Peptic ulcer disease affects 4.5 million people in the United States each year, and nearly 10% of the United States population has had a peptic ulcer at some time. Peptic ulcer disease refers to an ulcer of either the lining of the stomach or the lining of the duodenum, which is the part of the intestines that the stomach empties into.
While this disease itself is not deadly, the symptoms of peptic ulcer disease can be very distressing and painful, and the complications of peptic ulcers can be severe and require emergency treatment or surgery.
What is Peptic Ulcer Disease?
Peptic ulcers can originate due to several different reasons, however the two most common causes of peptic ulcer disease are H. Pylori infection and frequent NSAID use.
H. Pylori is a type of bacteria that lives in the stomach because it loves an acidic environment. H. Pylori infection can occur in anyone, and usually presents with epigastric pain worsened by eating. It can be diagnosed via a breath test, a blood test, or an endoscopy with biopsy of the ulcer. Most cases are easily treated with antibiotics and a proton pump inhibitor to reduce the acid in the stomach.
Use of on‐steroidal anti‐inflammatory drugs (NSAIDs) such as ibuprofen and naproxen is a frequent cause of peptic ulcer disease as well. Many people use NSAIDs daily or several times per week to control pain, however this can cause an ulcer to develop in a matter of a few months. NSAIDs turn off some of the enzymes that are protective of the stomach lining. They cause less blood flow into the stomach or duodenal lining, and help inflammatory cells enter and cause inflammation. This leads to damage of the lining of the stomach or duodenum, called an ulcer.
The treatment is to stop using NSAIDs and take a medication to decrease the acid in the stomach to allow the tissue to heal. Continuing to take NSAIDs can result in bleeding of the ulcer or a hole perforating through the lining of the stomach or duodenum, both of which are surgical emergencies.
- Epigastric pain
- Heartburn or chest discomfort
- Dyspepsia (belching, bloating, abdominal distension, fatty food intolerance)
- Severe symptoms that require prompt medical attention:
- Coughing or vomiting blood
- Blood in stool
- Unexplained weight loss
- Progressive trouble swallowing or painful swallowing
- Ulcer perforation through the wall of the stomach or first part of the intestines
- Ulcer erosion into an artery causing bleeding
- Symptom relief:
- H2 blockers such as ranitidine (Zantac), famotidine (Pepcid) and cimetidine
- Proton pump inhibitors such as omeprazole (Prilosec), esomeprazole (Nexium) and pantoprazole (Protonix) taken in the morning 30 minutes before eating
- Stop using NSAIDs such as naproxen and ibuprofen for pain relief
- H. Pylori treatment:
- Physician determines regimen ‐ a proton pump inhibitor combined with 2 antibiotics and sometimes a medication to coat the lining of the stomach
- Bleeding ulcer:
- Emergency endoscopy to clip the artery that is bleeding closed
- Emergency surgery to sew the artery that is bleeding closed
- Perforated ulcer:
- Emergency surgery to fix the ulcer or remove the ulcer
Reduce your risk of developing a Peptic Ulcer
- Stop smoking. Smoking can irritate the lining of the stomach and decrease blood flow, increasing the risk of developing an ulcer.
- Take NSAIDs less frequently, and always take with food.
- Don’t ignore your symptoms, you may be suffering with something that is easy to treat.
To learn more about Peptic Ulcers, visit Covenant Health’s library here.
Content provided by Amy Cecchini, Lincoln Memorial University, DeBusk College of Medicine, 3rd Year Student