Stomach Ulcer/Peptic Ulcer Disease: Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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Stomach Ulcer

1Overview

Stomach ache is a common symptom most people experience at least once in their lives.
In fact, it is one of the reasons why people go to their doctors for a medical checkup. Stomach ulcer or peptic ulcer disease is a major cause of abdominal pain.

Peptic ulcers are open sores or wounds that develop on the lining of the stomach.
These ulcers may also affect the small intestine. The most common symptoms of peptic ulcers are stomach pain, which can be extremely painful.

The term “peptic” means that the cause of the problem is due to acid in the stomach. Usually, the pain starts between meals or during the night, lasts for minutes to hours, stops briefly after you eat or has taken antacids, and is intermittent for several days or weeks. Consumption of spicy foods and stress can make ulcers worse, though they do not cause an ulcer.

A peptic ulcer is an illness affecting the upper gastrointestinal tract that occurs when bacteria, drugs, gastric acid and other factors cause breaks in the lining of the stomach or mucosa, the moist tissue that lines the stomach and the duodenum, the top part of the small intestine. Though the most common site of ulcer formation is in the stomach and duodenum, they can develop in the esophagus and other parts of the gastrointestinal tract.

According to statistics, about 500,000 new cases of peptic ulcer are seen each year in the United States alone. In fact, as many as 5 million people are affected in the country at any given time. Individuals with the illness may experience a wide range of symptoms,
and the condition may lead to serious complications if it’s left untreated.

2Types of Stomach Ulcers or Peptic Ulcers

Gastric ulcers

Gastric ulcers occur on the inside of the stomach

Duodenal ulcers

These ulcers develop on the upper portion of the small intestine called duodenum.

3Symptoms

In some people, they do not experience any symptoms at all, but when the ulcer becomes bigger and worse, it may lead to stomach pain and sometimes, nausea or vomiting.
The most common signs and symptoms of stomach ulcer include:

Though the most common peptic ulcer symptom is burning stomach pain, the pain becomes worse because of stomach acids. The pain is often relieved by eating food or taking antacids, which are acid-reducing medication, but the pain usually comes back.
In some cases, the symptoms may become worse over time, leading to the following symptoms:

  • Difficulty in breathing
  • Vomiting or vomiting blood (often, the color of the vomitus appear black or red)
  • Stools that are black and tarry (this indicate internal bleeding)
  • Feeling faint, weak and fatigued
  • Unexplained weight loss
  • Loss of appetite

4Causes

The main cause of stomach ulcer and peptic ulcer disease is the acids in the digestive tract. They eat away the inner mucosa of the stomach or small intestine. As a result, small wounds appear, and in the long run, these small lesions may become ulcers or painful open sores that may bleed.

The common causes of stomach ulcers include:

Bacteria

The bacteria, Helicobacter pylori, is a bacterium that lives inside the stomach of infected people. In the late 20th century, scientists Dr. Barry Marshall and Dr. J. Robin Warren discovered the bacteria as a cause of stomach ulcers. In fact, they won a Nobel Prize in 2005.

Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

These drugs are used to treat pain. They are common causes of peptic ulcers because they are readily-available in pharmacies without any prescription. They cause peptic ulcers by interrupting the natural ability of the stomach to protect themselves from stomach acid. People who use these drugs for long periods are at a higher risk of developing stomach ulcers.

Other medications

Taking certain medications along with NSAIDs may increase the risk of ulcer formation in the stomach. These medicines include anticoagulants, low-dose aspirin, steroids, alendronate, risedronate and selective serotonin reuptake inhibitors (SSRIs) can greatly increase the risk of ulcer formation.

Zollinger-Ellison syndrome (ZES)

This is a rare disorder wherein tumors form in the pancreas and duodenum.
Aside from tumors, ulcers also form. The tumors secrete gastrin, a hormone that causes the stomach to release acid.

5Risk Factors

Aside from the causes of peptic ulcer disease or stomach ulcers, there are many factors that may increase the risk of this disorder:

Family History

Stomach ulcers may run in families. The lifetime chance of first-degree family members having an ulcer is three times as great as that of the general population. In fact, about 20 to 50 percent of patients with duodenal ulcer report a family history of this type of ulcer.

