Peptic Ulcers

What Are Peptic Ulcers?

Although peptic ulcers are commonly known as stomach ulcers, these are also found in the oesophagus and the small intestine. As the name suggests, these are sores or lesions that appear in the inner lining of the above-mentioned organs. Research has shown that this condition is often linked with a certain kind of bacterial infection. The pathogen involved is one known as Helicobacter pylori. Alternatively, these sores appear when the delicate inner lining of the stomach or esophagus is damaged by corrosive acids in the stomach. Most often, patients complain of a dull, burning sensation in the stomach.

Gastric ulcers are those that develop in the inner lining of the stomach whereas duodenal ulcers are those that arise in the first section of the small intestine known as the duodenum. The former type is more common among women and the latter type is more frequently found in male patients. Oesophageal ulcers are those that appear in the esophagus, usually, it is the lowest section that communicates with the stomach.In some cases, especially when the condition is mild, the ulcers may go away on their own. However, if they persist and remain undiagnosed or untreated, there can be severe, even fatal, consequences.

What Causes Peptic Ulcers?

Digestion in the stomach is carried out with the help of stomach acids which are secreted by certain cells within the stomach. In terms of chemical composition, this acidic substance is identified as concentrated hydrochloric acid which is a highly corrosive compound. In order to counter the corrosive effects of acidic digestive juices, the delicate inner mucosa of the stomach is provided with certain protective mechanisms. For instance, the epithelial cells of the stomach produce an alkaline solution which coats the surface of the mucosa and neutralises the corrosive action of stomach acids. The stomach lining also secretes mucus which aids in protection from acid.

Any condition that disturbs this delicate balance between acid production and mucosal resistance to it can potentially give rise to peptic ulcers. For instance, in some individuals, there is an increased secretion of gastric acid, which overwhelms the protective defenses of the gastric or duodenal mucosa and corrodes it. Sometimes, this is linked with H. pylori infection. This bacterium is normally found in the stomach and small intestine, but sometimes it can give rise to inflammation in the mucosal lining. Other times lowered mucosal resistance may have to do with a reduction in blood supply. Alternatively, the patient may have a rare disease known as Zollinger-Ellison syndrome which induces the body to produce excessive quantities of stomach acid. This tends to lead to the peptic ulcer formation.

Risk factors

• Being older than 50 years of age makes it more likely to develop peptic ulcers.
• Smoking.
• Excessive consumption of alcohol.
• Stress.
• Hypercalcemia. In other words, having abnormally high levels of the mineral calcium in the blood.
• Having a family history of peptic ulcer disease. In fact, having first-degree relatives with peptic ulcer disease makes it three times more likely to develop the condition yourself.
• Regularly taking certain medications such as non-steroidal anti-inflammatory drugs like ibuprofen. Even aspirin can have a similar effect.
• Eating spicy foods.
• Cancer of the stomach.
• Taking radiation therapy.

Having one or more of these risk factors does not mean that you are sure to develop peptic ulcers. What it does mean is that you are more susceptible to it than others without these risk factors. Some risk factors are modifiable, which means that they are avoidable. For instance, if you have a family history of the condition or are middle aged, you can reduce your likelihood of developing peptic ulcers by avoiding smoking and spicy foods.

What Are Some Symptoms Of Peptic Ulcer Disease?

This condition is often asymptomatic. In other words, patients do not develop any symptoms. As a result, they are unaware of having the ulcers in the first place. This can also happen in the initial stages of disease or when the ulcers are small. However, those who do experience symptoms often complain of a burning pain running from the navel to the chest. Depending on whether the stomach, esophagus or duodenum is affected, the pain may worsen either before or after meals. The pain typically tends to come and go.

In symptomatic cases, patients may observe the following indications:

• Burning pain in the abdominal area. This may extend to the chest as well. This pain is temporarily relieved by taking antacids.
• Indigestion.
• Bloating.
• Frequent burps.
• Nausea.
• Vomiting.
• Difficulty breathing.
• Weight loss for no other apparent reason.
• Blood in stools, making the stools appear dark or black.
• Vomiting blood.

What Are Some Potential Complications?

If peptic ulcers are not treated or the underlying causes satisfactorily resolved, the condition will keep worsening. This can have some very serious consequences. Since a majority of patients with the condition may actually be asymptomatic and unaware of having peptic ulcers, it is quite likely that the disease could reach a severe stage before it becomes apparent.

For one thing, the ulcers are already present as open sores in the mucosal lining of the stomach, duodenum or esophagus. If these are allowed to remain and continue to worsen, the sores can actually start to bleed. An indication of this is discoloration of stools, causing it to appear black. If the patient loses significant quantities of blood in this way over an extended period of time, he or she may develop anemia. Alternatively, if the bleeding is sudden and severe, the patient will need hospitalization and a blood transfusion.

Yet another critical possibility is that the ulcers may become so severe that the acid eats right through the stomach, duodenum or esophagus. This results in actual holes or perforations in the organs. As a result, there can be additional complications such as infection in the abdominal region.

What Do Diagnosis And Treatment Involve?

If you have noticed some of the symptoms listed above, your doctor may be able to identify the condition based on the pattern of symptoms and other details relating to diet, lifestyle and medical history. In order to confirm this suspicion, the following procedures may be performed:

• Blood tests.
• Breath tests.
• Fecal occult blood test.
• Upper endoscopy.

As we already seen, peptic ulcer disease can be aggravated by certain modifiable habits such as eating spicy foods. Hence, the condition can be alleviated to some extent by making certain dietary and lifestyle modifications. In case the condition is linked with H. pylori infection, the patient will be given antibiotics. Medications can also help to heal the ulcers and alleviate symptoms.

In severe cases, especially where bleeding is involved, the patient may need to undergo surgery. This may be done by means of a minimally invasive endoscopic procedure. However, if the condition is severe enough to have caused perforations, surgery may be performed to remove a portion of the damaged tissue.

Prevention of peptic ulcers

Peptic ulcers are common. However, it is estimated that a majority of patients are actually unaware of having the condition since they may experience few or no symptoms at all. In mild to moderate cases, medications can provide relief and resolution to a certain extent. Prevention of peptic ulcers is deeply rooted in practicing healthy dietary and lifestyles habits. These include completely refraining from smoking and alcohol consumption, limiting the use of NSAID medications, and practicing hygienic habits to prevent contamination of food.

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