Peptic Ulcer disease

Most people know at least one person who has peptic ulcer disease and the general notion is that ulcers occur when people do not eat well. Hence the general misconception that hunger causes ulcers though this is not entirely true.

Peptic ulcers are deep wounds in the inner wall of the stomach or small intestine. When there is a superficial wound or erosion in your stomach or the small intestine, it is called gastritis and duodenitis respectively. Duodenal ulcers are more common than gastric ulcers.

What are the causes of Peptic ulcers?

Peptic ulcers are caused by a microorganism: most commonly a bacteria called Helicobacter Pylori. (H.Pylori). Viruses such as Herpes Simplex and cytomegalovirus can cause peptic ulcer as well.

Helicobacter Pylori. (H. Pylori)

H.Pylori infection is prevalent in developing countries and usually acquired in childhood through the faeco-oral or oro-oral route . The bacteria damages the lining of the stomach initially causing gastritis but with further damage, causes ulcer.

It is not everyone who has this infection that would develop peptic ulcer disease. Factors such as genes, immune response of individual to the infection and the type of chemicals or  proteins that the organism produces. Other factors that increase risk of developing peptic ulcer in persons who have H.Pylori infection include smoking of cigarette and increased secretion of gastric acid.

Drugs

Drugs may cause peptic ulcer disease as well. The drug group called non-steroidal anti-inflammatory drug (NSAID) is a well known cause of peptic ulcer disease because it inhibits the secretion of the slimy protective mucus. Prolonged intake of steroids may also cause peptic ulcer disease. The  gastrointestinal tract begins from the mouth to the oesophagus, stomach, small and large intestine and finally the anus?

The stomach is the part of the gastrointestinal tract that continues from the oesophagus or gullet. The stomach is in between the gullet and the small intestine. It stores foods  before expulsion of the foodstuff  to the small intestine for further digestion.The stomach secretes different types of chemicals including hydrochloric acid (HCl) which help in the digestion of food and protects the body from being invaded by germs through the gastrointestinal system.

To protect its inner walls, the stomach also produces mucus and other chemicals. The mucosal barrier is slimy and protects the stomach from the hydrochloric acid that it also secretes and from other substances that we may ingest such as alcohol, aspirin, Diclofenac, and feldene.

peptic ulcer
peptic ulcer-elenabsl/Shutterstock

Symptoms of Peptic ulcer

  • Abdominal pain in the middle upper tummy, which is usually burning in nature
  • Nausea
  • Vomiting
  • Anorexia
  • Weight loss.

Complications of peptic ulcer disease

  • Severe persistent pain that is not relieved by antacids
  • Generalized abdominal pain
  • Vomiting blood
  • Passing black stools
  • Severe persistent vomiting.

Diagnosis of peptic ulcer disease

Tests that your doctor may request to confirm the diagnosis of peptic ulcer disease are as follows

  • Endoscopy of the upper gastrointestinal tract: This involves passing a long pipe that has a camera attached to its tip into the stomach to see the inner linings. This long pipe is passed through the mouth into the stomach after some medications have been given to prevent retching during the procedure.
  • Blood tests for H.Pylori infection.
  • Stool tests for H.Pylori infection.

Treatment of peptic Ulcer

Treatment of peptic ulcer disease is to give antibiotics that would get rid of the microorganism if the cause is infectious

  • Withhold/avoid NSAID such as diclofenac, feldene, felvin, etc
  • Antacids to reduce neutralize acid
  • Other drugs e.g proton pum inhibitors (PPIs) that reduce acid production in the stomach.
  • Surgery may be indicated if complications have set in.

Prevention

Prevention of relapse in those that have been treated for H.Pylori infection can be achieved by stopping smoking. Smoking inhibits mucosal healing and would therefore make the healing of peptic ulcer to be delayed. Avoid non-steroidal anti-inflammatory drugs except it is absolutely necessary and where it is absolutely necessary, combine it with a drug that protects the stomach mucosa.

About the author

Doctor

Grace is an internist currently practising in Nigeria. She has gained experience practising both in the private and public health sectors over the last ten years. She is passionate about giving patients adequate information about their health conditions. She believes that a large part of the management of chronic diseases lies with patients' understanding of their illnesses and the need for lifestyle modifications and medications.