Peptic Ulcers: Diagnosis and Treatment

The pain behind any Ulcer is quite visible when someone with experience elaborates on it. The open sore or wound caused in the stomach and proximal duodenum by tissue swelling often has been differentiated into various types. This article will provide a guide to peptic ulcers and how to treat them.

Pectic Ulcers
Source- Freepik

1. What are Ulcers?

A painful sore that can be developed in various parts and can be divided accordingly to different types like:

a. Stomach ulcers in the stomach lining are caused by an infection of Helicobacter pylori, damaging the stomach’s protective mucus layer.

b. Mouth ulcers form inside the mouth and become painful projections. The cause is yet to be discovered, but it may involve stress, infection from certain foods, or gulping extremely hot food.

c. Venous ulcers are caused in the legs due to a poor blood circulation caused by damage to veins.

d. Arterial Ulcers reduce blood supply to the tissues and are also seen in legs because of narrowed arteries.

e. Genital Ulcers are affected by sexually transmitted infections such as herpes and syphilis.

f. Peptic Ulcers are the main topic of discussion. They are extremely painful and affect the stomach and small intestines. They may be caused by NSAID use or H. pylori infection. They cause burning pain in the abdomen, weight loss, and nausea.

Peptic ulcer has become one of the most common diseases in gastroenterology clinics, causing havoc until the last decade, affecting males mostly due to bacteria and negative side effects of NSAIDs, which are later talked about in detail.

1.1. Understanding Ulcers

Stomach ulcers are considered the same as peptic ulcers. They are open sores in the stomach lining of the upper part of the small intestine. The ulcer is formed when stomach acid, instead of digesting food, starts digesting the mucus protecting the inner lining of the digestive tract.

Gastric ulcers are most commonly located in the lower area of the stomach, whereas duodenal ulcers are most common in the duodenal upper area. The ulcer is round to oval with a smooth base. An ulcer extends beyond the muscularis mucosa.”

Peptic ulcer disease is a global health problem; maintaining proper health hygiene and sanitary practices reduces the probability of forming this disease but has a possibility of 5-10% to develop.

A peptic ulcer can be of two different types-
a. Gastric Ulcer: takes place inside the stomach.
b. Duodenal Ulcer: This occurs in the upper region of the small intestine. It has a higher risk factor and is more likely to form in men than women.

i) Classifications

Peptic ulcers are a form of acid-peptic disorder.
By location, they are typically-
Duodenum: duodenal ulcer
Esophagus: esophageal ulcer
Stomach: gastric ulcer
Meckel’s diverticulum: Meckel’s diverticulum ulcer

Modifications-
Type I: Ulcers to the inner stomach lining along the curve of incisura angularis.
Type II: Ulcers combined with duodenal ulcers accompanied by acid over secretions.
Type III: Found within 3cm of pylorus along the pyloric channel. It is associated with acid over secretions.
Type IV: Proximal gastroesophageal ulcer.
Type V: Associated with long-term usage of NSAIDs and occurs throughout the stomach.

ii) Causes

An H. pylori bacterium attack commonly causes Peptic Ulcers. Peptic ulcers can also be caused by long-term use of non-steroidal anti-inflammatory drugs like Ibuprofen and naproxen sodium (Advil, Motrin IB, Aleve). Spicy foods and increased stress levels elevate the effects of peptic ulcers.

Mechanisms-

When the stomach is empty, stomach acid in the digestive tract starts consuming the stomach’s inner lining or the small intestine. This mechanism causes open pores in the inner lining, which bleeds and causes excessive pain. This usually doesn’t happen because every human body has a mucous layer that protects the inner lining from being digested by stomach acid. Still, ulcers develop when there is a decreased mucous level or increased production of stomach acid.

The defect in the mucosa extends to the muscularis mucosa. A damaged superficial mucosal layer results in two problems: first, the probability of acid increases due to this damage, and second, the potential of mucosal cells to secrete bicarbonate is reduced.
The H. pylori engulfs and colonizes the mucosal layer gases, creating an inflammatory response.

