Peptic Ulcer

Peptic ulcers are painful open sores that get formed on the inner lining of the stomach and the upper portion of the small intestine. The most common sign of a peptic ulcer is stomach pain.

Peptic ulcers are of two types:

  • Gastric ulcers that develop in the stomach.
  • Duodenal ulcers that develop in the first part of the small intestine (duodenum).Duodenal ulcers that develop in the first part of the small intestine (duodenum).

The bacteria Helicobacter pylori (H. pylori) infection and long-term usage of NSAIDs like ibuprofen causes ulcer.There is no link between stress and peptic ulcers, but they might exacerbate the ulcer symptoms.

Peptic Ulcer

Symptoms

Following are the symptoms of peptic ulcer-

Dry gangrene:

The uncommon or severe symptoms of peptic ulcer include:

Stomach discomfort along with burning sensation is a common peptic ulcer symptom. Both stomach acids and an empty stomach can worsen the ulcer. Eat some meals that decrease the stomach acid or use an acid-reducing medication to alleviate the pain; nevertheless, the pain may return. Between meals and before bedtime, the pain could be more severe. Usually, many people with peptic ulcers show no signs or symptoms.


When To See a Doctor?

If you experience any of the above-mentioned severe signs or symptoms, see your doctor. Also speak with your doctor if, after using medicine to treat your discomfort and pain, the pain reappears.

Consult our Gastroenterologistfor more information and adequate treatment for peptic ulcer.


Causes

When the inner surface of the stomach or small intestine is attacked by digestive acids it leads to a peptic ulcer. The acid causes a painful open sore and it may bleed. A mucous layer covers the digestive tract, which often shields the tract from the acid. An ulcer may develop if the amount of acid is increased or the intensity of mucus is decreased. Other causes are:

Bacteria:

The mucous layer that covers and protects the tissues that line the stomach and small intestine is a popular habitat for Helicobacter pylori bacteria. The H. pylori bacterium usually causes no health issues, but it can lead to ulceration by inflaming the stomach's inner layer.

Use of specific painkillers on a regular basis:

The lining of the stomach and small intestine may become irritated or inflamed if you use aspirin or other specific over-the-counter and prescription painkillers known as nonsteroidal anti-inflammatory medicines (NSAIDs). Ibuprofen, naproxen sodium, and other drugs are some of the examples. Acetaminophen is not a component of them.

Different medicines:

Combining certain additional drugs with NSAIDs can significantly increase the risk of getting ulcers. These include steroids, anticoagulants, aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate, and risedronate-containing tablets.


Risk factors

You may be at a higher risk of developing peptic ulcers in addition to the hazards associated with taking NSAIDs in the following situations:

  • Smoking increases the risk of peptic ulcers in people having H. pylori infection.
  • Alcohol elevates stomach acid production that can irritate and erode the mucus lining of the stomach.
  • Take a lot of stress.
  • Eat hot and very spicy food.

These elements together do not create ulcers, but they can exacerbate the existing ulcers and make them difficult to treat.

Complications

Following are the peptic ulcer complications-

Internal bleeding:

Blood loss can be gradual and cause anemia, or it can be severe and necessitate hospitalization or blood transfusions. Black or bloody feces or vomit might result from significant blood loss.

Perforation in the stomach wall:

When the stomach or small intestine are perforated by peptic ulcers, there is more risk of developing a serious abdominal cavity infection (peritonitis).

Obstruction:

Peptic ulcers can prevent food from passing through the digestive tract, making you feel bloated easily, throw up, and lose weight either via scarring or swelling from inflammation

Stomach cancer:

Stomach Cancer: According to studies, individuals with H. pylori infection are more prone to stomach cancer.


Prevention

If you use the same methods suggested as home remedies for treating ulcers, the possibility of peptic ulcers decreases. It might also be beneficial to:

Defend yourself against infections: Although the exact mechanism by which H. pylori spreads is unknown, there is some indication that it may happen through contact with contaminated water or food.
You can safeguard yourself from infections like H. pylori by regularly washing your hands with soap and water and consuming fully cooked foods.

Be cautious when using painkillers: If you frequently use painkillers that can increase the threat of peptic ulcer, take steps to lessen the risk of stomach issues. For instance, take your medicines with food. Find the lowest dose of drug that will help to give pain relief by consulting the doctor. Avoid consuming alcohol while taking the prescribed drugs because taking two together can increase stomach distress. If you require an NSAID, you might also require the use of other drugs, such as antacids, proton pump inhibitors, acid blockers, or cytoprotective agents. COX-2 inhibitors are a subclass of NSAIDs that may have a lower propensity to produce peptic ulcers but a higher propensity to cause heart attacks.


Diagnosis and treatment

Your doctor may conduct a physical examination and request a medical history before looking for an ulcer. Later on, you might have to undergo diagnostic tests like:

H. pylori testing in the lab:

To find out if you have the bacterium H. pylori in your body, the doctor may suggest tests such as a blood, stool, or breath test to check for H. pylori bacteria. The most accurate test is the breathalyzer.
You consume radioactive carbon-containing beverages or foods prior to the breathalyzer test. In your stomach, H. pylori breaks down the substance, you then blow into a bag that is later sealed. Your breath sample will contain radioactive carbon in the form of carbon dioxide, if you are having H. pylori infection.
Inform the doctor if you're taking an antacid before the H. pylori test. Depending on the test, you might need to temporarily stop taking the drug because antacids might create false-negative findings.

