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Peptic Ulcer disease

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Sharon Praise C. Uyamadu
6th year medical student (UTG)

UTG Medical Students’ Association

“My stomach hurts a lot when I’m hungry” and “I have a very sharp pain in my upper stomach” are likely statements that suggest the presence of a peptic ulcer.

When someone complains of constant stomach pain, the word “ulcer” may come to mind. However, what exactly is an ulcer? Simply put, an ulcer is a sore that is painful and exposed, which can occur in any area of the body.

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When there is a sore in the lining of the stomach or first part of the small intestine, which is also known as the duodenum, it is referred to as a Gastric/Stomach ulcer or Duodenal ulcer, respectively. Peptic Ulcer disease (PUD) can occur anywhere in the digestive tract, and ulcers may also develop in the esophagus.

HOW MANY PEOPLE ARE AFFECTED?

Approximately four million people around the world are affected by peptic ulcer disease, with a lifetime occurrence of 5-10% in the general population. In 2016, Dr. Azadeh reported that approximately one in ten people in The Gambia will experience a gastric ulcer at some point in their life. The World Health Organization also reported that the disease was responsible for 56 deaths or 0.44% of total deaths in The Gambia.

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HOW DOES PEPTIC ULCER DISEASE HAPPEN?

Typically, the stomach and intestines are safeguarded by a thick layer of mucus that protects them from the effects of acid and digestive juices that are normally released by these organs. When this protective coating is reduced over an extended period, it can lead to the development of an ulcer.

Two main reasons have been identified by studies that can lead to a reduction in the protective layer and ultimately cause peptic ulcer disease.

o          HELICOBACTER PYLORI INFECTION: Helicobacter pylori is a common bacteria known to cause peptic ulcer disease, being responsible for 90% of duodenal ulcers and 70% to 90% of gastric ulcers. It is found in the mucous membrane that covers the tissues lining the stomach and small intestine. Although most people have this bacterium in their digestive tract without experiencing any symptoms or negative implications, it can stick to the mucus layer and cause irritation and inflammation, leading to a breakdown of the protective mucus lining. When this occurs, the stomach and intestine become exposed to stomach acid and digestive juices, ultimately leading to the development of an ulcer.

H. Pylori can be spread among people, particularly during childhood, through saliva, vomit, or stool, as well as through the consumption of contaminated food or water.

o          PAINKILLERS: Another significant cause of peptic ulcer is the use of NSAIDs (Non-Steroidal Anti-inflammatory Drugs), a group of drugs used to relieve pain and inflammation. Popular ones used in The Gambia include Diclofenac, Ibuprofen, Naproxen, and high-dose Aspirin. As much as these drugs have shown effectiveness in relieving pain and inflammation, regular use of these are harmful to the stomach and intestines and makes their walls susceptible to ulcer formation.

Paracetamol is not an NSAID and is not associated with ulcer formation, so individuals who are unable to use NSAIDs are often referred to paracetamol.

Other causes include;

o          Zollinger-Ellison syndrome: This condition forms an acid-producing cell tumor in the digestive tract resulting in excessive amounts of acid that overpowers the protective factors and damages the tissues of the digestive tract.

o          Other Medications: With the exception of NSAIDs, medications such as corticosteroids, bisphosphonates, potassium chloride, and fluorouracil have been associated with peptic ulcer disease.

o          Cancer (gastric/lung cancer, lymphomas)

o          Acute illness, burns, head injury

o          Viral infection

o          Vascular insufficiency

o          Radiation therapy

o          Crohn disease

o          Chemotherapy

RISK FACTORS

o          Smoking: Smoking is a well-known risk factor for peptic ulcer disease and there’s an even greater risk if you are already infected with the H.Pylori bacterium.

o          Alcohol Consumption: Alcohol can irritate and erode the lining of your stomach, and it increases the amount of gastric acid that is generated.

o          Family history of peptic ulcer disease

o          Frequent use of NSAIDs

o          Untreated burns and Injury

SYMPTOMS

o          Pain is usually the main symptom and many describe it as a gnawing or burning pain in the middle or upper stomach between meals or at night.

The pain associated with gastric ulcers typically intensifies approximately two to three hours after consuming food, and this condition may result in the reduction of body weight. Whereas the pain associated with duodenal ulcers tends to decrease after enjoying a meal, and this condition may lead to weight gain.

o          Bloating.

o          Heartburn.

o          Nausea or vomiting.

o          Weight loss/weight gain

Symptoms in serious cases may involve:

o          Vomiting or vomiting blood — which may appear red or black

o          Dark blood in stools, or stools that are black or tarry

o          Trouble breathing

o          Feeling faint

o          Unexplained weight loss

o          Appetite changes

DIAGNOSIS

To diagnose an ulcer, your doctor may first take a medical history and perform a physical exam. Subsequently, you may be asked to undergo various diagnostic tests, such as:

Endoscopy: Endoscopy is an informative procedure, in which a tiny tube equipped with a camera and lighting system is introduced through the mouth, to reach the stomach and observe the structure of the stomach and intestine.

