Who Let The Doc Out?! #006: Understanding peptic ulcer disease

Have you been experiencing on and off burning pain just below your sternum, especially when you haven’t had a meal in a while or when you eat certain foods? Then you might be suffering from peptic ulcer disease (PUD).

Peptic ulcer disease is a gastrointestinal condition where open sores form on the lining of your stomach and/or the first part of your small intestine, called the duodenum. This happens when the naturally occurring stomach acids eat away at the protective mucus coating of your stomach or duodenal lining.

Peptic ulcer disease is a relatively common condition worldwide, with studies showing a 0.15% prevalence rate in the general population annually. Most cases are uncomplicated and managed as outpatients, with less than a third of cases requiring hospitalization.

However, uncomplicated peptic ulcer disease can progress to severe disease without proper treatment, which is why it is important to understand the causes, presentation, and management of peptic ulcer disease.

Causes of peptic ulcer disease

The most common causes of peptic ulcer disease are Helicobacter pylori infection, and the regular use of drugs like aspirin and NSAIDs (diclofenac, ibuprofen, etc).

Helicobacter pylori is a bacterium that occurs in about half of the population. In most people, it does not cause peptic ulcer disease, However, in a small percentage, it causes excessive production of stomach acids which eat away at the intestinal lining, causing ulcers.

Drugs like aspirin and NSAIDs disrupt the protective layer of the stomach and duodenum, allowing stomach acids to cause mucosal injury.

Other causes may include:

  • Other medications like steroids, anticoagulants, and selective serotonin reuptake inhibitors (SSRIs like Prozac and Citalopram).
  • Stressful conditions like burns, central nervous system trauma, surgery, and severe medical illness.
  • Hypersecretory states like gastrinoma, antral G cell hyperplasia, and cystic fibrosis. These are uncommon.
  • Radiation therapy

Lifestyle factors like excessive alcohol consumption, tobacco use, and regularly eating very spicy or acidic foods may not directly cause peptic ulcer disease but can exacerbate already existing ulcers and slow down the healing process.

Signs and symptoms of peptic ulcer disease

Although the condition may be asymptomatic in many people, the most common symptom of peptic ulcer disease is burning stomach pain made worse by going long without eating or eating certain foods. The pain may wake you up at night sometimes, and may also radiate to your chest.

Other signs and symptoms of peptic ulcer disease are:

  • Heartburn
  • Appetite loss
  • Belching, abdominal bloating, and fatty food intolerance
  • Nausea and vomiting
  • Vomiting blood
  • Passing black “melena” stools
  • Rarely, passing frank blood in stool

The last three symptoms are indicative of bleeding ulcers and may be accompanied by symptoms of anemia like fatigue, dizziness, and headache. This is usually a sign that the condition has progressed to severe disease and requires immediate medical attention.

Complications of peptic ulcer disease

Some cases can progress to severe disease with life-threatening complications like:

  • Anemia: Ulcers may bleed heavily in some cases, leading to severe blood loss requiring transfusion and surgical management in some cases.
  • Gut perforation: If left untreated, peptic ulcers can eat a hole through the wall of your stomach or duodenum, causing severe pain and spillage of gut contents into your abdomen, a condition that can only be corrected surgically.
  • Gastric outlet obstruction: Peptic ulcers can block the passage of food from your stomach through your intestine, causing appetite loss, vomiting, and eventually, weight loss.
  • Gastric cancer: In some cases, untreated H.pylori peptic ulcer disease can progress to gastric cancer.

Management of peptic ulcer disease

The primary means of treating peptic ulcer disease is medical therapy accompanied by lifestyle modifications. Your doctor will run an H.pylori screening test to see if you require antibiotics in addition to other peptic ulcer disease treatment.

Apart from antibiotics, your treatment regimen may include:

  • Protective medications: such as Pepto-Bismol and magnesium trisilicate.
  • Proton pump inhibitors (PPIs): These drugs reduce the production of stomach acid, allowing the ulcers to heal. Examples include omeprazole, rabeprazole, and esomeprazole.
  • Histamine receptor blockers (H2 blockers): Like PPIs, these drugs also reduce the production of stomach acid and examples are famotidine and cimetidine.

Your doctor may also advise you to cut back on or completely stop smoking, alcohol intake, caffeine intake, and consumption of spicy or highly acidic foods, as they have been seen to slow the recovery process.

It can take several weeks of treatment for peptic ulcers to heal completely, therefore it is important to adhere to your doctor’s treatment plan and make the necessary lifestyle changes to speed up your recovery.

Innocent Immaculate Acan is a medical doctor and writer currently working at Adjumani Hospital. She won the Writivism Short Story Prize in 2016 and has published an illustrated children’s book titled The Pearl Trotters in Black, Yellow, Red. She was part of the 2018 class of the Young and Emerging Leaders Project.

Innocent Immaculate Acan