Endoscopy:

Endoscopy: The upper digestive system may be examined using a scope (endoscopy). An endoscope is a hollow tube with a lens attached to it that is passed down the throat, into the stomach, and small intestine. The doctor will check for ulcers during an endoscopy procedure.

If an ulcer is found, the doctor may take a small tissue sample (biopsy) to be examined in a lab. Additionally, a biopsy test can determine if H. pylori bacteria is present in the stomach lining.

If you are older, showing signs of bleeding, have recently lost weight, or have trouble swallowing and eating, the doctor is more likely to advise endoscopy. Even if the symptoms get better and the endoscopy examination reveals a stomach ulcer, a follow-up endoscopy should be done following treatment to find out if the ulcer is completely healed.

Upper gastrointestinal series:

This series of X-rays of the upper digestive system, often known as a "barium swallow," produces images of the esophagus, stomach, and small intestine. You take a white drink (including barium) before the X-ray which coats the lining of the digestive tract and it enhances the visibility of ulcers.


Treatment

The cause of peptic ulcers will determine the type of treatment needed. Typically, treatment includes eradicating the H. pylori bacterium, minimizing the use of NSAIDs, and aiding in the ulcer healing by using the medications.

The medications are as follows:

Antibiotics to eradicate H. pylori:

A combination of antibiotics may be suggested by the doctor if H. pylori is discovered in the digestive tract in order to eradicate the bacterium. These include tetracycline, levofloxacin, clarithromycin, metronidazole, tinidazole, amoxicillin, and clarithromycin.

Your location and the level of antibiotic resistance in that area will decide which medicines should be prescribed. For two weeks, you'll probably need to take antibiotics in addition to extra medications to lower stomach acid, such as a proton pump inhibitor and perhaps bismuth subsalicylate.

Drugs that help the body repair by preventing the creation of acid:

PPIs, or proton pump inhibitors, work to lower stomach acid by preventing the action of the cells' acid-producing mechanism. Omeprazole, Lansoprazole, and other prescription and over-the-counter treatments are among them.

Proton pump inhibitor usage over an extended period of time, especially high doses, may increase the risk of hip, wrist, and spine fracture. Consult your doctor to see whether taking a calcium supplement could lower this risk.

Medications that lower the formation of gastric acids:

Histamine (H-2) blockers, often known as acid blockers, lessen the amount of stomach acid produced into your digestive tract, relieving ulcer discomfort and promoting healing. Acid blockers include the drugs famotidine, cimetidine, and nizatidine, which are both prescription and over-the-counter drugs.

Stomach acid-neutralizing antacids:

A prescription for an antacid might be prescribed by the doctor. Antacids can quickly relieve pain while neutralizing any existing stomach acid. Although they can relieve symptoms, antacids are often not used to treat ulcers.

Drugs that safeguard the lining of the stomach and small intestine:

The tissues that line the stomach and small intestine can sometimes be protected by drugs called cytoprotective agents, which your doctor may occasionally prescribe.


Lifestyle changes and self-care

You may get relief from a stomach ulcer pain by following the below-given habits:

Think about switching painkillers:

If you are using pain relievers on a regular basis, discuss with your doctor whether acetaminophen may be an option for you.

Reducing stress:

The signs and symptoms of a peptic ulcer may intensify under stress. Find out the sources of the stress and try to prevent them. While some stress factors cannot be avoided, you may learn to manage it by getting some exercise, hanging out with friends, keeping a journal, etc.

Avoid smoking:

Smoking may harm the protective lining of the stomach and increase the risk of an ulcer. Additionally, smoking also increases the amount of gastric acid in the stomach.

Quit alcohol:

Alcohol abuse can inflame and destroy the mucous lining of the stomach and intestines, leading to bleeding and stomach upset.


Dos and Don’ts

Peptic ulcers are painful open sores that appear on the inner lining of the stomach or upper part of the small intestine. There are two types of peptic ulcers called gastric ulcers and duodenal ulcers. Follow the do’s and don’ts for peptic ulcers to manage it and its related symptoms and complications.

Do’s Don’ts
Consume food at regular intervals such as small meals every 3 hours. Eat too spicy and sour food.
Take a meal 2 to 3 hours before sleeping. Take coffee, tea and other caffeine-containing beverages
Eat food slowly and chew it properly. alcohol intake, cigarette smoking and tobacco chewing.
Take fresh fruits, salads and vegetables in adequate quantities. Eat fried and oily foods.
Regular exercise and yoga.. Self-medicate

Peptic ulcer symptoms include burning stomach pain, heartburn, nausea and intolerance to fatty foods. It is diagnosed by laboratory tests for H. pylori. and endoscopy. The treatment involves taking antibiotics, other acid reducing medications and following a healthy lifestyle.


Peptic Ulcer Care at Medicover Hospitals

At Medicover Hospitals, we have the most trusted team of medical experts who are experienced in providing excellent healthcare services to patients with compassion and care. Our diagnostic department is equipped with modern healthcare technology and equipment to conduct various tests required for the diagnosis of peptic ulcer based on which an accurate treatment plan is designed. We have an excellent team of gastroenterologists who diagnose and treat this condition with utmost precision that brings about successful treatment outcomes.

Citations

https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html
https://www.sciencedirect.com/science/article/abs/pii/S0140673602110300
https://www.sciencedirect.com/science/article/abs/pii/S0140673616324047
https://www.primarycare.theclinics.com/article/S0095-4543(11)00038-8/fulltext
https://gi.org/topics/peptic-ulcer-disease/
https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/peptic-ulcer-disease

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