Peptic Ulcer – How to Diagnose, Treat and Prevent

Peptic ulcer is a painful sore that forms in the lining of the stomach, esophagus, and small intestine. They are caused by an imbalance in the digestive system, most commonly due to the presence of the bacterium Helicobacter pylori.

Peptic ulcers can be painful and cause complications if left untreated. Fortunately, most cases can be effectively managed with medication and lifestyle changes.

What is a peptic ulcer?

A peptic ulcer is a sore that forms in the lining of the stomach, small intestine, and esophagus. It is usually caused by an imbalance between digestive juices, such as stomach acid and the protective mucus that coats the lining of the stomach and intestine.

This imbalance leads to inflammation and erosion of the protective mucus, which then allows digestive juices to come into contact with the sensitive lining of the stomach and intestine.

Types of Peptic Ulcer

Peptic ulcers may affect either the stomach or the duodenum, the first portion of the small intestine. Both types of ulcers can cause abdominal pain, nausea, bloating and other symptoms.

1. Gastric Ulcers:

Gastric ulcers, also known as stomach ulcers, are exposed sores in the stomach lining that are caused by Helicobacter pylori (H. pylori). Most individuals have H. pylori in their stomach, but in certain situations, it may cause stomach lining inflammation and progress to an ulcer. Some drugs, such as ibuprofen, aspirin, and steroids, may potentially induce gastric ulcers.

2. Duodenal Ulcers:

Duodenal ulcers are wounds that develop in the initial section of the small intestine. These ulcers are commonly caused by H. pylori but can also be caused by the use of certain medications, such as aspirin and ibuprofen, or due to an excess of stomach acid.

3. Other Types:

1.     Stress Ulcer:

Another type of peptic ulcer is stress ulcer, which occurs when the stomach lining is irritated or damaged due to stress, such as a major illness, surgery or trauma. Stress ulcers can cause abdominal pain, nausea, vomiting, and other symptoms.

2.     Esophageal Ulcers:

Peptic ulcers may also develop in the esophagus, the tube that transports food from the mouth to the stomach. Gastroesophageal reflux disease (GERD), in which acid from the stomach rushes back up into the esophagus, is a potential trigger for these ulcers. Aspirin and ibuprofen, as well as an H. pylori infection, may both contribute to the development of an esophageal ulcer.

3.     Ménétrier’s Ulcers:

Finally, there are Ménétrier’s ulcers, which are large, deep ulcers that occur in the stomach lining. These ulcers are caused by an excess of gastric acid and can lead to a condition called hypoalbuminemia, which is a low level of a protein called albumin in the bloodstream.

Signs and Symptoms of Peptic Ulcer:

The clinical presentation of PUD varies depending on the severity of abdominal pain and the presence of complications.

General:

• Pain in the upper abdomen, whether mild or severe, may range from uncomfortable to fatal

Symptoms:

• Abdominal pain is often epigastric and characterized as scorching but may also manifest as diffuse discomfort, abdominal fullness, or cramping.
• A common nocturnal discomfort that wakes the sufferer up (especially between 12 AM and 3 AM)
• The degree of ulcer pain varies from patient to patient and may be seasonal, appearing more commonly in the spring or autumn; periods of discomfort typically last a few weeks, followed by a pain-free phase or remission lasting weeks to years.
• Changes in the nature of the pain might indicate the possibility of problems.
• The discomfort is often accompanied by heartburn, belching, and bloating.
• Nausea, vomiting, and anorexia are more prevalent in gastric ulcer patients than in duodenal ulcer patients, although they may also be symptoms of an ulcer-related consequence.

Signs:

• Weight loss associated with vomiting, anorexia, and nausea
• Complications, including perforation, ulcer bleeding, obstruction, or penetration

Causes of Peptic Ulcer:

Peptic ulcers are often brought on by an infection with Helicobacter pylori. Other factors that can lead to peptic ulcers include the long-term use of certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), certain health conditions, and lifestyle factors.

