Peptic Ulcer Disease

Peptic ulcers are treated with a combination of lifestyle changes and medications.

Peptic ulcers are sores that develop on the inner lining of your stomach and the upper portion of your small bowel (duodenum).

There are two types of ulcers:

1. Stomach ulcers
2. Duodenal ulcers

A peptic ulcer can give you belly pain or sometimes bleeding or it may make a hole in your stomach or bowel.

Causes of peptic ulcer disease include the following:

• Drugs such as:
  • Painkillers like aspirin, diclofenac, and ibuprofen
  • Antibiotics
  • Diabetes medicine such as metformin
  • Hormones or antidepressants
• Poor lifestyle habits such as:
  • Poor eating habits including not having fixed meal times
  • Having an irregular sleep schedule or sleeping late into the night
  • Eating spicy food
  • Oily and greasy meals that increase the acidity in the body
• Family history of ulcers
• Smoking that causes increased acidity
• Helicobacter pylori (a bacteria) is a risk factor for peptic ulcer and it is related to unhygienic food practices.

If you have a stomach or bowel ulcer you may have the following signs and symptoms:

• Heartburn (gnawing pain between your breastbone and your belly button) 
• Pain when your stomach is empty
• Pain that is relieved after eating
• Episodes of vomiting late at night
• Bloating
• Nausea
• Vomit blood or dark, tarry stool
• A feeling of not wanting to eat
• Weight loss
• Anemia (low iron levels)
• Fatigue, weakness, and tiredness

After a physical examination and taking a detailed history of your family, disease, and medications, your doctor/gastroenterologist may sort out the cause of your peptic ulcer.

For further confirmation, your doctor may ask you for the following:

• Ultrasonography to look at the stomach.
• Barium study: This is X-ray imaging of the stomach and gut after swallowing a barium dye. This barium will highlight the ulcer margins, if any.
• Esophagogastroduodenoscopy: In this study, a thin tube with a front camera is inserted into the mouth and advanced into your stomach and small bowel. It photographs the esophagus, stomach, and gut and projects those images onto a screen.
• Urea breath test for H. pylori
• Stool samples to test for H. pylori bacteria by culture or microscopic examination
• Blood tests to examine antibody response to H. pylori bacteria
• A biopsy (a piece of the stomach or bowel that is removed) and examine it in the lab

Your doctor will work with you to find the best treatment plan based on what is causing your ulcers.

Lifestyle modifications are a must to manage peptic ulcers and prevent recurrences, such as:

• Have regular mealtimes (not skipping breakfast or lunch)
• Get at least seven to eight hours of undisturbed sleep daily
• Avoid certain foods such as spices, like excess chili in your diet
• Practice stress management and meditation

If you have an H. pylori infection, your doctor will prescribe the following:

• Antibiotic(s) for 7 to 10 days depending on the type, cause, and severity of your infection.
• A medicine that has bismuth to coat the ulcer, so it heals well.
• A medicine to reduce stomach acid such as a proton pump inhibitor and an antacid.
• A probiotic to increase good bacteria in your gut.
• An alternative painkiller such as paracetamol, as well as advising you to stop taking any other painkillers, analgesics, and anti-inflammatory drugs.

Your gastroenterologist may advise you to have a repeat endoscopy or imaging after treatment to check the status of your gut.

Complications of peptic ulcer disease may include the following:

• Bleeding from your stomach or small bowel
• Stomach or gut obstruction
• Hole in your stomach or small bowel

Wash your hands thoroughly before meals to prevent the spread of H. pylori infections.

Additionally, follow these tips to help prevent peptic ulcer disease:

• You should drink water from a safe and clean source.
• There is no vaccination currently available for an H. pylori infection.
• Complete the antibiotic course advised by your doctor as directed to avoid any antibiotic resistance and recurrence of the symptoms.
• Medications are taken for one to two weeks, which can usually cure ulcers.
• If you have ulcers not caused by H. pylori, stop using analgesics or painkillers and your doctor will start you on medicines to reduce stomach acid levels.
• If the ulcer fails to heal (rarely), you may need surgery.
• You should stop smoking, drinking alcohol, and consuming spicy food to reduce the risk of future ulcers.
• If a child is suffering, they may require extensive diagnostic workup for their symptoms.