Peptic Ulcer Disease

Symptoms: Nausea, vomiting blood, fatigue, heartburn, bloating, change in appetite, sudden weight loss, blood in stool, a feeling of fullness in abdomen.

Risk Factors: Helicobacter pylori infection, long-term use of NSAIDs, age, gender, spicy food, alcohol consumption, stress, smoking.

Prevalence: Currently, 8 million people worldwide have peptic ulcer disease. In India, the total number of individuals suffering from PUD is approximately 11%.

Severity: Mild- Severe.

Gender affected: Both male and female populations can be affected by PUD.

Which doctor to consult: General physician, gastroenterologist.

Overview: 

Peptic ulcer disease (PUD) is a condition where open sores called ulcers develop in the lining of the stomach or the upper part of the small intestine. Up to 10% of individuals worldwide are said to have suffered from it in their lives.

In most cases, this disease is caused due to the Infection with Helicobacter pylori bacteria or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). This can cause symptoms such as nausea, vomiting blood, fatigue, heartburn, bloating, change in appetite, etc. Remember, if you’re experiencing severe symptoms, it’s important to seek medical attention promptly. The other causes of PUD include smoking, alcohol and stress.

The best treatment of PUD includes proper diagnosis (blood test, stool test, endoscopy, and breath test), medications (antibiotics, proton pump inhibitors), and diet & lifestyle modifications. Recurrence of peptic ulcer disease can be managed by eating well-cooked food, avoiding frequent use of painkillers, and quitting smoking.

Types of Peptic ulcer disease:

Gastric Ulcers: These ulcers occur in the lining of the stomach. They can develop when stomach acid irritates the stomach lining until it creates an open sore.

Duodenal Ulcers: These are found in the duodenum, which is the first part of the small intestine. Duodenal ulcers are more common than gastric ulcers and are typically associated with a higher amount of stomach acid.

Esophageal Ulcers: Less common than gastric or duodenal ulcers, esophageal ulcers occur in the esophagus and are often associated with gastroesophageal reflux disease (GERD).

Each type of ulcer can cause similar symptoms, but they may have different causes and treatments. It’s important to get a proper diagnosis from a healthcare provider to determine the specific type of ulcer and the most effective treatment plan.

Symptoms

The symptoms of peptic ulcer disease (PUD) can vary from mild to severe and may include:

• Burning stomach pain: This pain can fluctuate, often worsening with an empty stomach and improving after eating or taking antacids.
• Feeling of fullness, bloating, or belching: These symptoms can occur due to the ulcer affecting the stomach’s ability to process and pass food.
• Intolerance to fatty foods: Fatty foods may increase stomach acid, which can aggravate the ulcer and cause discomfort.
• Heartburn: A burning sensation in the chest that may be related to the acid in the stomach1.
• Nausea: This can be a general feeling of being sick to the stomach.
• Vomiting or vomiting blood: The presence of blood can indicate a bleeding ulcer, and the vomited blood may appear red or black.
• Dark blood in stools, or stools that are black or tarry: This can also be a sign of bleeding in the digestive tract.
• Trouble breathing: If the ulcer is causing significant pain or bleeding, it may lead to difficulty breathing.
• Feeling faint: This may occur due to blood loss or severe pain.
• Unexplained weight loss: Weight loss can happen if eating becomes painful or if the ulcer interferes with digestion.
• Change in appetite: Fear of pain after eating may lead to a decrease in appetite.

These symptoms can be indicative of a peptic ulcer, but they can also be caused by other conditions. It’s important to consult a healthcare provider for an accurate diagnosis and appropriate treatment. If you experience severe symptoms or signs of a complication, such as vomiting blood or black stools, seek medical attention immediately.

Causes:

The causes of peptic ulcer disease (PUD) are multifactorial and can include:

Helicobacter pylori infection: This bacterium commonly lives in the mucous layer of the stomach and small intestine. It usually doesn't create any issues, but occasionally, it can irritate the lining, weaken it, and make it easier for stomach acid to pass through and cause ulcers.