Helicobacter Pylori Infection:

Helicobacter pylori is a spiral-shaped bacterium that can survive in the acidic environment of the stomach. It is a common cause of peptic ulcers and is estimated to be the cause of up to 75% of peptic ulcers in adults. It is usually spread through contact with saliva or vomit from an infected person. It can also be passed from person to person through contaminated food or water.

Long-term Use of Medications:

The long-term use of certain medications, such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), can weaken the protective layer of mucus in the stomach, making it more vulnerable to acid damage. This can lead to peptic ulcers.

Other Health Conditions:

Certain health conditions, such as Crohn’s disease and Zollinger-Ellison syndrome, can increase the production of acid in the stomach, leading to peptic ulcers.

Lifestyle Factors:

Lifestyle factors such as smoking, drinking excessive amounts of alcohol, and having an unhealthy diet can increase the risk of developing peptic ulcers. Smoking can weaken the protective layer of mucus in the stomach, making it more vulnerable to irritation.

Drinking excessive amounts of alcohol can also irritate the lining of the stomach, increasing the risk of peptic ulcers. An unhealthy diet can also increase the risk of developing peptic ulcers, as certain foods can irritate the stomach lining.

Diagnostic Tests for Peptic Ulcer:

• Studies on the Production of Stomach Acid
• Only individuals who have not responded to treatment or who have a suspected hypersecretory illness should have their fasting serum gastrin levels measured.
• Stool hemoccult tests appear positive, and the hematocrit and hemoglobin levels are low, suggesting bleeding.
• Evaluations for Helicobacter pylori

Other diagnostic tests:

• More than 90 percent of peptic ulcers are found using esophagogastroduodenoscopy, a fiberoptic endoscopy of the upper digestive tract that allows for direct examination, biopsy, detection of superficial erosions, and areas of current bleeding.
• Normal single-barium contrast methods may identify 30% of peptic ulcers, but double-contrast radiography can detect 60%-80% of ulcers.

Treatment of Peptic Ulcer:

The treatment for peptic ulcers is condition specific. In most cases, medicines to aid ulcer healing will be used with antibiotics to eradicate any H. pylori bacteria that may be present.

Some examples of medications are:

Antibiotic:

If your doctor discovers H. pylori in your stomach, he or she may prescribe an antibiotic mixture to eradicate the infection. These may include:

• Clarithromycin (Biaxin)
• Amoxicillin (Amoxil)
• Tinidazole (Tindamax)
• Metronidazole (Flagyl)
• Levofloxacin
• Tetracycline

Rates of antibiotic resistance in your area can help to establish which antibiotics may be safely and effectively administered. Antibiotics, a proton pump inhibitor, and maybe even bismuth subsalicylate (Pepto-Bismol), all intended to lower stomach acid, will probably be necessary for the next two weeks.

Proton Pump Inhibitors:

The acid in the stomach may be lowered by taking proton pump inhibitors (PPIs), which work by stopping the acid-making mechanism in cells from doing its job. These drugs include prescription and over-the-counter medications such as:

• Omeprazole (Prilosec)
• Esomeprazole (Nexium)
• Rabeprazole (Aciphex)
• Pantoprazole (Protonix)
• Lansoprazole (Prevacid)

The risk of wrist, hip and spine fractures may rise with prolonged use of proton pump inhibitors, especially at high dosages. Find out from your doctor whether taking a calcium supplement will help lower this danger.

Histamine (H-2) Blockers:

The discomfort of an ulcer may be alleviated and the ulcer itself can heal faster with the use of acid blockers, commonly known as histamine (H-2) blockers.

• Famotidine (Pepcid AC)
• Cimetidine (Tagamet HB)
• Nizatidine (Axid AR)

Antacids:

In certain cases, a doctor may prescribe medication in addition to an antacid. Since they work by reducing the stomach’s acidity, antacids are a quick solution to indigestion problems. Constipation and diarrhea are two possible side effects, albeit they depend on the active components.

