Peptic ulcer – Causes, Symptoms, Treatment, Measures, and Complications

A peptic ulcer occurs when the tissue lining the stomach or duodenum is eroded by acidic digestive juices. Peptic ulcers are also called stomach (or gastric) ulcers or duodenal ulcers, depending on their location.

The lining of the stomach and duodenum (the first part of the small intestine) is normally protected from the effects of acidic digestive juices by a barrier of mucus. If this barrier is damaged, acid may cause inflammation and erosion of the lining. The resulting eroded areas are known as peptic ulcers, and there are two different types: duodenal ulcers and stomach (gastric) ulcers.

Stomach ulcers are more common over age 50 but duodenal ulcers are more common in men between the ages of 20 and 45. Duodenal ulcers sometimes run in families, and stress, excess alcohol and smoking are risk factors. About 1 in 10 people in the UK develops an ulcer at some time.

Causes of Peptic ulcer

• Peptic ulcers are most commonly associated with Helicobacter pylori infection. This bacterium releases chemicals that increase gastric acid secretion. Acidic digestive juices are then more likely to erode the lining of the stomach or the duodenum, which allows peptic ulcers to develop.
• Peptic ulcers may sometimes result from the long-term use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, that damage the lining of the stomach.
• Other factors that may lead to peptic ulcers include smoking and alcohol.

In some people, there is a strong family history of peptic ulcers, suggesting that a gene may be at work.

NB It is currently thought that psychological stress is probably not one of the primary causes of peptic ulcers; however, it may make an existing ulcer worse.

Symptoms of Peptic ulcer

Many people with a peptic ulcer do not experience symptoms or dismiss their discomfort as indigestion or heartburn. Those with persistent symptoms may notice:

• pain or discomfort that is felt in the centre of the upper abdomen, often just under the tip of the breastbone
• pain going through to the back
• loss of appetite and weight loss
• a feeling of fullness in the abdomen
• nausea and sometimes vomiting.

Pain comes in attacks and is often present for several weeks and then disappears for months or even years. The pain from a duodenal ulcer can be worse before meals when the stomach is empty and can be quickly relieved by eating but usually recurs a few hours afterwards. By contrast, pain caused by a gastric ulcer is often worse after food.

Complication of Peptic Ulcer

• The most common complication of peptic ulcer is bleeding as the ulcer becomes deeper and erodes into nearby blood vessels.
• Minor bleeding from the digestive tract may cause no symptoms except those of anaemia, such as pale skin, fatigue and faintness.
• Bleeding from the digestive tract may lead to vomiting of blood.
• Alternatively, blood may pass through the digestive tract, resulting in black, tarry stools.
• In some cases, an ulcer perforates all the layers of the stomach or duodenum, allowing gastric juices to enter the abdomen and causing severe pain and peritonitis. Bleeding from the digestive tract and perforation of the stomach or the duodenum may be life-threatening and require immediate medical attention.
• In rare cases, stomach ulcers may result in narrowing of the stomach outlet into the duodenum, which prevents the stomach from emptying fully. Symptoms may then include bloating after meals, vomiting undigested food hours after eating and weight loss.

Measures For Peptic Ulcer

If your doctor suspects that you have a peptic ulcer, an endoscopy will be arranged to view the stomach and duodenum directly. During endoscopy, a sample of the stomach lining will be taken to look for evidence of H. pylori infection and exclude stomach cancer, which may cause similar symptoms. In some cases a barium X-ray may be done instead. Your doctor may also arrange for you to have blood tests to detect antibodies against the H. pylori bacterium and to check for evidence of anaemia.

Treatment of a Peptic Ulcer

Treatment of a peptic ulcer is designed to heal the ulcer and to prevent it from recurring. You will be advised to make some lifestyle changes, such as giving up smoking and drinking less alcohol.

• H. pylori is treated with a combination of antibiotics to kill the bacteria and ulcer-healing drugs to cut acid production and promote healing. Because three drugs may be involved the combination is often called “triple” therapy. Triple therapy needs to be taken religiously for 1-2 weeks, which usually eradicates H. pylori and the condition never recurs. Occasionally, however, it may be necessary to take another course. Ulcer-healing drugs are usually given to maximise the chance of healing even if tests for H. pylori prove negative.
• If long-term treatment with aspirin or a non-steroidal anti-inflammatory drug is the cause, your doctor may prescribe an alternative drug or an additional drug, such as misoprostol, to protect the lining of the stomach and duodenum.
• A bleeding or perforated ulcer is an emergency requiring urgent admission to hospital. If blood loss is severe, a blood transfusion may be necessary. Endoscopy may be done to view the stomach lining; during this, bleeding blood vessels may be treated with diathermy, a technique that uses heat to seal them. Alternatively, an injection of drugs may be given to stop bleeding. If bleeding is severe or the ulcer is perforated, surgery is usually necessary.

With treatment, about 19 in 20 peptic ulcers disappear completely within a few months. However, the ulcer may recur if lifestyle changes are not made or if there is reinfection with H. pylori.