Peptic ulcers – Causes, symptoms and diagnosis

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Peptic ulcers are painful ulcers in the stomach. If not treated, they can make it hard for you to eat your favourite food.

peptic ulcersWhat are peptic ulcers?

A peptic ulcer is a break in the lining of the wall of the stomach, or the first part of the small intestine known as duodenum. Acid is secreted in the stomach to digest the food, this hydrochloric acid and a digestive enzyme called pepsin can damage the lining of the stomach. When this happens frequently, an ulcer is formed.

Peptic ulcers are further divided into gastric ulcers and duodenal ulcers based on their location in the stomach or duodenum respectively. These ulcers have certain similarities and also some differences.

Causes of peptic ulcers

  1. One of the most common causes of peptic ulcer is infection due to a bacteria called Helicobacter pylori. This bacterium is the common culprit for causing ulcers in people, however some people who have H. pylori show no symptoms of ulcers. Researchers are still trying to find the link between H. pylori and peptic ulcers.
  2. The other common cause of ulcers is excessive use of NSAIDs or non-steroidal anti-inflammatory drugs which are available over the counter. These drugs damage the lining of the stomach and duodenum either directly or by inhibiting prostaglandins (a type of lipid), which have a protective effect on the inner wall of the stomach and duodenum. NSAIDs include aspirin, ibuprofen, naproxen and diclofenac sodium. NSAIDs are commonly used for headaches, arthritis and several other pains like backaches.
  3. A rare cause is due to Zollinger-Ellison syndrome. In this condition, excessive acid is produced which breaks down the delicate mucosal lining of the stomach and small intestine.
  4. Another theory is that stress leads to ulcers as it increases acid production in the gut. Also, stress may cause a person to eat at erratic hours or skip meals, so the acid, instead of helping digest the food, erodes the lining of the stomach.
  5. Doctors have noticed that liver disorders like cirrhosis co-exist with peptic ulcers.

Symptoms and signs of peptic ulcers

The signs and symptoms of an ulcer are misleading. Some ulcers have absolutely no symptoms and may be detected incidentally when an endoscopy is done for another reason. This is called a silent ulcer and is seen often in diabetics, elderly people and those who take NSAIDs regularly.

  • A common symptom is pain in the upper abdomen between the breastbone and navel or it could be all over the abdomen. In stomach ulcers, the pain is commonly noticed soon after eating; while in duodenal ulcers, it is felt a few hours after the meal, hence it’s known as hunger pain. The pain may be severe enough to wake up the patient at night.
  • The pain may be present on and off for a few days or may go away for a few days or weeks. This does not mean that the ulcer has gone away.
  • Nausea may be present. If vomiting occurs, nausea ceases.
  • There may be a feeling of fullness or bloating. Or the person may feel hungry a couple of hours after a meal.
  • Loss of weight and appetite is possible. Fearing pain after in the stomach after eating discourages patients from having food.
  • A bleeding ulcer may cause anaemia. It may lead to vomiting of blood (hematemesis) and/or vomiting of blood which looks like coffee grounds.
  • Blood may be seen in the stools or the stools may appear tarry in colour.
  • Fatigue and/or chest pain may occur.

Risk factors causing peptic ulcers

  • Alcohol - Regularly consuming alcohol in moderate to large quantities.
  • Smoking - It is directly linked to peptic ulcer.
  • Drug use - Taking NSAIDs daily or regularly for pain relief or for arthritis will increase your chances of developing an ulcer especially if you have H. pylori in your gut. If you must take these drugs regularly, ask your doctor for substitutes or to prescribe medication which can prevent the development of ulcers.
  • Radiation - Undergoing radiation as a form of treatment can cause peptic ulcers.
  • A person in ICU/seriously ill patient on a ventilator can be at a risk of developing peptic ulcers.

Diagnosis of peptic ulcers

A history of upper abdominal pain in a young or middle-aged person with or without other symptoms like heartburn, nausea, vomiting and feeling of fullness may be complained of. A thorough physical examination will follow.

Investigations for peptic ulcers

  1. Testing for H. pylori: It can be easily tested with a blood, breath or stool sample. If your doctor plans to do an endoscopy, he can take a sample from the stomach wall and send it to the laboratory to determine its presence.
  2. Endoscopy: The definitive way to see if the person actually has an ulcer and pinpoint its location is by doing an endoscopy of the stomach and duodenum which is called, hold your breath, esophagogastroduodenoscopy or OGD scopy. If your symptoms are mild or if you are a young adult, the doctor may keep you on medication without doing an OGD scopy. If the treatment is ineffective or the symptoms are severe, only then an endoscopy will be done. In this procedure, a tube is passed through the mouth into the oesophagus and then the stomach and duodenum to locate an ulcer, determine its size and thickness, see if it is bleeding, and stop the bleeding using an injection or metal clamps.
  3. An X-ray of the upper abdomen is done after ingesting a liquid containing barium. This outlines the stomach wall and shows the ulcer as a defect.
  4. Blood test for haemoglobin to detect anaemia and a stool test for occult blood is of value if bleeding is suspected.

In the next article, a comprehensive overview of treatment of peptic ulcers will be discussed.

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Written by Dr Nisreen Nakhoda, General Physician

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