Peptic ulcer disease refers to the open sores that develop on the inner lining of the stomach (gastric ulcers) and the upper part of the small intestine (duodenal ulcers).


Caused by a number of factors such as H. pylori infections and exacerbated by certain lifestyle and dietary habits, the condition is one that can be treated through the specialist care of a gastroenterologist. This is especially important since certain cases of peptic ulcer disease can lead to serious complications.


Causes, symptoms and complications


Medical professionals attribute various reasons for the appearance of gastric and duodenal ulcers, the underlying cause of which is believed to be an imbalance of digestive fluids, hydrochloric acid, and pepsin in the stomach and duodenum.


Beyond this, H.pylori infections, which are caused by a bacteria identified as Helicobacter pylori, are another leading cause of peptic ulcer disease and is detected in more than 70% of gastric ulcers and 90% of duodenal ulcers in Australia.


While earlier thinking in this area attributed symptoms of peptic ulcer disease to dietary habits, particularly the consumption of spicy food, this was later replaced with the current position on peptic ulcer disease and H. pylori infections.


In 1983, a breakthrough in this area, led by pathologist, Dr Robin Warren, demonstrated that a certain bacterium was present in samples of peptic ulcers, contrary to the traditional view that bacteria could not survive in the stomach’s acidic environment. Joined by Dr Barry Marshall, Dr Warren grew this bacteria in culture and succeeded after some time.


The former even swallowed a solution that contained the bacteria, leading to symptoms of peptic ulcers, proving that there was a relationship between the presence of this bacteria and the onset of this condition. Despite this new evidence, however, the medical community only embraced this line of thinking around a decade later.


Apart from infections of this kind, peptic ulcer disease can also be caused by long-term use of anti-inflammatory drugs or NSAIDs, as they are known among the medical community. These include common over-the-counter medications such as Advil, ibuprofen, aspirin, naproxen, and similar drugs that are used for pain-relief purposes. Aspirin even contains a special coating that is known to cause ulcers.


Ulcers can also be caused as a result of excessive acid production, resulting from conditions like Zollinger-Ellison syndrome or a gastrinoma, which is a tumour that occurs in cells responsible for producing acid in the stomach.


While not all cases of peptic ulcer disease are symptomatic, you may experience symptoms such as heartburn, bloating, nausea or vomiting, and a burning sensation or pain in the middle or upper section of the stomach between meals or during the night.


In severe cases of this condition, you may even experience bloody or black stool, unintended and unexplained weight loss, as well as severe pain in the middle or upper section of your abdomen.


In addition to this, complications such as perforation, bleeding, penetration, and gastric outlet obstruction could also occur in certain cases.


Diagnosis


In order to confirm a diagnosis of peptic ulcer disease, physical examinations and lab tests are useful in assisting this.


Lab tests include blood tests, H.Pylori serology and Iron Studies to look for signs of chronic bleeding related to peptic ulcer disease.


Urea breath test

Urea breath tests are also used to diagnose this condition. Here, you will be asked to drink a special solution containing urea - a byproduct made by the body as it processes protein.


In the presence of H. pylori, the bacteria will convert the urea into carbon dioxide, which is a gas eliminated from the body when we exhale. A medical professional will have you breathe into a bag and send this sample for further testing. Higher levels of the carbon dioxide will indicate the presence of H.pylori in the stomach.


You may also be subjected to a stool test, where a collection of your stool will be collected for analysis. Through testing, it may be possible to detect the presence of H. pylori.


Endoscopy

Upper gastrointestinal endoscopy may be used to examine your upper gastrointestinal tract.


As a part of this process, an intravenous sedation will be administered through which you will be sedated, although in certain cases this may be waived. The endoscope, with a camera attached to the end, is sent down your oesophagus and into the stomach and duodenum.


In this process, the specialist may extract a biopsy, which is a small sample of tissue from the lining of the oesophagus. This is generally a painless process.


CT Scan

Here, x-ray technology is used to generate images that are developed by computers. You will be asked to drink a certain solution and will be injected with a dye.


For a CT scan, you will be asked to lie down, after which the x-ray machine will take pictures of your stomach. Once the x-rays are taken, a radiologist will interpret them and help diagnose complications related to the peptic ulcer.


Treatment


Medication

In order to treat peptic ulcer disease, range of medication may be prescribed including antibiotics that are targeted at killing H. pylori bacteria. Some of the most commonly prescribed antibiotics include drugs like Amoxicillin, Metronidazole, Clarithromycin, and Levofloxacin, which are often combined when they’re being prescribed.


Apart from antibiotics, you may also be asked to take drugs that block or reduce acid production in the digestive system, including proton pump inhibitors, which block specific parts of cells that produce acid.


Apart from proton pump inhibitors, H2 Antagonists such as Ranitidine and Nizatidine may also be prescribed.


You may also be prescribed antacids, which are useful in terms of neutralising stomach acid and providing quick and effective relief, although they may cause certain short-term side effects. Antacids, however, will not heal the ulcer itself.


Apart from these you may even be asked to take other drugs that protect the lining of the stomach and small intestine.


Dietary and lifestyle changes

Relief from the symptoms of peptic ulcer disease can also be sought through dietary modification including the incorporation of vitamin-rich food including fruits, vegetables, and whole grains.


Probiotics are also highly recommended. To reduce the severity of your symptoms or prevent any flare ups, try and incorporate more yogurt, sauerkraut, kombucha, miso and other probiotic-rich items into your meal plan. In this process, be wary of consuming too much dairy items such as milk, which can trigger the production of acid, while it may reduce pain in the short run.


If you rely on painkillers or have been prescribed NSAIDs for a concomitant condition, speak to your doctor and switch your medicine to drugs that won’t irritate your digestive tract. Given that stress can also exacerbate your symptoms and thereby increase your pain and discomfort, regulating stress needs to be a part of the lifestyle changes you make.


In addition to this, cut down on smoking and drinking alcohol if this is a frequent part of your lifestyle. Both alcohol and smoking can lead to the development of an ulcer through the irritation and damage of the lining in the stomach and intestine.



Request more information on peptic ulcer disease from an experienced gastroenterologist


Given that the complications of peptic ulcer disease can be particularly serious, ignoring symptoms of this condition or neglecting to get them treated can be very damaging to your health. Fortunately, the treatment and management of this condition is not complicated, especially with the support of a gastroenterologist with experience in this area of care.


For more information on personalised care, get in touch with Dr Suhirdan Vivekanandarajah, an interventional gastroenterologist and hepatologist in Sydney.

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