Peptic ulcer or Peptic ulcer disease is a non-malignant disease that erodes the lining of parts of the digestive tract that are exposed to the gastric secretions. Typical ulcer tends to recur or heal; and as a result, the pain may occur for few days or weeks, then reduce or disappear. Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies peptic ulcer. The pain can be misinterpreted as hunger, indigestion or heartburn. The pain which is usually caused by the ulcer may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The peptic ulcer pain can be felt anywhere from the navel up to the sternum, lasting from few minutes to several hours and it may be worse when the stomach is empty. The pain which sometimes flare-up at night can be temporarily relieved by eating foods that buffer stomach acid or by taking anti- stomach acid medications.
WHAT IS PEPTIC ULCER
Peptic ulcer or peptic ulcer disease is associated with the erosion of the mucosal areas of the gastrointestinal tract that is usually acidic; and is extremely painful. This can occur when the acid and pepsin in the gastric secretions of digestive tract are abnormally high, causing the normal protective mechanism of the mucosa to be reduced or destroyed.
Peptic ulcer is a defect in the lining of mainly the stomach or the first part of the small intestine area called the duodenum or esophagus. The peptic ulcer in the stomach is called gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer while the ulcer in the esophagus is called esophageal ulcer.
Ulcer is a round to oval parietal defect (hole) of 2 to 4 cm in diameter, with a smooth base and perpendicular borders. These borders are not elevated or irregular in the acute form of peptic ulcer, but regular with elevated and inflammatory surroundings in the chronic form. The surrounding mucosa may present radial folds, as a consequence of the parietal scarring.
About 80% of peptic ulcer is linked to Helicobacter pylori and can be worsened by drugs such as aspirin, ibuprofen and other non- steroidal anti-inflammatory drugs. Overall, Helicobacter pylori infections show a worldwide decrease, more so in developed countries. Helicobacter pylori is a bacterium usually found in the stomach where it can weaken the protective mucous of the stomach and duodenum with final outcome of peptic ulcer or stomach cancer. More than 50% of the world’s population has Helicobacter pylori in their upper gastrointestinal tract.
TRANSMISSION OF PEPTIC ULCER
Peptic ulcer or peptic ulcer disease can be transmitted through:
- Contaminated food
- Contaminated ground water
- Infected human saliva (from kissing or sharing eating utensils).
COMPLICATIONS OF PEPTIC ULCER
There are some complications associated with peptic ulcer disease. They include:
Gastrointestinal bleeding– Bleeding inside the body (internal bleeding) is the most common complication. Sudden large bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood vessels, such as the gastro duodenal artery.
Perforation– Hole in the wall of the stomach and intestines often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity. Perforation at the anterior surface of the stomach leads to acute peritonitis (inflammation of the tissue that lines the wall of the abdomen, initially chemical and later bacterial peritonitis). Often the first sign is sudden intense abdominal pain. Posterior wall perforation leads to bleeding due to involvement of gastro duodenal artery that lies posterior to the first part of duodenum.
Perforation and Penetration– Occur when the ulcer continues into adjacent organs such as the liver and pancreas.
Gastric outlet obstruction– This is the narrowing of pyloric canal by scarring and swelling of gastric atrium and duodenum due to peptic ulcer. Patient often presents with severe vomiting without bile involvement.
Cancer (elucidated by biopsy) – Helicobacter pylori being the etiological factor makes it 3 to 6 times more likely for patients to develop stomach cancer from peptic ulcer disease.
SIGNS AND SYMPTOMS OF PEPTIC ULCER
Usually, children and the elderly do not develop any signs and symptoms unless there are complications. However, peptic ulcer disease signs and symptoms which may be different for every sufferer can be abdominal pain, classical epigastric pain with strong correlation to mealtimes. In case of duodenal ulcer, the pain appears about three hours after taking a meal.
There are signs and symptoms of bloating and feeling of abdominal fullness that results to inability to drink much fluid; and water brash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus – although this is more associated with gastro esophageal reflux disease). There are presentations of upper abdominal pain that wakes the sufferer up at night; mild nausea and copious/severe/continuous vomiting, possibly bloody due to bleeding directly from gastric ulcer or damage to the esophagus. Other signs and symptoms of peptic ulcer disease are chest pain, fatigue, loss of appetite, weight loss, hunger, an empty feeling in the stomach ( often 1 – 3 hours after a meal) and melena (bloody or dark tarry foul-smelling feces due to oxidized iron from hemoglobin).
The timing of the signs and symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid production is increased as food enters the stomach. Signs and symptoms of duodenal ulcer would initially be relieved by a meal, as the pyloric sphincter closes to concentrate the stomach contents; therefore acid is not reaching the duodenum. Duodenal ulcer pain would manifest mostly 2–3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum.
OBSERVE THESE AND AVOID PEPTIC ULCER
Drinking too much alcohol (above 66cl per day) and regular use of aspirin, ibuprofen, naproxen or other nonsteroidal anti-inflammatory drugs (NSAIDs) without medical supervision are avoidable. People should avoid smoking cigarettes or chewing tobacco; and having radiation treatments as much as possible. Observe safe contact with people; and avoid consumption of contaminated water and food.
TREATMENT OF PEPTIC ULCER
Peptic ulcer disease had tremendous effects on morbidity and mortality until the last decades of the 20th century when there is development of new effective medication against Helicobacter pylori; and acid suppressants that heal the ulcer and reduce the chance of peptic ulcer reoccurrence. Treatment of Helicobacter pylori attack usually leads to clearing of the infection, relief of symptoms and eventual healing of ulcers.
Contact expert healthcare professionals immediately the ulcer signs and symptoms are observed, for proper medical evaluation, counseling and treatment. Take all your medications exactly as prescribed to heal and stop ulcer from coming back.
There are other effective non pharmaceutical treatments and preventions of ulcers. Take a tablespoon of raw, unprocessed honey spread on bread or biscuits in the morning and at night until ulcer signs and symptoms disappear. Eat cooked unripe plantain 2-3 servings a week to prevent the formation of ulcers. Unripe plantain soothes inflamed and irritated mucous membranes; helps to heal ulcers and inhibits Helicobacter pylori infection. Eat a cup of broccoli, raw or cooked; or broccoli sprouts daily for vitamin C and fibre which help to fight ulcers. Eat cups of slippery elm daily to help coat the stomach and get some relief from ulcer pain.
Eat good quantity of raw cabbage with salads or drink a quart of raw cabbage juice daily for three weeks to fortify the mucosal lining of the gut and to improve blood flow to the stomach so as to prevent and hasten the healing of ulcers. Drink a cup of unsweetened yogurt (fermented milk products) at least once a day to inhibit Helicobacter pylori and help peptic ulcer heal faster. Every day, eat 25-35grams of soluble fibre found in fruits, vegetables, oats, beans, barley and pears to form a barrier between the stomach lining and corrosive stomach acids that causes peptic ulcer.