Helicobacter Pylori Test: The H. Pylori Test is a diagnostic procedure that employs blood samples, stool samples, and even breath tests to identify the presence of H. Pylori in the patient.

Imaging: Medical imaging techniques, such as X-rays and CT scans, are utilized to detect the presence of ulcers in one’s body.

TREATMENT

Peptic ulcer treatment varies according to the root cause. Generally, the aim of treatment is to eradicate the H. pylori bacterium in case it’s present, reduce or eliminate the use of NSAIDs if possible, and use medication to aid the healing of the ulcers. It is recommended you consult with your doctor to determine the most suitable medication for you.

Medications can include:

o          Antibiotics against H.Pylori infection

o          Protective medications- These drugs cover the ulcer and prevent further damage from acids.

o          Proton-Pump Inhibitors- Reduce production of acids

o          Histamine receptor blockers- Also reduce stomach acids

COMPLICATION

Complications of peptic ulcer disease (PUD) include bleeding, penetration, perforation, gastric outlet obstruction, and gastric cancer.

PREVENTION

o          It is advisable to steer clear of all tobacco products.

o          Abstain from consuming alcoholic beverages

o          Use caution with aspirin and/or NSAIDs.

o          Pay attention to any symptoms or signs of ulcers

o          Regularly washing your hands and consuming thoroughly cooked foods can help protect you from getting infected with H.Pylori

DEBUNKING PEPTIC ULCER MYTHS

1.         Spicy foods are the main cause of ulcers.

Fact: Spicy foods are not the cause of ulcers; rather, they can worsen the condition if you already have ulcers. It is crucial to note that spicy foods do not trigger ulcers; they only aggravate the illness.

2.         Sour foods cause Ulcers

Fact: Initially, it may appear logical that acidic foods such as tomatoes, peaches, and citrus fruits would worsen ulcers. However, there is no proof that their consumption has any impact on them. Sour foods may aggravate pre-existing ulcers for some, and it is recommended that they avoid consuming them.

3.         Stress causes Ulcers.

Fact: Ulcer formation is often attributed to stress, but this assertion is inaccurate. Stress and anxiety may affect physical well-being, but they alone are not responsible for ulcers. Although stress can hinder ulcer healing and exacerbate pain, they do not initiate ulcer formation.

4.         Milk cures Ulcers

Fact: Milk may provide short-term relief from ulcer pain as it coats the lining of the stomach. However, consuming milk also triggers the production of acid and digestive juices in the stomach, which could potentially worsen ulcers.

5.         Smoking does not cause Ulcers

Fact: Being a smoker can elevate your risk for various medical conditions like ulcers, as smoke can cause inflammation and irritation in the delicate inner linings of the body. Moreover, smoking can hinder normal blood circulation and interfere with the protective factors of the stomach and intestines. It also negatively impacts the natural healing process of the body.

6.         Ulcers are not curable

Fact: Stomach ulcers can be treated effectively if diagnosed early. The treatment options may vary depending on the underlying cause and the compliance of sufferers with their medication regime. If the cause of your stomach ulcer happens to be an H. pylori bacterial infection, your doctor will recommend you undergo a treatment course that involves the intake of a proton pump inhibitor (PPI) and antibiotics.

If you suspect that drugs such as ibuprofen, aspirin, and others might be causing your condition, it is important to have an open discussion with your doctor and keep them informed about your health status. This can help you receive suitable alternative medications that will not have similar effects on your body as these drugs.

7.         Fasting Causes Ulcers

Fact: There is little evidence to prove that fasting directly causes ulcers, but there are varying opinions regarding how it may impact ulcer formation. While some studies suggest that intermittent fasting can increase the risk of ulcer formation by exposing the stomach lining to digestive juices and acids, others argue that fasting does not inherently cause ulcers. However, both parties agree that fasting may worsen existing ulcers and related symptoms.

SUMMARY

Peptic ulcers refer to the condition of having an open sore in the stomach or intestinal lining, primarily caused by Helicobacter Pylori and regular use of NSAIDs. Among its prominent symptoms is pain, which calls for a visit to a doctor immediately. The treatment of peptic ulcers typically takes several weeks, with compliance to medications being a critical aspect for full recovery. 

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