Understanding Peptic Ulcer Disease

Peptic ulcer disease is a condition in which sores or ulcers occur in the lining of the stomach or first portion of the small intestine called duodenum. Normally, our digestive tract is protected by a mucosa layer that produces mucus that protects against digestive juices. An ulcer may develop if for some reasons, this protective layer is compromised.

In the United States, peptic ulcer affects around 4.5 million people every year. One out of ten people may have an ulcer at one point in time. Increasing age and the growing use of aspirin or other non steroidal anti inflammatory drugs (NSAIDs) contributes to the incidence of peptic ulcer disease. In the past, males were more likely to be affected. However, current evidence shows that women are almost as likely to develop peptic ulcer disease as men. The prevalence tends to increase in older female population and decrease in young male population.

How does a peptic ulcer develop?

When the mucosa layer is broken down, digestive juices that contain hydrochloric acid and an enzyme called pepsin can damage the stomach or duodenal tissue. In contrary to popular belief, spicy foods and daily lifestyle stress do not cause peptic ulcers. They can make the symptoms worse, but diet and psychological factors are not causative factors.

The known causes of peptic ulcers are:

• Infection by bacteria called Helicobacter pylori (H. pylori)
• Use of non steroidal anti-inflammatory drugs (NSAIDs) like aspirin (Anacin, Bufferin, Empirin), naproxen (Aleve), ibuprofen (Advil, Motrin, Excedrin), and many others
• Abnormal gastric acid production such as in Zollinger Ellison syndrome where a tumor called gastrinoma produces excessive acid
• Physiologic (not psychological) stress like severe burns, head trauma, major surgery, systemic infection, and respiratory failure may cause deep ulcers associated with high acid production
• Smoking and excessive alcohol consumption may worsen symptoms and prevent ulcers from healing. However, it is still inconclusive whether or not they are really causative factors. 

 

What are the types of peptic ulcer?

Ulcers that develop in the stomach are called gastric ulcers, where those that develop in the duodenum are called duodenal ulcers. Often times, gastric and duodenal ulcers cannot be differentiated based on the history alone.

What are the symptoms of peptic ulcer?

The most common symptom of a peptic ulcer is abdominal pain that usually occurs in the upper part of the abdomen (epigastric pain) with gnawing or burning quality. In gastric ulcer, pain usually follows shortly after meal. In duodenal ulcer, it occurs several hours after meal and typically happens in the night and awakens the patient from sleep. However, ulcers may not always cause noticable symptoms, especially in the elderly. 

 

a gastric ulcer as seen in endoscopy

Other than abdominal pain, other symptoms that may accompany peptic ulcer disease are:

• Bloating and belching
• Nausea or vomiting
• Chest discomfort or heartburn
• Dark, black, or tarry stool due to bleeding ulcer
• Vomiting blood
• Anemia
• Loss of appetite and weight loss

Danger signs in peptic ulcer

If you experience any of the following symptoms related to your ulcer, seek immediate medical attention.

• Severe abdominal pain
• Bleeding or anemia
• Unexplained weight loss
• Progressive difficulty in swallowing foods or liquid

What are the complications of peptic ulcer?

Untreated ulcer can cause chronic bleeding or sudden massive hemorrhage associated with perforation. Mortality is higher in patients with gastric perforation compared to duodenal perforation. People with gastric ulcers are also at a higher risk to develop stomach cancer.

How are ulcers diagnosed?

A complete medical history and physical examination will usually help your doctor in making the diagnosis. However, to confirm it, you may need to have a blood or breath test to check for Helicobacter pylori infection or even a more elaborate procedure like endoscopy. Upper gastrointestinal endoscopy will allow your doctor to view the inner surface of your stomach or duodenum through a small tube inserted through your mouth.

What are the treatments for ulcers?

Lifestyle changes like stop taking NSAIDs and quit smoking will help the healing process. Ulcers can heal on their own, but if the symptoms are severe or if H. pylori infection is not treated, they will develop into complication.

Medications used to treat ulcers may include:

• Antibiotics to treat H. pylori infection
• Proton pump inhibitors (PPI) like omeprazole (Prilosec), lanzoprazole (Prevacid) or esomeprazole (Nexium) to reduce acid production
• H2 receptor blockers like ranitidine (Zantac) or famotidine (Pepcid)
• Cytoprotective agents like misoprostol or sucralfate to increase mucus production

In severe cases such as in massive bleeding and perforation, endoscopic procedure or open surgery will have to be preformed to control the symptoms. 

 

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Other articles related to peptic ulcer disease:

• Use of non steroidal anti-inflammatory drugs (NSAIDs), especially for long periods of time, is one of the cause of peptic ulcer disease. Read more about over-the-counter (OTC) painkillers
• Abdominal pain is one of the most common reasons for doctor visit with severity ranging from mild to life threatening. Read more about common causes of abdominal pain
• The digestive system consists of two main components: the digestive tract-which starts from the mouth and ended up in the anus, and internal organs that are not part of the digestive tract. Read more about how your digestive system works