Peptic ulcer

What is peptic ulcer?

Peptic ulcer is a sore on the lining of the stomach where it joins the small intestine (duodenum). The stomach secretes various juices and acids that help in digestion of food. These acids are normally produced in the quantity that is needed to break down the food particles. Sometimes, when these acids are produced in excess, they erode the lining of the stomach and the duodenum resulting in ulcers.

The stomach is naturally protected from these acids by a mucous layer that covers it. The body secretes an alkali into this layer which neutralizes the acids and, thus, protects the stomach lining. A hormone-like substance called prostaglandin is also produced by the body that helps the blood vessels to expand and thus provide enough blood to the stomach. This also protects the stomach against injury.

What are the causes?

Some of the major causes of peptic ulcers are:

1. Bacterial infection – helicobacter pylori bacteria is the major cause of stomach ulcers in most cases. This bacteria is also responsible for causing other conditions like stomach inflammation and cancer. It acts by causing changes in the individual's immune system and survives for most of the person's life.
   
2. Non-steroidal Anti-Inflammatory Drugs (NSAIDs) – some medicines given to reduce pain may also cause stomach ulcers. Some of the common NSAIDs are aspirin, ibuprofen, nimesulide, diclofenac and naproxen. These medications reduce the production of prostaglandin to reduce pain. But in doing so, they also impair the natural protection of the stomach against the acids.
   
3. Zollinger-Ellison syndrome – in this condition, the pancreas produce excessive amounts of the hormone gastrin which stimulates the production of acids.
   
4. In rare cases, peptic ulcers may be caused due to physical injury to the concerned organs, increased consumption of alcohol and bacterial or viral infections.

What are the symptoms?

Though some people may not experience any symptoms for a long time, some of the common signs of the condition are:

• Dyspepsia - this includes a feeling of pain, bloating and discomfort in the stomach. This may be accompanied by nausea, heartburn and frequent belching.
  
• Sometimes there may be severe abdominal cramps with blood in the stool.

How is it diagnosed?

The disease is diagnosed by a thorough clinical history and examination. This includes recording the medications the patient is taking, any recent history of disease and any history in the family. In most cases, the doctor may prescribe acid blocking medication to see if the ulcers heal by themselves. If they still persist, then tests like endoscopy may need to be done. In this, a thin tube is inserted into the stomach to examine the damaged lining. In addition to this, a complete blood count (CBC) and a Stool occult blood test may be used to detect the pressure of blood in the stools.

How is it treated?

The treatment depends on the cause of the disease. If the cause is the use of NSAIDs, then they should be discontinued immediately. If the cause is h. pylori infection, then the doctor prescribes drugs like are omeprazole, amoxicillin and clarithromycin.

In some cases of bleeding ulcers, endoscopy is done in which the tubes inserted into the stomach coagulate the blood vessels with heat to stop the bleeding. In cases where endoscopy is not successful, operation may need to be done. In this surgical procedure called vagotomy, the nerve that transmits messages from the brain to the stomach to produce gastric acid is cut. This leads to reduction in acid production. However, this surgery may impair the emptying of stomach contents. Surgery is not recommended if the ulceration is caused due to NSAID use.

What are the lifestyle changes that are needed?