Follow-up Treatment:

It’s common for peptic ulcers to recover after receiving treatment. On the other hand, your doctor may suggest endoscopy if the symptoms are really serious or if they persist after therapy.

If your doctor discovers an ulcer during an endoscopy, they may want to repeat the procedure after you’ve been treated to be sure the sore is gone.

When Ulcers fail to heal

Refractory ulcers are peptic ulcers that do not respond to therapy. Several factors might contribute to an ulcer not healing, such as:

• Medications not taken as prescribed
• Because certain strains of H. pylori are immune to common medicines
• A habitual user of tobacco
• The use of ulcer-promoting painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), regularly

Refractory ulcers may less often stem from:

• Conditions like Zollinger-Ellison syndrome, in which the stomach produces excessive amounts of acid,
• Unlike H. pylori, stomach cancer may be caused by other infections.
• Other disorders, including Crohn’s, may also bring on stomach and intestinal ulcers.

Refractory ulcers are often treated by employing a combination of antibiotics and removing any potential healing barriers.

Alternative Medicine:

While peptic ulcer is mainly treated with conventional medicine, there are some alternative medicine options that could be beneficial in alleviating symptoms and providing relief.

Acupuncture:

Acupuncture is an ancient form of Chinese medicine. It is based on the belief that the body’s energy, or qi, flows through channels known as meridians. This energy can be disrupted due to stress or illness, leading to pain and other symptoms. Acupuncture involves the insertion of thin needles into specific points on the body, allowing the qi to flow more freely.

Studies have shown that acupuncture may be beneficial in treating peptic ulcers. One study found that patients with a peptic ulcer who underwent acupuncture experienced less pain and improved symptoms compared to those who did not receive the treatment.

Herbal Remedies:

Herbal remedies have been used for centuries to treat various ailments, including peptic ulcers. Herbs such as ginger, turmeric, licorice, and chamomile have been found to have anti-inflammatory and healing properties. Additionally, certain herbs may reduce the production of stomach acid, which can help to reduce the symptoms of peptic ulcers.

Probiotics:

Probiotics are beneficial bacteria that live in the digestive tract. They can help to reduce inflammation and improve digestion, as well as protect the digestive system against infection. Studies have found that supplementing with probiotics can reduce the symptoms of peptic ulcer, such as abdominal pain and nausea.

Dietary Changes:

Making certain dietary changes can also help to alleviate symptoms of peptic ulcer. Foods that are high in fiber and antioxidants, such as fruits and vegetables, can help to reduce inflammation in the digestive tract. Additionally, avoiding spicy foods, caffeine, and alcohol may help to reduce symptoms. Eating small, frequent meals throughout the day can also be beneficial.

Mind-Body Practices:

Mind-body practices, such as meditation, yoga, and tai chi, can help to reduce stress, which can have a positive effect on peptic ulcer. These practices can help to reduce the production of stress hormones, which can lead to an improvement in symptoms.

Related Books:

• Gastroenterology and Hepatology (Lecture Notes) – 2nd Edition
• Gastroenterology: An Illustrated Colour Text – 1st Edition
• Mayo Clinic Gastroenterology and Hepatology Board Review – 5th Edition

Also Read:

• Irritable Bowel Syndrome – Its Types, Sign & Medications
• Role of Pharmacists in Patient Counseling
• Urinary Tract Infections- Management and Classification
• Diarrhea Its Types And Management

Video Lecture:

Conclusion:

Peptic ulcers are painful sores that form in the lining of the stomach, small intestine, and esophagus. They are usually caused by an imbalance between digestive juices, and the most common cause is the bacterium Helicobacter pylori. Treatment usually involves a combination of medications and lifestyle changes. If you think you may have a peptic ulcer, it is important to see your doctor for diagnosis and treatment.