Long-term use of NSAIDs: Nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen, and naproxen can irritate the stomach lining and lead to ulcers.

Other factors: These can include smoking, alcohol consumption, stress, and eating spicy foods. While these do not directly cause ulcers, they can exacerbate symptoms and may contribute to the development of ulcers.

It’s important to note that not everyone with these risk factors will develop PUD, and the condition can sometimes occur without any clear cause. If you suspect you have a peptic ulcer or are experiencing symptoms, it’s crucial to consult a healthcare provider for proper diagnosis and treatment.

Risk factors:

The risk factors for peptic ulcer disease (PUD) include a combination of lifestyle choices, medical conditions, and environmental factors. Here are some of the key risk factors:

• Helicobacter pylori infection: This common bacterial infection can lead to inflammation and ulcers in the stomach lining.
• Long-term use of NSAIDs: Regular use of nonsteroidal anti-inflammatory drugs can irritate the stomach lining and increase the risk of ulcers.
• Smoking: Tobacco use can increase stomach acid, reduce the effectiveness of the stomach lining’s defense mechanisms, and slow the healing process of existing ulcers.
• Alcohol consumption: Excessive alcohol can erode the mucous lining of the stomach and increase acid production, leading to ulcer formation.
• Stress: While stress alone doesn’t cause ulcers, it can exacerbate existing conditions and may contribute to the development of ulcers.
• Spicy foods: They do not cause ulcers but can irritate the stomach lining and exacerbate symptoms in some people.
• Age: Being older, especially over 70, increases the risk of developing ulcers.
• Gender: Females may have a slightly higher risk of developing NSAID-induced ulcers.
• Medical conditions: Having multiple medical conditions or a history of peptic ulcers can increase the risk.
• Medications: Taking corticosteroids or certain other medications alongside NSAIDs can increase the risk.

It’s important to manage these risk factors through lifestyle changes and medical interventions when necessary. If you have concerns about PUD, consulting a healthcare provider is recommended for personalized advice and potential screening.

Complications:

Peptic ulcer disease (PUD) can lead to several serious complications if not treated properly. Here are the main complications associated with PUD:

• Internal Bleeding: Ulcers can cause bleeding as they erode into blood vessels. This can lead to anaemia and may require hospitalization or blood transfusions if the bleeding is severe.
• Perforation: An ulcer can create a hole in the wall of the stomach or small intestine, leading to peritonitis, an infection of the abdominal cavity.
• Obstruction: Inflammation and swelling caused by ulcers can block the movement of food through the digestive tract, leading to feelings of fullness and weight loss.
• Penetration: An ulcer can extend through the stomach or duodenum wall and into nearby organs, causing additional complications.
• Stricture: Scar tissue from an ulcer can cause narrowing of the digestive tract, leading to obstruction.
• Cancer: Long-standing ulcers, particularly those not caused by H. pylori, may have a higher risk of developing into gastric cancer.

These complications are serious and require immediate medical attention. If you or someone you know is experiencing symptoms of PUD, it’s important to consult a healthcare provider for proper diagnosis and treatment to prevent these complications.

Prevention:

Preventing peptic ulcer disease involves a combination of lifestyle adjustments, medical treatments, and dietary changes. Here are some key prevention strategies:

