Peptic ulcers, or peptic ulcer disease (PUD) is a condition wherein ulcers are formed in the esophagus, stomach, and the duodenum lining.
Different Types of Ulcers
Esophagus is a muscular tube that carries the food and water we consume, to the stomach. Ulcers formed in this tube are known as esophageal ulcers. Ulcers formed in the stomach are known as gastric ulcers, and ulcers formed in the duodenum, which is the upper portion of the small intestine, are known as duodenal ulcers.
Peptic ulcer disease is very common all across the globe, affecting approximately 4.6 million people every year, including both men and women. It is a very rare scenario when children and teenagers are affected by these ulcers.
How are Ulcers Formed?
Our digestive tract has a mucous membrane (mucosa), which is a lining that protects the tissues from the digestive juices and acids produced by the stomach. A damage to this lining can damage the tissues, thereby forming ulcers in the respective area. Unlike the common belief that an ulcer is an outcome of too much production of digestive acid in the stomach affecting the mucous lining, the fact is that an ulcer can form even in the presence of minimal acid.
The most common location of a peptic ulcer is the duodenum, whereas, ulcers in the esophagus are relatively rare. Research within the United States of America states that approximately 10% of the people are likely to develop a duodenal ulcer during their lifetime. Speaking of women, about 8%-11% women are likely to develop peptic ulcers at some point of time and the percentage of men under that risk being within the range of 11%-14%.
Not everyone will experience symptoms, or, the same kind of symptoms. However, ignoring peptic ulcer symptoms, if any, or not getting treated in time, may cause inflammation in the abdominal cavity. There may also be an obstruction and/or narrowing of the intestinal opening that can prevent food from leaving the stomach and entering the small intestine. These complications can be serious and life-threatening. Therefore, it is essential that one shouldn't ignore the warning signs, and consult a doctor as early as possible. Some noticeable symptoms include -
This happens to be the most commonly observed symptom indicating the presence of peptic ulcers - be it in the stomach, duodenum, or the esophagus. Pain is mostly observed in the middle or upper abdomen, that may, at times, reach to the breastbone or the back. The pain usually arises while the stomach is empty. The intensity may vary from person to person, and so may the duration of the pain. While some people may experience it for a few minutes, others may endure it for hours. It is usually more prevalent in the night, or early in the morning. You may also notice that the pain might stay for several days, and then disappear suddenly. If the ulcer has developed to a point that it has perforated (made a hole) in the stomach, then this causes intense pain, wherein emergency surgical treatment may be needed.
The gnawing abdominal pain is accompanied with a burning sensation in the chest. For example, if the stomach acid, due to some abnormality like gastroesophageal reflux disease (GERD), ends up entering the esophagus, it may cause heartburn. Another point to be noted is that peptic ulcers have been observed in people with GERD.
Nausea and Vomiting
For many people, vomiting relieves the intensity of the pain they experience. However, if one ends up vomiting blood, or if the vomit appears to be dark brown or black in color, then this is an alarming sign that may indicate internal bleeding caused by the ulcer. The vomit may also appear to be like coffee grains, which is nothing but the clotted blood. Immediate medical attention should be sought in this case.
Indigestion is another common symptom of peptic ulcer that causes a burning sensation somewhere in the middle of the chest. It is often accompanied with burps, frequent hiccups, and abdominal bloating. The discomfort or uneasiness often disappears by taking an antacid.
Unexpected Weight Loss
Peptic ulcers are nothing but sores in the lining of the stomach, esophagus, or the duodenum. These ulcers can cause swelling in the stomach, thereby preventing the food to pass on to the small intestine. Because the food is not completely digested, the person may feel full, thereby decreasing the food intake. This eventually ends up in weight loss, or loss of appetite.
Blood in Stool
If the feces is dark in color, appear to be tarry or bloody, then it calls for an emergency visit to the doctor. This is one of the most serious symptoms of peptic ulcer disease, which might indicate that the ulcer has perforated the wall of the stomach or duodenum. This is a critical condition and may require a surgery.
Other symptoms which may be observed include - fatigue, paleness, and hunger pangs. Peptic ulcers may also lead to anemia, which is a consequence of the slow internal bleeding at the site of the ulcer. The loss of blood accounts for lack of adequate amount of red blood cells, thereby making the person anemic.
It is very important to keep a track on your symptoms, especially when you suspect the presence of a peptic ulcer. Taking a note of important details like - the duration of the pain, the medications that you consume, the frequency of the pain - if there are any specific situations that flare or subside the pain, or if you have any history of gastrointestinal diseases, and so on, is important. Also, it is mandatory for you to tell your doctor about each and every symptom, even if you think it is irrelevant.
