Peptic Ulcers: Causes, Symptoms, Diagnosis, and Treatments

What are Peptic Ulcers?

Peptic ulcers are open sores that form on the mucous membrane of the digestive system. They are typically found in the stomach (gastric ulcers), the upper part of the small intestine (duodenal ulcers), or the lower part of the esophagus (esophageal ulcers). These ulcers occur when the protective mucus that lines the stomach is reduced, allowing the acidic digestive juices to damage the stomach lining.

Causes and Risk Factors

Peptic ulcers occur due to a reduction in the mucosa’s normal defensive power against the acidity of gastric juices. These juices, essential for food digestion and pathogen destruction, are corrosive. Therefore, specialized cells produce a mucus layer to protect the stomach’s internal lining cells. Any factor that alters this barrier and hinders natural tissue repair processes can expose an individual to the risk of ulcer formation.

The causes of the balance breakdown between “aggressive” and “protective” factors are complex and not fully understood. However, some primary factors contribute to the development of a peptic ulcer:

1. Helicobacter pylori infection: This bacterium, which thrives in the stomach’s acidic environment, does not cause the ulcer through direct tissue destruction. Instead, it triggers an immune response that makes the mucous lining more vulnerable to attack by gastric juices. This results in chronic inflammation that can damage both the stomach and duodenum walls.
2. Chronic use of corticosteroids and non-steroidal anti-inflammatories (NSAIDs): These drugs inhibit the production of protective factors that defend the stomach from gastric juices’ effects. Hence, during prolonged therapies, they should be taken in conjunction with a gastroprotective drug.
3. Lifestyle factors: These include the abuse of coffee, smoking, an unbalanced diet (especially if too fatty or spicy), and chronic alcohol abuse.

Symptoms of Peptic Ulcers

The most significant symptom of a peptic ulcer is a burning sensation or pain in the abdomen. This discomfort is typically located in the lower part of the mid-chest, just below the sternum, and can extend to the navel. The pain is often worse when the stomach is empty or shortly after eating, as this is when acid secretion is at its highest.

Other common symptoms of peptic ulcers may include:

• Loss of appetite or increased appetite
• Indigestion or heartburn
• Difficulty swallowing (dysphagia)
• Abdominal pain or discomfort
• Nausea or vomiting
• A bloated feeling in the stomach
• Dark or black stool (a sign of bleeding in the stomach)
• Long-term weight loss due to anorexia and food aversion
• Epigastric pain and burning
• Signs of acute abdomen (extreme pain, hard abdomen, sweating, tachycardia, weak pulse)
• Iron deficiency anemia caused by modest bleeding

Less common symptoms can include:

• Bad breath (halitosis)
• Iron deficiency anemia
• Diarrhea
• Chest pain
• Unusual fatigue or weakness
• Changes in appetite

Diagnosis

Gastroscopy, a pivotal procedure in the diagnosis of a peptic ulcer, involves the insertion of a flexible tube with a camera into the upper gastrointestinal tract, allowing for direct visualization of the esophagus, stomach, and duodenum. During this procedure, biopsies may be taken to confirm the presence of a peptic ulcer and investigate potential causes, particularly Helicobacter pylori infection.

Identifying and treating H. pylori is vital not only for addressing the current ulcer but also for preventing its recurrence.

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Radiographic examinations, complementary to gastroscopy, using contrast medium enhance the visibility of the gastrointestinal tract in imaging studies, aiding in locating and assessing the size of the ulcer, as well as identifying any complications.

Doctor holding endoscope for gastroscopy

Pharmacological Treatments

Pharmacological treatments for peptic ulcers include:

• Histamine H2 receptor antagonists: These inactivate the proton pump and reduce the release of hydrogen ions.
• Antacids: These neutralize stomach acid.
• Proton pump inhibitors (PPI): These block the production of histamine, gastrin, and acetylcholine.
• Gastric mucosal protectors: These protect the mucosa from aggressive agents.
• Prostaglandin analogues: These protect the mucosa thanks to the reduction of gastric secretion.
• Antibiotics: These are used to eliminate Helicobacter pylori.

Natural Remedies

While natural remedies may offer supportive measures for peptic ulcers, it’s crucial to prioritize medical guidance and treatment.Here are a few natural remedies that might be considered:

• Sodium bicarbonate: Acts quickly but may cause side effects like alkalinization of the urine, swelling, and sometimes diarrhea.
• Chamomile Tea: ‍Known for its anti-inflammatory properties, it may help soothe the digestive tract.
• Deglycyrrhizinated Licorice (DGL): May stimulate mucus production, providing a protective barrier.
• Cabbage Juice: ‍Traditionally used to promote healing and strengthen the stomach lining.
• Manuka Honey: ‍Possesses antibacterial properties that may inhibit the growth of Helicobacter pylori.
• Probiotics: ‍Found in fermented foods, they support a healthy balance of gut bacteria and digestive health.

Surgical Therapy

In certain cases, surgical intervention may be necessary. This is typically considered for ulcers that are resistant to therapy, cause severe pain, significantly limit the patient’s quality of life, or are suspected to be malignant. Surgery is also indicated in cases of severe complications like substantial or recurrent hemorrhage, perforation, or occlusion due to adhesions between ulcer scars.

The objectives of surgical intervention for peptic ulcers are to remove the ulcer by resecting the affected portion of the stomach or duodenum and reduce gastric acid secretion. It’s worth noting that elective surgical interventions for peptic ulcers have significantly decreased over the years with the advent of effective drug therapies.

Lifestyle Modifications: Dos and Don’ts

Maintaining a healthy lifestyle is key in managing peptic ulcers. Here are some recommendations:

What to Do:

• Follow a balanced diet that promotes digestion, limits gastric distension, and reduces gastric secretion.
• Recognize and respond to symptoms early.
• Seek immediate medical help if symptoms persist.

What NOT to Do:

• Ignore initial symptoms.
• Neglect specific therapy, including medication and surgery.
• Smoke or drink alcohol excessively.
• Lead a stressful lifestyle.
• Use gastro-damaging drugs without the use of gastro protectors.

What to Eat:

• Small, frequent meals.
• Lean and digestible foods of animal and plant origin.
• Foods cooked using methods that optimize digestibility, such as boiling, steaming, or baking.
• Fresh, unpreserved foods.

What NOT to Eat:

• Alcohol, cocoa, black chocolate, and mint.
• Foods and drinks containing xanthines.
• Highly seasoned and fatty foods.
• Foods cooked using techniques that make them difficult to digest.
• Hot or frozen foods, milk, broth, carbonated drinks, and junk foods.

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Medical Disclaimer

This article is solely for informational purposes, any medical information contained is not a substitute for professional medical advice and readers should not rely on it as such.

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