Peptic ulcers are open sores that develop in the lining of the digestive tract it could in the oesophagus, stomach, and small intestines.
Peptic is related to digestion which is derived from pepsin, the major digestive enzyme that stomach produces. Pepsin and stomach acid are the active ingredients in the stomach juices that help to chemically break down food for digestion. Some of these juices also pass into the first part of the small intestine which is the duodenum.
The gastrointestinal tract has a protective mucous lining that insulates it from the substances inside. It’s especially strong in the stomach and duodenum but in the case of peptic ulcer disease, this protection fails, and digestive juices corrode through the lining. An ulcer occurs when there is an erosion that penetrates through all three layers of the mucous lining. Most peptic ulcers occur in the stomach or duodenum, where gastric juices are most active. Less commonly, they can also occur elsewhere in your GI tract.
PUD is said to develop between 5% and 10% of people worldwide and can affect people at any age. It has enormous economic impact, as it accounts for a sizable amount of spending on healthcare each year.
Myths
You have often heard that not eating, spicy foods, foods high in fat and sugar etc can cause ulcer and also, milk can curse ulcer and that it’s not treatable. These are not true as there are no scientific evidence that backs them up. Let’s look at some of these myths:
Not eating can cause it: Some people are usually shocked when they are told that they have ulcers because, in their books, they eat very well and are not supposed to have anything to do with it. Lack of eating only makes the acidic content in the stomach more concentrated, which can worsen the ulcer pain. While not eating doesn’t cause ulcers, it makes them worse because of the high acidic pH.
Spicy foods cause ulcers:When it comes to spicy foods in people who have ulcers, it is not a one-size-fits-all situation, as different people react differently to different kinds of spicy food. However, there is no evidence to support the claim that spicy foods cause ulcers; what has been ascertained is the ability of spicy foods to trigger ulcer pain in some people. Some of the spices that could trigger ulcer pain include pepper, ginger, garlic, onion, and some foods like beans, yams, etc.
Foods high in fat and sugar cause peptic ulcers: While having a diet full of fast food is unhealthy, it will not cause a stomach ulcer. They can make an ulcer worse and its symptoms worsen. If a person does have ulcers, it is best to avoid fatty foods.
Milk can heal ulcers:Milk cannot heal ulcers and does not relieve the pain that results from them. Cold or warm milk can not even prevent ulcers from coming about. Though milk may provide temporary relief, it can make things worse by causing the stomach to produce more acid.
They are not treatable: People assume they have ulcers and never get the necessary test to confirm a diagnosis. When left untreated, it can cause severe discomfort and other health problems. Ulcers can be treated completely and cured with medication and adherence to restriction.
Types
It most often affects the stomach and duodenum. Duodenal ulcers account for almost 80% of peptic ulcers and stomach ulcers account for almost 20% of peptic ulcers. Peptic ulcer can also be anywhere in the gastrointestinal tract under unusual circumstances that cause stomach juices to pass through those parts. For example:
Oesophageal ulcer. This is a chronic acid reflux of stomach acid rising into the oesophagus which may eventually erode the mucous lining causing ulcer.
Jejunal ulcer. Ulcer in the jejunum which is the middle part of the small intestine is as a result of side effect of surgery connecting the stomach to jejunum (gastrojejunostomy).
Causes and Risk Factors
The mucous lining in the gastrointestinal tract is designed to withstand digestive acids and enzymes and repair itself from damage, especially in the stomach and duodenum. Peptic ulcer disease occurs when something interferes with these natural defences. It takes a chronic or persistent condition to lower these defences long enough for an ulcer to erode. The two main cause are;
Helicobacter pylori: Nearly half of the world’s population has this common bacterial infection living in their stomach and/or duodenum. In most people, it doesn’t seem to cause any trouble. But when it overgrows too much, it upset the natural balance of microbes living there, therefore invoking an inflammatory response. H. pylori causes ulcers by wearing down the mucus lining of the stomach, thereby causing digestive enzymes like pepsin and acid to have access to the wall. This creates a perfect environment for ulcers to develop.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These are non-prescription medications that are used to manage pain; examples are ibuprofen, diclofenac, meloxicam, piroxicam, etc. When used over a long period of time, it causes ulcers. NSAIDs inhibits the production of prostaglandin, which the stomach needs for its coating. As a result of this, it induces ulcer.
The risk factors include alcohol intake, smoking, untreated stress. These factors on their own do not cause ulcers, but they can make the symptoms worse.
Symptoms
- Burning stomach pain
- Feeling of fullness, bloating or belching
- Intolerance to fatty foods
- Heartburn
- Nausea
The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night. It can cause severe signs and symptoms such as:
- Vomiting or vomiting blood, which may appear red or black
- Dark blood in stools, or stools that are black or tarry
- Trouble breathing
- Feeling faint
- Nausea or vomiting
- Unexplained weight loss
- Appetite changes
Diagnostic Tests
- Laboratory test for Helicobacter pylori
- Endoscopy
- Upper gastrointestinal series such as barrow swallow
Prevention
- Get Tested for H. Pylori
- Use NSAIDs Wisely: Take the lowest effective dose for the shortest duration. Avoid taking NSAIDs on an empty stomach. Also, consider alternative pain relievers like paracetamol (acetaminophen/ Tylenol).
- Manage Stress: Practice stress-reducing techniques like meditation or deep breathing.
- Quit Smoking: Reduce your risk of developing peptic ulcers and other health issues.
- Dietary Changes: Avoid trigger foods like citrus fruits, tomatoes, chocolate, spicy foods, and fatty foods that can irritate the stomach lining. Instead, boost your fibre intake with whole grains, fruits, and vegetables, and opt for low-acid foods like lean proteins, low-fat dairy, and complex carbohydrates. Staying hydrated by drinking plenty of water is also crucial.
- LifestyleModifications: Maintain a healthy weight to reduce pressure on the stomach. Regular exercise, getting enough sleep and avoiding alcohol and caffeine can also reduce your risk for peptic ulcers and relieve symptoms.
Treatment
Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. Pylori bacterium if present, eliminating or reducing use of NSAIDs if possible, and helping the ulcer to heal with medication.
- Antibiotics: To treat H. Pylori infections.
- Acid Reducers: These are also called histamine (H-2) blockers. It helps to reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing eg. Ranitidine, cimetidine
- Antacids: To neutralise stomach acid and provide quick relief.
- Proton Pump Inhibitors (PPIs): To block acid production in the stomach. These drugs include the prescription and over-the-counter medications like omeprazole and rabeprazole.
- Cytoprotective Agents: They help protect the tissues that line the stomach and small intestine such as sucralfate (Carafate) and misoprostol (Cytotec).
Complications
When left untreated, they can lead to serious complications, including:
- Bleeding Ulcers: Can lead to severe blood loss and even death.
- Perforation: A hole in the stomach wall which can cause infection and peritonitis.
- Obstruction: Blockage of food passage, leading to severe vomiting and dehydration.
- Anemia: Iron deficiency due to chronic bleeding.
- Gastric Cancer: Increased risk of developing stomach cancer.
Peptic ulcers are common and treatable. Treatment is important, even if you don’t have severe symptoms as untreated ulcers can become more serious. Don’t wait to consult about your symptoms.