Peptic ulcer is a type of ulcer in the internal lining of the stomach or the initial part of small intestine (duodenum).
- Over the last two decades, it has been recognised that H.pylori, a bacteria colonising the stomach is the most common cause for peptic ulcer – a discovery celebrated by nothing less than the Nobel Prize.
- Another common cause is the consumption of a group of pain-killer drugs called as Non-steroidal Anti-Inflammatory Drugs (NSAIDs) like Aspirin, Ibuprofen, etc. Ulcers caused by chronic consumption of NSAIDs are more often found in people, especially women who are above the age of 60 and above, or have had an ulcer earlier.
- It is a popular myth that stress or spicy food cause peptic ulcers – they surely make ulcers worse and keep them from healing.
Can You Feel It?
A dull or burning pain in your stomach is the most common symptom of peptic ulcers. You may feel the pain anywhere between your belly button and breastbone. The pain often:
- Starts between meals or during the night.
- Briefly stops if you eat or take antacids.
- Lasts for minutes to hours.
- Comes and goes for several days or weeks.
Other symptoms of peptic ulcers may include weight loss, poor appetite, bloating, burping, vomiting, feeling sick in your stomach.
Your doctor also may want to look inside your stomach and duodenum by doing an endoscopy or an upper gastrointestinal series (a type of X-ray). Both procedures are painless, thankfully.
Peptic ulcers can be cured. Depending on what caused your ulcers, your doctor may prescribe one or more of the following medicines:
- A Proton Pump Inhibitor (PPI) or Histamine receptor blocker (H2 blocker to reduce stomach acid and protect the lining of your stomach and duodenum.
- One or more antibiotics to kill the H.pylori infection.
If a Non Steroidal Anti Inflammatory Drug (NSAID) like Aspirin, Ibuprofen, Naproxen, etc. caused your peptic ulcers, your doctor may ask you to:
- Stop taking the NSAID or reduce the dosage you take. Take a PPI or H2 blocker with the NSAID.
- Switch to another medicine that won’t cause ulcers.
- Smoking and drinking alcohol slow the healing of ulcers and can even make them worse.
There Could Be Trouble
Complications that can occur due to peptic ulcer include:
- Internal bleeding: This may be caused in the stomach or the duodenum.
- Perforation: When ulcers are left untreated, digestive juices and stomach acid can literally form a hole in the intestinal lining, requiring immediate hospitalisation, and often, surgery.
- Obstruction: Swelling and scarring from an ulcer may close the outlet of the stomach, preventing food to pass and causing vomiting and weight loss.
Is Your Ulcer Bad?
Meet your doctor right away if you have sudden sharp stomach pain that does not subside, black or bloody stools, bloody vomit or vomit that looks like coffee grounds. These symptoms besides indicating that you might need urgent medical treatment including surgery, scream out that your ulcer has:
- Broken a blood vessel
- Gone through, or perforated, your stomach or duodenal wall
- Prevented food from moving from your stomach into the duodenum.
It Could Bleed
Bleeding from an ulcer can be slow and can go unnoticed or cause life-threatening haemorrhage. Ulcers that bleed slowly might not produce the symptoms until the person becomes anaemic. Symptoms of anaemia include fatigue, shortness of breath while exercising and a pale skin colour.
When someone has an ulcer that has bled significantly, treatment might be done at the time of Oesophagogastroduodenoscopy
(OGD), an examination of the lining of the oesophagus, stomach, and upper duodenum with a small camera (flexible endoscope) which is inserted down the patient’s throat.
There are a number of techniques that can be performed during an OGD to control bleeding from ulcer. The gastroenterologist might inject medications or use cautery to burn the ulcer. However, not all ulcers need to be treated this way. The doctor performing the EGD will decide if treatment is indicated based on the way the ulcer looks. The doctor will usually treat an ulcer that is actually bleeding. He will also often treat other ulcers if they have a certain appearance. These findings are sometimes called “stigmata of recent haemorrhage” or just “stigmata”. Stigmata will usually get treated during the OGD if they are classified as high-risk. Common high-risk findings include a “visible vessel” and an “adherent clot”.
People with gastric ulcers (only in the stomach) must undergo another OGD several weeks after the treatment to ensure the ulcer is gone. This is because some gastric ulcers, though a very small number, could contain cancer. Duodenal ulcers (at the beginning of the small intestine) however, usually do not need to be checked again.