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Stomach (Peptic) Ulcers

  • What are stomach (peptic) ulcers?

    peptic ulcer

    Stomach (peptic) ulcers are open sores in the lining of the stomach or the duodenum (the first part of the small intestine). These painful sores develop when the acidic digestive fluids in the stomach eat away the protective lining of the organs and result in the development of ulcers.

    Untreated peptic ulcers can lead to serious complications including bleeding in the stomach and perforation (tear) of the stomach wall.

    Types of peptic ulcers

    Peptic ulcers are named according to where they occur:

    • Duodenal ulcers develop on the inside of the upper part of the small intestine, known as the duodenum. It is the most common type of peptic ulcer.
    • Gastric ulcers develop on the inner lining of the stomach.
  • The most common causes of peptic ulcers include:

    • Helicobacter pylori infection. H. pylori are bacteria found in the stomach in many people. It can break down the protective mucous coating on the stomach and duodenum lining. The stomach acid can therefore reach the stomach and the duodenum lining, causing the formation of peptic ulcers. 
    • Non-steroidal anti-inflammatory drugs (NSAIDs). Long-term use of NSAIDs such as aspirin and ibuprofen can cause peptic ulcers. NSAIDs block or reduce an enzyme in the body that promotes pain and fever. However, this enzyme also protects the stomach lining from stomach acid. Continuous NSAID use can damage the stomach lining, increasing the chances of developing peptic ulcers. 
    • Alcohol. Excessive consumption of alcohol increases stomach acid production and may cause peptic ulcers. 
    • Smoking. Smoking increases the risk of developing stomach ulcers. It also makes treatment less effective and increases the likelihood of the ulcers recurring.

    Preventing or reducing the risk of stomach ulcers

    • Limit use or lower dose of NSAIDs such as aspirin and ibuprofen 
    • Take additional medicines to protect your stomach and duodenum such as antacids or proton pump inhibitors if you need to take NSAIDs for a long time or at high doses 
    • Stop smoking and limit alcohol consumption to small amounts of dilute alcohol 
    • Protect yourself from H. pylori infections by frequently washing hands with soap and water and by avoiding foods that are not fully cooked. 
  • The most common symptom of peptic ulcers is a dull or burning pain in the stomach. This is often felt in the upper abdomen, anywhere between the navel and breastbone. You can identify the pain by the following characteristics:

    • Happens when the stomach is empty, i.e. between meals. Pain from duodenal ulcers tends to happen at night.
    • Stops briefly when a meal or an antacid is taken. Pain relief is better in duodenal ulcer than in gastric ulcer.
    • Lasts for minutes to hours.
    • Happens on and off for several days, weeks, or months

    Other possible symptoms include:

    • Bloating and belching
    • Changes in appetite
    • Heartburn
    • Nausea and vomiting
    • Unexplained weight loss
    • Trouble breathing and feeling faint
    • Black stool, which is a sign of bleeding
    • Vomiting of blood
  • Treatment of peptic ulcers depends on the severity and the cause of your condition, and may include avoiding the use of non-steroidal anti-inflammatory drugs (NSAIDs), discontinuing smoking and alcohol consumption, taking prescribed antibiotics to kill the bacteria, and using acid control medications to neutralise acid levels in the stomach.

    Prescription medications

    If your peptic ulcer is caused by NSAIDs, your doctor may advise you to stop or reduce your consumption of the NSAID or switch to a different medicine. You may also be prescribed the following medicines to reduce stomach acid and help your ulcers heal:

    • PPIs to reduce stomach acid and protect the stomach and duodenum lining
    • Histamine receptor blockers to stop the production of histamine
    • Mucosal protective agents to coat ulcers and protect them against acid and enzymes, thus facilitating the healing process
    • Antacids to quickly weaken or neutralise stomach acid for symptom relief

    Lifestyle changes

    • Avoiding foods that make your symptoms worse
    • Quitting smoking to facilitate healing of the ulcers and preventing recurrence
    • Limiting alcohol and caffeine
    • Losing weight if you are overweight

    Surgery

    In rare cases, surgery may be required for the following reasons:

    • Tear or block in the stomach or duodenum
    • Uncontrolled or recurrent bleeding
    • Symptoms that do not respond to drug therapy

    Speak to a gastroenterologist to learn more about treatment options best suited for you.

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  • The most common complications of peptic ulcers are bleeding and perforation of the stomach or duodenum wall.

    • Bleeding occurs when blood vessels are damaged due to the presence of ulcers and may be deadly in the elderly or those with multiple medical problems. It is more common among those who take blood thinning agents.

    • Perforation of the stomach or duodenum wall occurs when a severe, untreated ulcer makes a hole, allowing digestive juices and food to leak into the abdominal cavity. Immediate surgery is usually required to treat this condition.

    • Blockage of the duodenum opening may be seen when ulcers located where the duodenum joins the stomach causes swelling or scarring. This prevents food from leaving the stomach to enter the small intestine, resulting in vomiting and inability to eat.
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