Smoking

Cigarette smoking and H.pylori are cofactors in stomach ulcer. However, their exact relationship has not been well-established. However, many scientists have linked cigarette smoking to the increase of the susceptibility of the lining to damage. Furthermore, smoking may reduce the gastric mucosal defense factors against the stomach acids.

Drinking alcohol

Excessive alcohol intake may heighten the risk of peptic ulcers in people who have H.pylori.

Stress

Stress has been linked to the formation of peptic ulcer disease.

Other risk factors include:

  • Eating spicy food
  • Eating foods that irritate the gastric area
  • Old age (50 years old or older)
  • Chewing tobacco
  • Other diseases such as those that affect the lungs, kidneys, and liver.
  • Radiation therapy in the area

6Complications

Though ulcers may heal on their own, you should never ignore the warning signs that may indicate serious complications of stomach ulcers – bleeding ulcers, perforated stomach, and swelling or scarring. Other complications include infection and obstruction.

Bleeding

Internal bleeding is a serious complication of stomach ulcers. This can occur as slow blood loss that may lead to anemia. However, the patient can experience severe blood loss that may need hospitalization or a blood transfusion. The warning signs of internal bleeding may include black and tarry stools, racing heartbeat, low blood pressure and increased in breathing rate.

Perforation of the stomach

A rare complication of peptic ulcer disease is when the stomach mucosa splits open, which is dubbed as perforation. This is a serious complication because when the cause of your ulcer is a bacterium, it can escape into the abdomen and infect the peritoneum, the lining of the gastrointestinal tract.

Peritonitis or the inflammation of this lining may lead to sepsis. This happens when the infection rapidly spreads into the blood before affecting other organs. This is a medical emergency, and if it’s left untreated, it may lead to serious complications and even death.

Gastric Outlet Obstruction

This is a condition wherein there is scarring on the part where the stomach and small intestine meet. In some cases, when the lining of the stomach is inflamed, it may cause scarring and obstruction on the passageway of food. The most common symptoms include persistent vomiting, bloating, unexplained weight loss and feeling full after eating less food than usual.

7Diagnosis

The doctor may perform a complete physical assessment and a medical history interview to determine the cause of the stomach ulcer. There are other tests the doctor may recommend:

Endoscopy

During an endoscopy, the doctor inserts a long tube with a camera down the throat and into the stomach. This procedure aims to help the doctor view the area for the presence of ulcers. Aside from examining the lining, the doctor can get tissue samples for further examination.

Though endoscopy is not recommended for all cases of stomach ulcer, people who are at a higher risk may undergo the procedure, especially those who:

  • People who are 45 years old and above
  • Experiencing unexplained weight loss
  • Has internal bleeding
  • Suffer from difficulty in swallowing
  • Has anemia

Test for H. pylori

The doctor may recommend some tests to see if the bacteria is present in the body.
The tests include blood tests, stool exams, and breath test. The most accurate diagnostic procedure is breath test.

Upper gastrointestinal series

Another way to diagnose stomach ulcers is to conduct an upper GI series, which involves drinking a barium, a white chalky substance and then taking a series of x-rays to examine the stomach lining.

8Treatment

The treatment will depend on the underlying cause of the stomach ulcer. However, only a licensed doctor is allowed to prescribe these medications. Avoid self-medicating, especially if you are not aware of the possible side effects of these medicines.

Antibiotics

Antibacterial agents are used to killing the H.pylori, which is found in the digestive tract. The doctor may include a combination of various antibiotics. However, a diagnosis should be made by the doctor based on the result of the testing. The common drugs used are amoxicillin, metronidazole, tinidazole, tetracycline, and clarithromycin.

Proton Pump Inhibitors

PPIs reduce the stomach acid by blocking the action of the cells that secrete acid. These drugs protect the lining of the stomach and the duodenum. The most common drugs used are esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole. However, long-term use of these drugs may increase the risk of wrist, hip, and spine fracture.

Histamine (H2) blockers

Acid blockers reduce the amount of stomach acid in the digestive tract. Some examples of these drugs include ranitidine and famotidine.

Antacids

These drugs neutralize the acid in the stomach.

9Prevention

You can prevent stomach ulcers with the help of the following preventive measures.

  • Avoid foods that irritate the stomach like spicy foods, fatty foods, and citrus fruits.
  • Stop smoking
  • Limit alcohol intake
  • Control stress levels through relaxation techniques
  • Take NSAIDs with food to reduce stomach irritation