The root cause for ulcer formation is the tissue break out due to an imbalance between the digestive juices, acids, and protective mucous layer in the digestive tract. There are many factors that can disturb this balance. Some of them include -
Almost 60% of gastric ulcers, and 90% of duodenal ulcers are caused because of the bacterium H. pylori. The reason behind this is the simple fact that almost 50% of the world's population is infected by this bacterium. H. pylori doesn't always cause problem, in fact, only 10%-15% of the infected population is prone to get ulcer disease. During an infection, H. pylori builds colonies in the mucosa, thereby damaging it in the process, leading to inflammation and swelling in the area. The bacterium releases an enzyme called urease, which neutralizes the hydrochloric acid (HCl), a gastric acid in the stomach. As a result the hormone gastrin releases more acid at frequent intervals of time which causes the erosion of mucosa, leading to the formation of ulcers.
Non-steroidal Anti-inflammatory Drugs
Regular use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen can also affect the balance between stomach acid and mucosa. These medications suppress the body's natural mechanism for releasing protective mucus and acid-neutralizing bicarbonate which disrupts the normal acid production. NSAIDs cause peptic ulcers in people who frequently take such pain relievers, especially on an empty stomach. Painkillers should always be consumed with meals to avoid damage to the mucous layer.
Cigarette smoking can also become a contributing factor in the development of peptic ulcers. Smoking aggravates the development of peptic ulcers. Also, if you are on medications for the treatment of ulcers, then smoking slows down the process of healing. The risk of developing peptic ulcer increases through smoking if you are infected by the H. pylori bacteria.
If some members of the family have this condition, then it is likely to occur in the rest as well. This is not because of genetics, but because of the risk of being infected by the bacterium H. pylori.
Other causes include - Zollinger-Ellison syndrome in which tumors in the duodenum and pancreas release excessive amount of stomach acid causing peptic ulcers. Medications used to treat osteoporosis can also develop peptic ulcers.
There was a time when it was considered that stress, alcohol consumption, caffeine, aerated drinks, and spicy food can cause ulcer formation. However, these factors do not cause PUD but can contribute in aggravating the condition.
After understanding your symptoms, the doctor would conduct some tests to confirm the presence of peptic ulcer disease. The following tests are done for diagnosis.
H. pylori Test
The doctors will need to confirm the presence of H. pylori in your body. For this, a sample of your blood or stool may be taken and sent to the laboratory for detecting the presence of the bacterium.
Detection of H. pylori
H. pylori may also be detected through a breath test. For this, you may be asked to drink a small amount of liquid containing urea. It has no taste or color. The urea enters the body and the bacterium breaks it down into water and carbon dioxide. Later on, you will be asked to blow your breath into a bag. This bag is sent to the laboratory to check for the levels of carbon dioxide, which if found elevated, indicate the presence of H. pylori.
This test is usually done on patients showing severe symptoms of PUD like vomiting, weight loss, difficulty in eating, etc. A hollow tube with cameras attached in it, known as an endoscope, is inserted into the mouth, thereby passing through the esophagus, stomach, and duodenum. The camera enables the doctors to see if there are any ulcers in the area. A small tissue sample may be collected for biopsy testing. The results would confirm the presence of ulcers.
Upper Gastrointestinal Series (UGI Series)
Also known as a barium swallow, this is a special type of X-ray, wherein you will be asked to drink a liquid containing barium. This substance coats the digestive tract and increases the contrast during x-ray, making the ulcers appear more visible.
After determining the exact cause and condition of peptic ulcers, the doctor will suggest a treatment plan accordingly. For instance, your doctor may prescribe different medications if the ulcer is caused by pain relievers. Given below are the possible treatment options that are most likely to be prescribed by the doctor.
The bacterium H. pylori is known to cause peptic ulcers in a majority of cases. To kill this bacterium, the doctors are likely to prescribe a two-week course of antibiotics. These may include - amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl) and tetracycline.
Acid Blockers and Antacids
It is not only important to kill the bacterium through antibiotics, but medications are also prescribed to reduce the level of acids in the digestive tract. Some drugs that are widely prescribed are Ranitidine (Zantac), Famotidine (Pepcid), Cimetidine or Tagamet. The use of antacids can provide rapid pain relief and neutralize existing stomach acid. These may also be included in your treatment plan.
Medication to Protect the Mucosal Lining of the Stomach and Small Intestine
Sucralfate (Carafate), Misoprostol (Cytotec), and Bismuth Subsalicylate are a group of prescribed medication, known as cytoprotective agents, that protect the lining of your stomach and small intestine.
Periodic assessment and medical checkups help to keep a tab on the progress and elimination of ulcer from the body. If the ulcer symptoms persist even after following the prescribed medication, then there are chances that you may be suffering from refractory ulcers - peptic ulcers that don't heal. If that is the case, then your doctor will analyze the possibility of any other cause behind the ulcers, other than H. pylori or NSAIDs.
Your daily lifestyle plays a very important role in determining how healthy you are. Having discussed the causes and symptoms of peptic ulcers, you must have understood how important it is to follow a healthy lifestyle, not only for prevention, but also to enable faster healing. Eat a balanced diet, avoid smoking and drinking, avoid taking stress, and make sure that you control your consumption of painkillers. In case of any doubt, consult a doctor at the earliest and don't resort to self-diagnosis and self-medication.
Disclaimer: This article is for informative purposes only, and should not be used as a replacement for expert medical advice.