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When you hear peptic ulcer, what comes to mind? Stomach pain because of lack of food? Well, it would interest you to know that there is a lot more to peptic ulcer than hunger and starvation. Grab your popcorn, drink, pen, and paper, and let’s get proper information about this common digestive tract disease.
What is Peptic Ulcer?
Peptic ulcers refer to sores in the lining of the lower esophagus, stomach, or the first part of the intestine, known as the duodenum. Although rare cases can occur in other parts of the intestine, most cases occur in the stomach and the duodenum. They are known as gastric and duodenal ulcers, respectively.
Generally, the prevalence of peptic ulcers is higher in developing countries than in developed countries. It is also more common in men than women. Some people have gastric ulcers, some have duodenal ulcers, and some have both.
What Causes Peptic Ulcer?
Peptic ulcers can be caused by a number of things, including:
Bacterial Infection
The most common cause of peptic ulcers is infection by a bacterium known as Helicobacter pylori (H. pylori). It can be transmitted through saliva, such as kissing or sharing cutlery. It can also be contracted through the feco-oral route.
H. pylori is a bacterium with multiple flagella, which it uses to dig into the stomach lining. Once there, it triggers chronic inflammation. This leads to a decrease in the production of somatostatin—a hormone that suppresses the secretion of other gastric hormones. At the same time, H. pylori increases the production of gastrin, a hormone that stimulates gastric motility and hydrochloric acid (HCl) secretion. All these changes contribute to the creation of ulcers in the stomach.
According to a 2022 study, the prevalence rate of H. pylori infection in Nigeria is about 87.7%. However, most people are asymptomatic. This is because not everyone with H. pylori infection develops peptic ulcers, and not all cases of peptic ulcer disease are caused by H. pylori.
H. pylori does not only cause peptic ulcers. It also contributes to conditions like gastritis, GERD, gastric outlet obstruction, and even stomach cancer. It has been classified as a Class 1 carcinogen by the World Health Organization (WHO).
Medications
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are a group of drugs commonly used to treat pain, fever, and other inflammatory conditions. Examples include aspirin, diclofenac, ibuprofen, indomethacin, and celecoxib. Chronic use of NSAIDs can damage the mucosal lining in the stomach and duodenum, predisposing to ulcer formation. To prevent this, some physicians prescribe proton pump inhibitors (PPIs) alongside NSAIDs.
PPIs suppress acid secretion in the stomach, thereby reducing—but not eliminating—the risk of ulcer formation. Chronic use of PPIs is associated with an increased risk of hip fracture. Hence, it is important to carefully weigh the risks and benefits of an NSAID-PPI co-prescription before commencing one.
Stress
Although not as common as those mentioned above, stress can also cause peptic ulcer disease. In fact, stress was one of the earliest causes of peptic ulcer disease to be identified. Mental and emotional stress, in particular, have been pinpointed.
What are the Features of Peptic Ulcer Disease?
Peptic ulcer disease is typically chronic, and an affected person can have multiple spontaneous relapses or flares several years apart. Things that can trigger flare-ups include excess alcohol, smoking, NSAID abuse, stress, etc.
Acute episodes can be characterized by:
Recurrent Episodic Pain in the Upper Abdomen: This pain may be linked to hunger or eating spicy or fatty foods. Sometimes, the pain may be felt in the back, too.
Hematemesis: An ulcer may start to bleed and cause the affected person to vomit blood.
Melena: In some cases, bleeding from an ulcer is passed out in stool.
Nausea and Vomiting: Non-bloody vomiting may also occur.
Recurrent Anemia: Excessive bleeding from an ulcer can cause anemia, which can be noticed as paleness, excessive tiredness, fainting, etc.
How to Know If You Have Peptic Ulcer Disease
If you think you have peptic ulcer disease, there are ways to confirm or disprove your suspicions. Some of them include:
- Endoscopy
- Endoscopy with biopsy for histological and microbiological studies
- Urea breath test
How Is Peptic Ulcer Disease Treated?
The aim of treating peptic ulcers is to relieve symptoms, induce healing, and prevent recurrence. If the ulcer is caused by H. pylori, the organism should be eradicated.
Three drugs are needed to eradicate H. pylori: a PPI and two antibiotics. These drugs are used for at least a week. One of the antibiotics that can be used for this is Metronidazole (Flagyl). Unfortunately, some people have used and abused Flagyl so much that they have developed resistance to it, and it ends up not working for them. In such cases, a different antibiotic may be chosen. Regardless of the choice of drugs, compliance is important to increase the chances of success.
For people on long-term NSAID use, a PPI co-prescription may be considered. H. pylori eradication can also be done before commencing long-term NSAID use.
In some extreme cases, surgery may be done to remove the ulcerated area.
What Can Happen if A Peptic Ulcer is Left Untreated?
An ulcer can become so extensive that it leads to a stomach perforation. This causes the stomach’s contents to leak into the surrounding environment.
Perforation can also occur in someone previously asymptomatic. It is often associated with the long-term use of NSAIDs, and it is characterized by sudden, severe upper abdominal pain that gradually spreads throughout the rest of the abdomen.
Conclusion
Peptic ulcer disease is a disease of the digestive system commonly caused by Helicobacter pylori infection, long-term NSAID use, or significant psychological stress. Acute flare-ups can be triggered by hunger and starvation, drinking too much alcohol, smoking, eating spicy or fatty foods, and so on.
