Peptic Ulcers

What is Ulcers?

Peptic Ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating but it usually comes back. The pain may be worse between meals and at night.
Peptic ulcers include:

  • Gastric ulcers that occur on the inside of the stomach
  • Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen . Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse

How do I know I have Ulcers?

If you experience these symptoms you may be having ulcers

  • Burning stomach pain
  • Feeling of fullness, bloating or belching
  • Intolerance to fatty foods
  • Heartburn
  • Nausea

The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.
Many people with peptic ulcers don’t even have symptoms.
Less often, ulcers may cause severe signs or symptoms such as:

  • Vomiting or vomiting blood — which may appear red or black
  • Dark blood in stools, or stools that are black or tarry
  • Trouble breathing
  • Feeling faint
  • Nausea or vomiting
  • Unexplained weight loss
  • Appetite changes
What puts me at risk of getting Ulcers?

In addition to having risks related to taking NSAIDs, you may have an increased risk of peptic ulcers if you:

  • Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
  • Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced
  • Have untreated stress.
  • Eat spicy foods.
  • H.Pylori infection
How is Ulcers diagnosed?

To detect an ulcer, your doctor may first take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as: Laboratory tests for H. Pylori and Endoscopy and Upper gastrointestinal series (Barium swallow).

Why treat Ulcers?

Left untreated, peptic ulcers can result in:

  •  Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
  • A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
  • Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring.
  • Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of gastric cancer.
How is Ulcers treated?

The following drugs are used to treat ulcers:

  1. Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium.
  2. Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications esomeprazole (Esomac)
  3. Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing. Antihistamines such as Ranitidine were used previously however in 2020, the US Food and Drug Administration (FDA) removed it after testing showed that some products were found to be contaminated with a substance that can increase a person’s risk of cancer if consumed at high enough levels over time. It has been withdrawn from the market by the Pharmacy and Poisons Board in Kenya.
  4. Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief
  5. Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.Options include the prescription medications sucralfate.
How can I prevent myself from getting ulcers?
  •  Protect yourself from infections. It’s not clear just how H. pylori spreads, but there’s some evidence that it could be transmitted from person to person or through food and water.
  • You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.
  • Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals.
    Work with your doctor to find the lowest dose possible that still gives you pain relief. Avoid drinking alcohol when taking your medication, since the two can combine to increase your risk of stomach upset.
    If you need an NSAID, you may need to also take additional medications such as an antacid, a proton pump inhibitor, an acid blocker or cytoprotective agent. A class of NSAIDs called COX-2 inhibitors may be less likely to cause peptic ulcers, but may increase the risk of heart attack.
Can Ulcers fail to heal?

Peptic ulcers that don’t heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal, including:

  • Not taking medications according to directions
  • The fact that some types of H. pylori are resistant to antibiotics
  • Regular use of tobacco
  • Regular use of pain relievers — such as NSAIDs — that increase the risk of ulcers

References

1. Kellerman RD, et al. Gastritis and peptic ulcer disease. In: Conn’s Current Therapy 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed July 8, 2020.
2. Peptic ulcer disease. American College of Gastroenterology. https://gi.org/topics/peptic-ulcer-disease/. Accessed July 8, 2020.
3. Peptic ulcers (stomach ulcers). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers. Accessed July 8, 2020.
4. Feldman M, et al. Peptic ulcer disease. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Saunders Elsevier; 2021. https://www.clinicalkey.com. Accessed July 8, 2020.
5. Nehra AK, et al. Proton pump inhibitors: Review of emerging concerns. Mayo Clinic Proceedings. 2018; doi:10.1016/j.mayocp.2017.10.022.
6. AskMayoExpert. Peptic ulcer disease (adult). Mayo Clinic; 2019.