the small intestine. Perforation is dangerous as it can lead to peritonitis which is an infection of the stomach wall lining. This infection can then rapidly spread to other organs.

Complications caused by peptic ulcers can be quite dangerous and require immediate medical care. Immediate surgery may become necessary to treat complications.