Peptic Ulcer

Overview:

Ulceration in the inner lining of the stomach or upper part of the small intestine is called peptic ulcer. The sore is a result of inflammation caused by the bacteria H.pylori or due to erosion from acids present in the stomach. Stomach pain is the most common symptom experienced by people suffering from peptic ulcer amongst others like bleeding, bloating, and rarely perforation.

Types:

Peptic ulcers are generally classified into two types:

• Gastric ulcers - Ulcers present inside the stomach.

• Duodenal ulcers - Ulcers that develop in the duodenum, that is the upper part of the small intestine.

Causes:

Normally, the digestive tract is covered with a protective mucous layer, that prevents the stomach acid from destroying the inner stomach lining. Conditions that cause an increase in the stomach acids and decreases the amount of mucus results in inflammation in the stomach. The excess acid destroys the mucus layer and eats away the stomach lining.

The common causes are as follows:

• Helicobacter pylori (H.pylori) infection - More than half of the population has H.pylori living in the mucous layer of the stomach. It is harmless in most people, but in a few individuals, it increases the stomach acids causing inflammation and ulcer formation. The exact mode of transmission is still not known, but it is believed to spread through direct contact and contaminated food and water.

• Indiscriminate use of painkillers - Frequent use of analgesics of the nonsteroidal anti-inflammatory drug (NSAIDs) group like Aspirin, Ibuprofen, Naproxen, and Ketoprofen can irritate or inflame the lining of the stomach.

• Smoking, consuming too much alcohol, radiation therapy, too much stress, eating spicy food, family history of peptic ulcer, and stomach cancer can increase the risk of developing a peptic ulcer.

Symptoms:

Burning type of abdominal pain is the most common symptom of peptic ulcers. This pain radiates from the navel to the chest and varies from being mild to severe. Small ulcers do not produce any pain in the initial stages. The symptoms include:

• Feeling bloated.

• Belchings.

• Heartburn.

• Nausea.

• Vomiting.

• Stools become black and tarry because of the presence of blood in them.

• Loss of appetite.

• Unexplained weight loss.

• Chest pain.

• Indigestion.

Risk Factors:

People with the following adverse habits are at risk of developing peptic ulcers.

• Indiscriminate use of NSAIDs (painkillers).

• Smoking.

• Alcoholism.

• Untreated stress.

• Eating a lot of spicy food.

Diagnosis:

If you are experiencing any of the above symptoms, it is best that you consult a doctor. Your doctor will ask you about the symptoms and history, and if he or she suspects a peptic ulcer, you would have to undergo the following tests:

• Upper GI (gastrointestinal) endoscopy - This test is not done for all suspected cases of ulcers but is done for people with a higher risk of stomach cancer, bleeding or symptoms not responding to usual medications.

Here, the doctor inserts a long tube with a camera attached on one side (endoscope) through your mouth and throat, into the stomach. This will help the doctor to see the stomach and small intestine lining, and to visualize the ulcer. They can also collect tissue samples for testing.

• Upper GI series - Upper GI radiography is a real-time fluoroscopy technique that involves taking series of X-rays of the esophagus, stomach, and small intestine after the patient drinks a thick liquid called barium (barium swallow). This liquid coats the digestive tract, making the ulcer more visible.

• Tests for H.pylori - The presence of H.pylori bacteria is tested in the biopsies from stomach (taken during endoscopy), blood, stool, or breath. Endoscopic biopsies are the gold standard for detection of H.pylori in stomach tissue. The breath test is the most accurate of them all. In the breath test, the patient is asked to drink or eat something that contains radioactive carbon. H.pylori breaks down the radioactive carbon that is released as carbon dioxide, the presence of which is tested in the breath.

Treatment:

The treatment depends on the cause. The following treatments are used:

1) Medications:

• Antibiotics are given to kill H.pyori in the stomach. The combination of antibiotics includes Amoxicillin, Clarithromycin, Metronidazole, Tinidazole, Tetracycline, and Levofloxacin.

• Proton pump inhibitors (PPIs) are used to reduce the acid production in the stomach. Examples of PPIs are Omeprazole, Rabeprazole, Pantoprazole, Lansoprazole, and Esomeprazole.

• Histamine (H2) blockers are used to block the cells that produce acids in the stomach. These medicines include Ranitidine, Famotidine, Cimetidine, and Nizatidine.

• Antacids help in neutralizing the stomach acid and help in relieving the pain.

• In a few cases, cytoprotective agents are given to protect the tissues in the lining of the stomach. Sucralfate and Misoprostol are the examples.

2) Home Remedies:

• Consume a diet rich in vitamins, minerals, and proteins. Eat fruits, vegetables, and whole grains.

• Include probiotics in your diet. Examples of probiotics are yogurt, miso, and sauerkraut.

• Avoid taking painkillers frequently. Talk to your doctor about taking Paracetamol instead.

• Reduce stress by doing things you like, go out, talk to your friends, and exercise.

• Avoid smoking and drinking alcohol.

• Get enough sleep.

Complications:

It is essential to detect and treat ulcers as soon as possible because untreated ulcers can cause serious health complications like:

• Bleeding from the ulcers can cause anemia and other emergency conditions. Blood transfusion might be required if there is a severe loss of blood. Signs of bleeding include blood in vomit, black stools, lightheadedness, and dizziness.

• Sometimes, peptic ulcer can perforate the wall of the stomach. This puts you at risk of serious infections.

• The scar tissue formation over an ulcer can obstruct the passage of food through the digestive tract.

All the above conditions are serious, so seek medical attention if you experience any of the following symptoms:

• Sharp and sudden abdominal pain.

• Fainting.

• Profuse sweating.

• Confusion.

• Rigid abdomen.

Prevention:

A few alterations in your lifestyle and habits can reduce the risk of you developing peptic ulcers. The lifestyle changes and habits include:

• Reduce the consumption of alcoholic beverages.

• Do not consume alcohol when on any medication.

• Wash your hands frequently to avoid infections.

• Limit the use of painkillers.

Most peptic ulcers heal with proper care, but some ulcers, called refractory ulcers, do not heal with treatment. In such cases, your doctor will run additional tests to rule out stomach cancer and other gastrointestinal diseases. You can recover faster if you follow home remedies and preventive measures along with the prescribed medicines. A lot of medicines used in the treatment of other illnesses can increase the symptoms caused by a peptic ulcer, so always inform your treating doctor about the ulcer.