Peptic Ulcer Disease (PUD) is a condition characterized by painful sores or open wounds (ulcers) that develop on the lining of the stomach (gastric ulcers), the first part of the small intestine (duodenal ulcers), or sometimes the lower esophagus. These ulcers occur when the protective layer of mucus that lines the digestive tract is eroded by stomach acid, allowing the acid to damage the underlying tissue. While stress and spicy foods were once thought to be primary causes, it is now known that most peptic ulcers are caused by infection with a specific bacterium or by the long-term use of certain medications.
Causes:
The two most common causes of peptic ulcers are infection with a bacterium called Helicobacter pylori (H. pylori) and the regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). Other factors can contribute to ulcer formation or make them worse.
- Helicobacter pylori (H. pylori) Infection:
- This is the most common cause of peptic ulcers. H. pylori is a spiral-shaped bacterium that can live in the acidic environment of the stomach.
- It colonizes the stomach lining, causing inflammation (gastritis) and weakening the protective mucus layer, making the lining more susceptible to acid damage.
- Many people have H. pylori without developing ulcers, suggesting other factors play a role.
- Long-Term Use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs):
- NSAIDs (e.g., ibuprofen, naproxen, aspirin) can irritate the stomach lining and interfere with the body’s ability to produce protective prostaglandins, which help maintain the stomach’s mucous barrier.
- This direct irritation and reduced protection make the lining vulnerable to acid.
- Zollinger-Ellison Syndrome:
- A rare condition where one or more tumors (gastrinomas) form in the pancreas or duodenum.
- These tumors produce large amounts of gastrin, a hormone that causes the stomach to produce excessive acid, leading to severe and multiple ulcers.
- Other Less Common Causes:
- Severe Physiological Stress: (e.g., severe burns, head injury, major surgery) can lead to “stress ulcers.”
- Other Medications: Certain medications, like corticosteroids, SSRIs, or bisphosphonates, may increase ulcer risk, especially when combined with NSAIDs.
- Smoking: Increases the risk of ulcer development, delays healing, and increases recurrence.
- Alcohol Consumption: Can irritate the stomach lining and increase acid production, potentially worsening ulcers.
- Genetics: Some individuals may have a genetic predisposition.
Symptoms:
The most common symptom of a peptic ulcer is abdominal pain, but symptoms can vary depending on the ulcer’s location and severity. Some people may have ulcers with no symptoms at all.
- Burning Stomach Pain:
- The most characteristic symptom. Often described as a burning, gnawing, or aching pain in the upper abdomen (between the breastbone and the belly button).
- Pain typically occurs between meals or at night when the stomach is empty.
- May be temporarily relieved by eating certain foods that buffer stomach acid or by taking antacids, only to return later.
- Duodenal ulcer pain often improves with food and worsens 2-3 hours after eating. Gastric ulcer pain may worsen with food.
- Bloating.
- Belching.
- Nausea and Vomiting.
- Feeling of Fullness: Especially after eating only a small amount of food.
- Heartburn: Similar to GERD, but often more localized to the upper abdomen.
- Unexplained Weight Loss.
- Appetite Changes.
- Symptoms of Bleeding Ulcer (Medical Emergency):
- Black, Tarry Stools (Melena): Due to digested blood.
- Vomiting Blood (Hematemesis): May appear red or like “coffee grounds.”
- Feeling faint, dizzy, or weak.
- Pale skin.
Diagnosis:
Diagnosing peptic ulcers involves a review of symptoms, medical history, and specific tests to identify the presence of an ulcer and its underlying cause (e.g., H. pylori).
- Medical History and Physical Exam: The doctor will ask about symptoms, medication use (especially NSAIDs), and any history of digestive issues. A physical exam may reveal tenderness in the abdomen.
- Tests for H. pylori Infection:
- Urea Breath Test: You drink a special liquid, and then your breath is tested for carbon dioxide, which indicates the presence of H. pylori.
- Stool Antigen Test: Checks for H. pylori proteins in your stool.
- Blood Test: Checks for antibodies to H. pylori. Less commonly used as it cannot distinguish between active and past infections.
- Upper Endoscopy (EGD – Esophagogastroduodenoscopy):
- The most common and effective diagnostic test. A thin, flexible tube with a camera is inserted down the throat to visualize the esophagus, stomach, and duodenum.
- Allows direct visualization of ulcers, determination of their size and location, and assessment for bleeding.
- Biopsies can be taken from the ulcer or surrounding tissue to test for H. pylori or to rule out cancer.
- Upper Gastrointestinal (GI) Series (Barium Swallow): An X-ray exam where you swallow a liquid containing barium. It can show the outline of the esophagus, stomach, and duodenum, and identify ulcers, but is less precise than endoscopy.
Treatment:
Treatment for peptic ulcers aims to eliminate the cause (e.g., H. pylori, NSAIDs), reduce stomach acid, heal the ulcer, and prevent recurrence. Most ulcers heal with medication and lifestyle changes.
- Eliminating H. pylori Infection (if present):
- Antibiotics: A combination of two or more antibiotics (e.g., amoxicillin, clarithromycin, metronidazole, tetracycline) is typically prescribed for 10-14 days.
- Proton Pump Inhibitor (PPI): Usually given along with antibiotics to reduce acid and help heal the ulcer.
- This is known as “triple therapy” or “quadruple therapy.”
- Reducing Stomach Acid:
- Proton Pump Inhibitors (PPIs): (e.g., omeprazole – Prilosec, lansoprazole – Prevacid, esomeprazole – Nexium). These are the most effective medications for suppressing acid production and allowing ulcers to heal. Typically taken for several weeks.
- H2 Blockers (Histamine-2 Receptor Blockers): (e.g., famotidine – Pepcid AC, ranitidine – Zantac). Reduce the amount of acid released into the digestive tract. Less potent than PPIs.
- Stopping NSAID Use: If NSAIDs are the cause, discontinuing them is crucial for ulcer healing. If NSAIDs are essential, alternative pain relief or concomitant acid suppression may be considered.
- Medications to Protect the Lining:
- Sucralfate (Carafate): Forms a protective barrier over the ulcer surface.
- Bismuth Subsalicylate: (e.g., Pepto-Bismol) Can also help protect the ulcer surface and has some antibacterial effects against H. pylori.
- Lifestyle Modifications:
- Avoid Alcohol.
- Quit Smoking.
- Manage Stress: While not a direct cause, stress can worsen symptoms.
- Avoid Trigger Foods: Foods that worsen your symptoms (e.g., spicy foods, caffeine, highly acidic foods).
- Surgery (Rarely Needed):
- Considered for complications such as bleeding that cannot be stopped endoscopically, perforation (a hole in the stomach/intestinal wall), or obstruction (blockage).
Following the prescribed treatment plan and making necessary lifestyle changes are essential for ulcer healing and preventing recurrence. A follow-up endoscopy may be done to confirm healing.
