“Ulcer” is a terminology in every household that transcends different age groups and genders, and it is used, sometimes wrongly, to refer to various forms of discomfort arising from the abdominal area. Although the word “ulcer” itself is a broad terminology that refers to breakage or discontinuity on any surface of the body—whether internal and external—but it’s so commonly used to refer only to stomach ulcers that its use elsewhere in the body is only confined to medical environments.
According to data derived from the Global Burden of Disease study from 1990—2019, Peptic Ulcer Disease (PUD) affects about 4 million people annually, with a lifetime prevalence of 5-10% in the general population. Although in Nigeria, the exact prevalence of PUD is not known, but according to World Health Organization’s data published in 2020, cited in World Life Expectancy, death due to PUD was 0.39% of total deaths.
According to a research article published in the Nigerian Journal of Pharmaceutical Research in 2016, which assessed the pharmaco-economics of PUD in Nigeria, the national direct cost of PUD borders around N200 billion!
In this article, we’ll look at Peptic Ulcer Disease, to arm ourselves with the necessary information needed to protect ourselves from this common disease.
Definition
Peptic ulcers refer to breach or loss of the lining of the gastrointestinal tract, especially the oesophagus, stomach and the small intestine caused either by a bacteria called helicobacter pylori or erosion from the acid produced in the stomach. Sometimes, they occur as sores in the lining of these areas, and when exposed to acid, the typical symptoms occur.
Types of peptic ulcer
Although other areas of the gastrointestinal tract may be affected, but there are two areas that are most commonly affected, and they are:
- Gastric Ulcer: Also known as stomach ulcer. This type of ulcer develops inside the stomach.
- Duodenal Ulcer: this type develops in the duodenum, which is the first part of the small intestine, just adjacent to the tail end of the stomach.
Risk factors of peptic ulcer
The following factors can cause a breach in the lining of the gastrointestinal tract, predisposing the individual to developing any of the peptic ulcer disease.
- Infection with helicobacter pylori
- Exposure to gastric contents of individual infected with helicobacter pylori
- Advanced age
- Cigarette smoking
- High dose NSAIDs or frequent use of NSAIDs (e.g. Diclofenac, Ibuprofen)
- Alcohol consumption
- Radiation therapy
Symptoms and signs of peptic ulcer disease
- Epigastric pain: this is the commonest symptom of PUD. It is a pain experienced at the epigastric area, usually centrally between the lower border of the chest and the umbilicus. It is burning, gnawing, may occur at night. The pain may happen within an hour of meal if it is gastric ulcer, may take three hours after meal if it is duodenal ulcer.
- Dyspepsia which is persistent and recurrent abdominal pain or discomfort usually in the upper abdomen.
- Nausea
- Vomiting
- Indigestion
- Changes in appetite
- Chest pain
- Dark stool
- Unexplained weight loss
- Tenderness at the epigastric area
- Fast pulse rate
- Board-like abdomen suggests perforation.
Making diagnosis
Although your doctor may ask a few questions and make a few examinations, they are not reliable in establishing the diagnosis of PUD. The most reliable are imaging investigations and they include:
- Upper GI endoscopy: in this, the doctor after preparing you, inserts a long, slender tube with a camera at the leading part, through your mouth and it’ll allow him visualize your oesophagus, stomach and upper part of the small intestine. This will allow him identify any ulcer along the lining of your GI tract. It is also equipped with the ability to take a small piece of tissues for histological examination. As this is an invasive procedure, it is indicated for people with advanced age, especially where cancer is suspected, and more especially where there are associated symptoms like weight loss, bleeding from the GI, anaemia, etc.
- Barium Studies: in this, your doctor asks you to swallow a thick liquid called barium, and radiographic image of your esophagus, stomach and small intestine are taken in series. It’ll outline the areas and show anywhere there’s breach of the lining.
Aside these, there are other tests which your doctor may request in order to detect the presence of Helicobacter pylori and they include:
- Urea breath test
- H. Pylori antigen, etc.
Treatment of peptic ulcer
Pharmacological treatment for PUD can vary. Based on their mechanism of action, there are majorly four classes of drugs used in the treatment of peptic ulcer and they are:
- Inhibition of stomach acid secretion: since stomach acid is one of the culprits in the aetiology of PUD, these drugs inhibit its secretion. There are several classes under this e.g. proton pump inhibitors (PPIs), H2 receptor blockers, Prostaglandin analogues.
