Definition

A peptic ulcer is a wound or inflammation caused by the erosion of the stomach lining. It is typically triggered by stomach acid that damages the submucosal layer. Under normal conditions, the body employs several substances to protect the digestive system from various diseases and disorders. The primary defense mechanism of the digestive system is the mucus layer, which lines the stomach and duodenum. This mucus functions by neutralizing digestive acid fluids by releasing alkaline fluid in the form of bicarbonate. Additionally, the body produces substances such as prostaglandin hormones, which help ensure smooth blood flow.

Peptic ulcers are common, affecting millions of people worldwide. Although they rarely become serious problems and can be treated with medication, if ignored, they can lead to severe medical issues such as stomach and duodenal perforation, gastric obstruction, upper gastrointestinal bleeding, and digestive tract stricture. Symptoms of peptic ulcers typically include stomach pain, and in more severe cases, bleeding may occur.

Causes

Peptic ulcers can appear in the stomach, duodenum, and esophagus. They are caused by various factors that disrupt the balance of stomach acid in the digestive tract. The main causes of peptic ulcers include:

• Infection with Helicobacter pylori bacterium. This bacterium resides in the mucous layer and can cause inflammation in the stomach's inner layer
• Use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, or diclofenac sodium. These drugs have side effects that irritate the inner lining of the stomach and can lead to ulcers
• Smoking and alcohol consumption
• Untreated stress
• Other health issues, such as pancreatic tumors
• History of radiation therapy in the stomach area

The human digestive tract is primarily lined by a mucosal layer that protects it from stomach acid. However, the factors listed above disrupt the balance of stomach acid, leading to erosion of the inner wall of the stomach and small intestine. When stomach acid erodes the wall, it can cause wounds and pain. It can lead to bleeding if it affects the deeper layers where blood vessels are present.

Risk Factor

Risk factors related to the onset of peptic ulcers include the following:

• Aging
• Use of non-steroidal anti-inflammatory drugs such as aspirin
• Use of blood thinners (anticoagulants)
• Use of immunosuppressive drugs such as corticosteroids
• Individuals are infected with the Helicobacter pylori bacterium

Peptic ulcer is a recurring disease, emphasizing the importance of avoiding its main causes to prevent its recurrence.

Symptoms

The primary symptoms of peptic ulcers are:

• Abdominal pain: This pain usually centers around the upper abdomen. Its emergence is due to stomach acid contacting the injured area of the stomach wall. Typically, the pain occurs at night and worsens on an empty stomach. The pain can radiate to the neck, navel, and back in more severe cases
• Loss of appetite
• Nausea
• Belching
• Intense hunger typically occurs between one and three hours after eating
• Bloating
• Difficulty digesting
• Weight loss
• Fatigue

Diagnosis

To diagnose peptic ulcers, a medical interview was conducted to gather information about:

• Experienced symptoms
• Onset of symptoms
• Dietary history
• History of medication use
• History of radiation therapy

During physical examination, palpable pain in the epigastrium may be observed. To support the diagnosis, the doctor may recommend several diagnostic tests, such as:

• Endoscopy (gastroscopy): This is typically performed on patients over 55 years old who are experiencing ulcer symptoms for the first time or have danger signs such as gastrointestinal bleeding, anemia, unexplained weight loss, swallowing difficulties or pain, persistent vomiting, and a family history of gastrointestinal malignancy
• Radiological examination (X-ray or CT scan): If endoscopic facilities are unavailable, a double-contrast abdominal X-ray examination can be performed
• Examination to confirm the presence of Helicobacter pylori bacteria: This can be done through blood tests, stool tests, or breath tests. The urea breath test is a non-invasive diagnostic test preferred by patients. It involves swallowing a capsule containing radioactive carbon and then exhaling it into a plastic bag for testing. The presence of H. pylori in the stomach and intestines indicates that urea is broken down and converted into carbon dioxide

Management

The treatment of peptic ulcers depends on the cause. Generally, the aim is to eradicate H. pylori bacteria and reduce the use of medications that can cause peptic ulcers, such as NSAIDs. Peptic ulcers can be treated with medication or surgery, depending on their severity. To aid the recovery process, several lifestyle changes can be beneficial:

• Stop smoking
• Limit consumption of alcohol, tea, and coffee
• Avoid spicy or fatty foods
• Increase consumption of probiotic-rich foods like yoghurt
• Increase consumption of fruits, vegetables, and grains
• Get enough rest
• Manage stress

Medications used to treat peptic ulcers include:

• Antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin treat Helicobacter pylori bacterial infections
• Medications that inhibit stomach acid production, such as proton pump inhibitors
• Medications that reduce stomach acid production, such as ranitidine
• Medications that neutralize stomach acid, such as antacids
• Medications that protect the stomach lining, such as sucralfate

Triple therapy is typically used to treat H. pylori infection, which involves a combination of stomach medication that inhibits or reduces stomach acid production and two kinds of antibiotics.

Complications

Although rare, peptic ulcers can lead to serious complications if not promptly treated. Some complications that may occur include:

• Bleeding
• Inflammation of the thin inner layer of the stomach wall (peritonitis)
• Disruption of food movement in the digestive system causes mechanical blockage (obstruction)
• In recurring cases, gastric cancer may develop

Prevention

Some steps can be taken to prevent peptic ulcers, including:

• Adopting a healthy lifestyle, such as quitting smoking and avoiding alcohol consumption
• Ensuring adequate rest
• Managing stress effectively
• Avoid long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) and other medications that may contribute to ulcer formation
• Maintaining personal hygiene is necessary to prevent Helicobacter pylori bacterial infections

When should I see a doctor?

Seek medical attention promptly if you experience abdominal pain, especially persistent upper abdominal pain. Symptoms may be accompanied by nausea, vomiting, weakness, loss of appetite, and weight loss. Immediately seek care at the nearest emergency department if symptoms of nausea are accompanied by vomiting, blood, and black stools.