• Avoid H. pylori infection: Since Helicobacter pylori is a major cause of ulcers, practicing good hygiene like regular hand washing and eating well-cooked food can help prevent infection.
• Limit NSAIDs: If you need to use NSAIDs for pain relief, do so sparingly and consider using them in conjunction with acid-reducing medications to protect your stomach lining.
• Quit smoking: Smoking can increase the risk of ulcers by affecting the mucous lining of the stomach and increasing acid production.
• Moderate alcohol consumption: Excessive alcohol can irritate and erode the lining of the stomach and increase acid production, which can lead to ulcers.
• Manage stress: While stress alone doesn’t cause ulcers, it can exacerbate symptoms and contribute to their development. Finding ways to manage stress through relaxation techniques or therapy can be beneficial.
• Eat a balanced diet: Consuming foods rich in vitamins, especially vitamin C, and avoiding spicy and fatty foods that may irritate the stomach can help maintain a healthy digestive system.
• Monitor weight: Maintaining a healthy weight can reduce the pressure on the stomach and help prevent ulcers.
• Eradicate H. pylori: If you have been diagnosed with an H. pylori infection, completing the full course of prescribed antibiotics can prevent the development of ulcers.
• Early detection: Regular check-ups and early detection of conditions like Zollinger-Ellison syndrome can prevent the development of ulcers.

By following these preventive measures, you can reduce your risk of developing peptic ulcer disease. If you have concerns or are experiencing symptoms, consult a healthcare provider for personalized advice and potential screening.

When to visit a doctor:

You can visit a general physician or a gastroenterologist if you have any symptoms such as nausea, vomiting blood, fatigue, heartburn, bloating, change in appetite, sudden weight loss, blood in stool, a feeling of fullness in abdomen, etc. Based on your physical examination and the signs and symptoms, your doctor will advise diagnosis.

Diagnosis

The diagnosis of peptic ulcer disease typically involves a combination of medical history, physical examination, and specific tests.

Medical and Family History:

Your doctor will ask about your symptoms, medical history, including any past peptic ulcers or H. pylori infections, and the medicines you take, especially NSAIDs.

Physical Exam:

A doctor may check for swelling in your abdomen, listen to sounds within your abdomen using a stethoscope, and tap on your abdomen checking for tenderness or pain.

Diagnostic Tests:

• Blood Test: To check for signs of H. pylori infection or complications of peptic ulcers.
• Urea Breath Test: To detect H. pylori. You’ll swallow a substance containing radioactive carbon, and later, your breath will be tested for radioactive carbon dioxide.
• Stool Test: To check for H. pylori infection.
• Upper Gastrointestinal (GI) Endoscopy and Biopsy: A flexible tube with a camera is used to view the lining of your upper GI tract and obtain tissue samples.
• Upper Gastrointestinal Series (Barium Swallow): A series of X-rays of your upper digestive system after swallowing a barium-containing liquid.

If you suspect you might have a peptic ulcer, it’s important to consult a healthcare professional for proper evaluation and guidance.

Treatment:

The treatment of peptic ulcer disease typically involves a combination of medications and lifestyle changes to help heal the ulcer and prevent it from returning. Here’s an overview of the treatment options:

Medications:

• Antibiotics: If an H. pylori infection is present, a combination of antibiotics such as amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline, and levofloxacin may be prescribed.
• Proton Pump Inhibitors (PPIs): Medications like omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole are used to reduce stomach acid production, which helps the ulcer heal.
• H2 Blockers: These reduce the amount of acid released into the digestive tract, which relieves ulcer pain and encourages healing.
• Bismuth Subsalicylate: This can protect the stomach lining and may be used along with other medications.

Surgery:

In severe cases, such as when complications like bleeding, perforation, or obstruction occur, surgery may be necessary.

Lifestyle Changes:

• Diet: Incorporate foods rich in vitamin C and be cautious with milk products, as they can increase stomach acid. Avoid spicy foods and alcohol, which may irritate the stomach.
• Avoid NSAIDs: If the ulcer is caused by the use of NSAIDs, your doctor may recommend stopping or changing these medications.
• Quit Smoking: Smoking can increase the risk of peptic ulcers and slow healing.

Follow-Up Care:

After treatment, especially if an ulcer was found during an endoscopy, a follow-up endoscopy might be recommended to ensure that the ulcer has healed.

It’s important to follow the treatment plan prescribed by your healthcare provider and to have regular follow-ups to monitor the condition. If you’re experiencing symptoms of a peptic ulcer, please consult a healthcare professional for personalized advice and treatment.