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Peptic Ulcer Disease: Symptoms, Causes, Treatment, and Prevention

Peptic ulcer disease (PUD) causes open wounds in the stomach lining. PUD often presents with symptoms, such as pain and indigestion. Peptic ulcer disease affects the duodenum and stomach.

What is PUD?

Peptic ulcer disease is a disease condition that leads to open sores (ulcers) developing in the digestive system. The stomach juice contains two active ingredients, such as stomach acid and pepsin (highly corrosive), that break down food into smaller particles (digestion). The word “peptic” is derived from pepsin, a digestive enzyme produced by the stomach.

The gastrointestinal tract is protected by a mucous lining that protects it from stomach contents. But in the case of peptic ulcer disease, the digestive juices corrode through the lining to cause open sores.

Therefore, an ulcer is an abrasion that passes through the three protective layers of the mucosa (mucous lining). Most peptic ulcers can occur anywhere in the gastrointestinal tract, but most commonly in the duodenum or stomach where peptic juices are most active.

Types of peptic ulcers?

1. Stomach ulcer disease – develops in the lining of the small intestine, stomach, or esophagus

2. Duodenal ulcer disease – develops in the lining of the duodenum

3. Jejunal ulcer – develops in the middle part of the small intestine.

Incidence of Peptic ulcer

PUD is the most common ailment of the alimentary canal. It affects about 4 million people worldwide with an incidence of 10 – 20%. Peptic ulcer disease can develop at any age but is usually more common in young adults.

Symptoms of PUD

Most people with peptic ulcer disease don’t present with symptoms. However, the most common symptoms reported by people include indigestion and epigastric pain.

Indigestion comes in the form of a feeling of fullness immediately after eating and lasts for a long time afterwards. It comes with epigastric pain and a burning sensation.

This burning sensation is a result of enzymes and stomach acids corroding through the gastrointestinal lining.

Also, it’s difficult to tell the location of the ulcer, whether it is in the duodenum of the stomach. But some signs can guide you. For instance, a stomach ulcer will often present with the feeling of pain immediately after food when the gastric juice is at optimal function.

While a duodenal ulcer recedes immediately after food. But becomes severe again after about 3 hours afterwards. Most people confuse this as a sign of hunger because food brings relief.

A lot of people with duodenal ulcers report severe pain that keeps them awake at night. The same as jejunal ulcers. Though jejunal pain occurs at the belly button area. In the same vein, esophageal ulcers present with a feeling of heartburn, which worsens at night.

PUD also presents with these related symptoms:

·   Vomiting

·   Bloated stomach

·   Nausea

·  Belching.

·  Loss of appetite.

·   Bloody stool

·   Dark stool

·   Paleness

·   Dizziness

·   Pain at the back of the chest

·   Fever

·   Weight loss

·   Constipation (loss of bowel movement)

Causes of peptic ulcer

The mucous lining covering the gastrointestinal tract functions as a protective mechanism against the corrosive effects of the digestive enzymes. Peptic ulcer disease manifests when these natural defences are compromised.

There are two main causes of PUD:

1.  H. pylori: When this bacteria usually found in the stomach or duodenum multiplies excessively in population, it upsets the natural balance of bacteria living there. This will activate an inflammatory response in the gastrointestinal tract lining, wearing it out.

2.  Abuse of nonsteroidal anti-inflammatory drugs (NSAIDs): These pain relievers, such as ibuprofen and aspirin, when overused upset the chemical balance in the stomach and duodenum. NSAIDs act by inhibiting the prostaglandins responsible for the repair of damaged gastrointestinal lining.

Risk factors associated with peptic ulcer disease

·   H. pylori

·   NSAIDs

·   Smoking

·  Alcohol use

Diagnosis of Peptic ulcer disease

·   Laboratory investigations: Your doctor might recommend blood, stool, or breath tests to find out if the bacterium H. pylori is living in your gastrointestinal tract.

·   Endoscopy: Your doctor will examine your upper digestive tract using a scope. During the process of endoscopy, a hollow tube with a lens (endoscope) is passed through your mouth into the esophagus and stomach. And in most cases down to the small intestine, looking for ulcers.

Endoscopy is usually recommended in older patients, with signs of bleeding, difficulty in swallowing, and weight loss.

·   X-Ray: Your doctor will recommend an X-ray of your upper digestive tract using a barium swallow method. This white liquid helps to make your ulcer more visible.

Management and Treatment of PUD

The first choice of peptic ulcer disease management is the combination of drugs to reduce stomach pain. This helps to protect tissues and also repair damaged ones. Furthermore, the inclusion of antibiotics will help to treat any infection.

Medications

Medications used in the management and treatment of ulcers include:

  1. Cytoprotective agents – help to cover and protect the gastrointestinal lining as it heals. 

Examples;

  • Bismuth subsalicylate
  • Sucralfate.
  • Misoprostol.
  1. Antibiotics help to eradicate the presence of bacteria such as H. pylori. A combination of antibiotics works best in this regard.

Examples;

  • Amoxicillin
  • Doxycycline
  • Clarithromycin
  • Metronidazole
  1. Histamine receptor blockers – help to reduce peptic acid by inhibiting the chemicals that activate its release.

Examples;

  • Nizatidine
  • Cimetidine
  • Famotidine.
  1. Proton pump inhibitors – help to minimize stomach acid and protect the lining to promote healing.

Examples;

  • Omeprazole
  • Lansoprazole
  • Dexlansoprazole
  • Rabeprazole

Prevention of peptic ulcer disease

PUD can be prevented with the following measures;

  1. Eradication of H. pylori – go for a laboratory test and if H. pylori is confirmed, treat it before it causes any issues. Additionally, consider routine retesting as the organism tends to come back after treatment.
  1. Use nonsteroidal anti-inflammatory drugs (NSAIDs) only as directed by your doctor. Avoid personal management of pains and aches by overdosing on these drugs.

Peptic ulcer and Dieting 

PUD is not caused by foods or drinks, though they play a key role in aggravating it if you already have an ulcer. Foods rich in spices and acid are the major culprits and should be avoided. Additionally, alcohol and smoking should be avoided if you are having signs and symptoms of an ulcer.

Ensure you talk to your doctor about any medications you are currently taking, especially NSAIDs. 

Antacids act by neutralising stomach acid and reducing symptoms, such as reflux, indigestion, and heartburn. They make you feel better temporarily but do not cure ulcers. 

Ensure to always speak with a doctor on the Aegle Health app if you suspect a stomach ulcer. Even though you can control the painful symptoms with over-the-counter drugs, this approach won’t heal the ulcer. There is a need for you to detect and treat the underlying cause.

An ulcer that is left untreated can elicit more severe complications, even if you don’t have painful symptoms. Furthermore, H. pylori, which is the major cause of ulcer disease can aggravate other complications including stomach cancer. 

Seek emergency care on the Aegle Health app if you suddenly develop symptoms of serious complications, such as:

  • Signs of faintness.
  • Signs of elongated pain.
  • Signs of blood in your stool.
  • Signs of blood in your vomit.
  • Signs of severe blood loss, such as paleness.

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