- Neutralisation of stomach acid: these drugs act on the acid, and neutralize the acid. They are called antacids, meaning anti-acids.
- Ulcer protectives: these drugs form a layer over the gastrointestinal lining, preventing the acid from having contact with the ulcers.
- Anti H. Pylori: these are antibiotics that attack the organism that’s thought to be largely responsible for PUD.
Note: There is a standard treatment for PUD in patients who tested positive for H. Pylori, and it is called the triple therapy. In consists of two antibiotics and one inhibitor of stomach acid secretion e.g. a proton pump inhibitor.
Surgical treatment
There is a potential indication for surgery, although with the level of success recorded in medical therapy, surgery is only reserved for complications that are amenable only to surgery.
Complications of peptic ulcer
Peptic ulcer, if untreated, may lead from having recurrence of symptoms to other life-threatening symptoms which include:
- Perforation: a hole may form along the wall of the gastrointestinal tract through the ulcerated part. It presents as severe abdominal pain that occurs suddenly.
- Upper gastrointestinal bleeding: presents with dizziness, black stool and if the bleeding is massive, frank bloody stool. May also present as bloody vomiting.
- Obstruction: This happens due to swelling and inflammation of the area, and also due formation of scar tissue. This may obstruct the flow of gastric contents and lead to vomiting.
Role of diet in peptic ulcer disease
Initially, all conversations around peptic ulcer disease revolved around diet. Certain foods were said to be the cause of ulcer, while certain foods were said to be helpful in its treatment. With the identification of Helicobacter pylori as the main cause of peptic ulcer, most of those theories were dispelled.
Nevertheless, people have reported having relief of their symptoms by taking certain foods, and having worsening of their symptoms by taking some other foods. Largely, these are individualized.
Symptoms-relieving foods
- Foods with probiotics: these foods have “good” bacteria in them and help fight H. Pylori e.g Yoghurt
- Fibre-rich foods: they lower gastric transient time, and may ease bloating and pain. Research has shown them to be effective in preventing gastric ulcers. E.g Apples, oatmeal, etc.
- Foods rich in Vitamin A: Helps in shrinking ulcers and can help prevent ulcers. E.g sweet potatoes, carrots, spinach etc.
- Foods rich in Vitamin C: Vitamin C facilitates wound healing, and protects against peptic ulcer. E.g Red bell pepper, citrus fruits, strawberries, etc.
Symptoms-worsening foods
- Milk: contrary to prior beliefs, milk may worsen your symptoms by prompting the stomach to produce more acid.
- Fatty foods: they take longer to digest, and may cause bloating and pain.
- Spicy foods: if they make your symptoms worse, it’s best to avoid them.
- Alcohol: alcohol can destroy the digestive tract and predispose you to ulcer. It should be cut down, or stopped completely.
Prognosis
Peptic ulcer is a stubborn disease that is difficult to treat, probably because of its location. With treatment and obedience to guidelines though, it may heal completely.
Peptic ulcer is a disease that is very common in our environment, it transcends all socioeconomic status.
Avoiding NSAIDs, alcohol and smoking play important role in the prevention of this disease.
The role of healthy diet and good hygiene in its management can never be overemphasized.
Healing may take long, but It is treatable, and there are several classes of drugs for its management.
References
Abbasi-Kangevari, M., Ahmadi, N., Fattahi, N., Rezaei, N., Malekpour, M., Ghamari, S., Moghaddam, S. S., Azadnajafabad, S., Esfahani, Z., Kolahi, A., Roshani, S., Rezazadeh-Khadem, S., Gorgani, F., Naleini, S. N., Naderimagham, S., Larijani, B., & Farzadfar, F. (2022). Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990–2019. PloS One, 17 (8), e0271284. https://doi.org/10.1371/journal.pone.0271284
Best and worst foods for stomach ulcers. (n.d.). WebMD
Peptic ulcer disease in Nigeria. (n.d.). World Life Expectancy.
Suleiman, I., & Okafor, E. (2016). Peptic ulcer disease drugs usage patterns and its economic burden in a tertiary health institution in Niger Delta, Nigeria
