Peptic Ulcers: Causes, Symptoms and Treatment

Peptic ulcers are sores in the lining of the stomach, small intestine, or esophagus. Peptic ulcers are ulcers that occur in the digestive tract and can be either gastric ulcers, which form on the inside of the stomach, or duodenal ulcers, which begin on the inside of the upper portion of the small intestine (duodenum).

Peptic ulcers or stomach ulcers are caused by an imbalance of digestive fluids or when the digestive acids damage the walls of the stomach or duodenum. The most significant causes of peptic ulcers are:

• H. pylori bacteria (Helicobacter pylori). Heliobacter infection is the most common factor for the formation of ulcers. This bacterial infection damages the mucosal layer, the defensive barrier for the stomach and proximal duodenum, allowing gastric acid to penetrate the epithelial tissue.
• NSAIDs (nonsteroidal anti-inflammatory drugs). The prolonged usage of over-the-counter analgesic and antipyretic medications, such as aspirin, ibuprofen, and naproxen, can also damage the gastric mucosal barrier resulting in ulcers.
• Lifestyle Habits: Cigarette smoking and consuming alcohol can increase your chances of developing ulcers. Although stress and spicy foods are not the cause of peptic ulcers, they can aggravate the symptoms and make it more challenging to manage the condition.

Less common causes of peptic ulcers may include:

• Microbial infections other than H. pylori bacterial infection.
• Surgery or medical procedures affecting the stomach
• Medical conditions and diseases such as:

·        Gastrinomas (tumors), stomach cancer, or Crohn’s disease

·        Blockage, lack of blood flow, or injury affecting stomach or duodenum

·        Chronic diseases, such as cirrhosis or chronic obstructive pulmonary disease (COPD)

Signs and Symptoms of Peptic Ulcers

Burning stomach pain is a common symptom that typically begins between meals or during the night. It can be alleviated for a short period if you eat or take antacids, but it may come and go for several days or weeks and last for minutes to hours. Other symptoms include:

• Nausea or vomiting
• loss of appetite and weight loss
• bloating or belching
• feeling full quickly after eating
• dark or black stools
• fatigue
• heartburn

The severity of ulcer symptoms can vary from person to person and can also be asymptomatic. However, if you experience any of these symptoms, it is important to consult your doctor for diagnosis and treatment.

Clinical complications associated with peptic ulcers: 

Severe complications can occur if the ulcer erodes through the stomach or intestinal wall and causes perforation, which can be life-threatening. Additionally, untreated ulcers can cause scarring of the stomach lining and increase the risk of developing stomach cancer. Undiagnosed and untreated peptic ulcers may result in:

Internal hemorrhage is a medical emergency that can manifest in two ways: slow and gradual blood loss that can lead to anemia or sudden and severe blood loss that requires hospitalization and potentially a blood transfusion. Symptoms of severe blood loss may include vomiting or excreting black or bloody vomit or stools.

Peritonitis is a chronic abdominal infection caused when peptic ulcers damage the abdominal lining creating a perforation or hole in the wall of the stomach or small intestine, making it susceptible to infections.

Obstruction of the digestive tract due to peptic ulcers can lead to a feeling of fullness after only a small amount of food, vomiting, and weight loss, either from swelling of the tissues due to inflammation or scarring.

Diagnosis of Peptic Ulcers

A combination of medical history, physical examination, and diagnostic tests can be used to detect peptic ulcers. Your physician may inquire about your medical and familial backgrounds, conduct a physical exam, and request tests to diagnose a peptic ulcer to determine its source and check for any related issues.

Physical Examination - A physical exam is a valuable tool for diagnosing peptic ulcers or associated complications. The doctor will typically check for any swelling in the abdomen and listen for any sounds within it using a stethoscope. Additionally, they will tap on the stomach to check for any tenderness or pain.

Lab Tests – The doctor may recommend medical tests such as blood tests, urea breath tests, or stool tests to detect the presence of H. pylori infection and other clinical parameters associated with peptic ulcers. Lab tests for peptic ulcers can help diagnose the condition and monitor its progression. Tests might also include a complete blood count to check for anemia, a stool sample to look for the presence of blood, and other tests such as a liver function test to assess the liver’s health. A test to measure the level of stomach acid, such as a gastrin level, may also be ordered.

Imaging Tests - Imaging tests are sometimes used to diagnose and monitor peptic ulcers. Endoscopy is the most common imaging test for peptic ulcers, where a thin, flexible tube with a camera and light is inserted into the mouth and down the throat to view the stomach and small intestine. Other imaging tests, such as X-rays, CT scans, and MRI scans, can also help detect changes in the stomach or intestines that could indicate a peptic ulcer. These tests may also be used to monitor the healing process of an ulcer and to identify any complications that may arise.

Treatment and Prevention of Peptic Ulcers

Doctors typically prescribe medications to aid in the healing of peptic ulcers. In addition, they investigate the cause of the ulcers and provide treatment for the underlying cause.

• Antibiotics such as amoxicillin or clarithromycin may be prescribed if the ulcers are due to a bacterial infection.
• If the ulcers are caused by nonsteroidal anti-inflammatory drugs (NSAIDs), these should be stopped and possibly replaced with acetaminophen or an alternative pain relief medication.
• Proton pump inhibitors (PPIs) may also be prescribed to reduce acid production in the stomach.
• If the ulcers are severe, endoscopic treatments such as injection sclerotherapy or radiofrequency ablation may be necessary to treat them.
• Lifestyle changes such as avoiding spicy foods or alcohol can also help to reduce symptoms.

To help prevent peptic ulcers and averts the risk of clinical complications, it is crucial to lead a healthy lifestyle, maintain a balanced diet, and take suitable preventative measures. Eating smaller meals throughout the day, avoiding spicy and fatty foods, and avoiding stress can help to protect the lining of the stomach. Additionally, avoiding smoking and alcohol and taking appropriate medications as prescribed by a doctor can help to reduce the risk of developing a peptic ulcer.