Some of the rare causes of peptic ulcers are:
• Zollinger- Ellison syndrome
• Gastric malignancy, lymphoma or lung cancer
• Radiation therapy and chemotherapy
• Crohn disease
• Vascular deficiency or any stress-induced pressure

iii) Symptoms

Burning Stomachaches.
Bloating or Belching
Heartburn
Nausea
Inability to consume fatty foods.
Vomiting blood
Dark blood in stools
Trouble breathing
Feeling fatigued
Unexplained weight loss or weight gain
Change in appetite, losing appetite.
Hematemesis
Melena

Some symptoms are considered severe and should prompt immediate doctor assistance like-
The sudden weight loss
Progressive dysphagia
Internal bleeding visibility
Iron deficiency anaemia.
Recurrent emesis
Family history of any gastrointestinal malignancy.

iv) Evaluation

Diagnosis requires an assessment of thorough detail and invasive-noninvasive tests.
The detailed history will provide clarity in case of emergencies. If the patient complains about abdominal pain before meal intake, epigastric abdominal pain, and a feeling of a bloated, full stomach, be cautious about Peptic Ulcer Disease. The pain is usually different for gastric and duodenum ulcers. The increased pain and inflammation after meals are due to gastric ulcers, and the decreased pain is due to duodenum ulcers.
Physical examination becomes essential as it reveals epigastric abdominal pressure tendencies, and signs of anemia may also be revealed. Certain symptoms confirm the diagnosis, such as the patient showing signs of anemia, melena, hematemesis, and sudden weight loss.

2. Diagnosis

  • Diagnosis is based solely on tests to be conducted to determine the root cause of the ulcer and treat it accordingly.
  • Blood tests: There are a variety of tests that come out of this, including calculating Red blood cell count, white blood cell count, platelet count, haemoglobin count, hematocrit level check, and mean corpuscular volume level test. All these combined are based on what the doctor finds suitable for counting. The main prognosis is to draw blood from a patient’s professional and send it for further testing.
  • The urea breath test is performed to check for infection of H. pylori. A capsule, liquid or pudding of urea is ingested by the patient with carbon atom labelling that has special properties. If the bacterium is present, the urea will be converted to carbon dioxide, and a breathing test will be performed later to confirm the presence of carbon dioxide.
  • The stool test is performed to check for the presence of bacteria.
  • Upper gastrointestinal endoscopy is performed to determine the cause of peptic ulcers. A camera-equipped tube monitors the GI tract, oesophagus, stomach, and duodenum.
  • A barium swallow monitors the upper gastrointestinal series, in which the X-ray series captures pictures of the esophagus, stomach, and intestine. A white fluid with barium content is swallowed, making the ulcer appear more visibly.

2.1. Tests to be Done.

  • Helicobacter pylori test
  • Urea Breath Test
  • Stool Antigen Test
  • Urine-based ELISA and rapid urine tests.
  • Endoscopic biopsy
  • Serum gastric test
  • Esophagogastroduodenoscopy (EGD)
  • Barium swallow
  • Complete Blood test
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-unsplash

3. Treatment

The treatment aims to eliminate harmful bacteria from the stomach, reduce excessive stomach acid production, promote healing of open sores caused by the ulcer, and maintain a conscious lifestyle that will stop the ulcer from growing again.

  • Proton pump inhibitors are best known for reducing stomach acid production; drugs like omeprazole (Prilosec) and lansoprazole (Prevacid) allow ulcers to heal better.
  • H2 Blockers like ranitidine (Zantac) and famotidine (Pepcid) also decrease acid production but do not work as efficiently as PPIs.
  • Antibiotics kill the bacteria H. pylori if that is the root cause of ulcers. Drugs like amoxicillin, clarithromycin, and metronidazole work best.
  • Cytoprotective agents like sucralfate coat the ulcer, protecting it from further harm.
  • The antidiarrheal drug provides relief from blood-filled diarrhea or any momentary relief. Medications that have electrolyte solutions help replace the lost fluids.
  • Antacids counter the side effects of stomach acids and help provide relief.
  • All of these are complemented with Calcium supplements for long-term usage of PPIs, which may have harmful aftereffects.
  • Recent advances in drug therapy have introduced new drugs that have shown some development in treating peptic ulcers, these include somatostatin-14, tetrapenylacetone, chemically some work is undergoing to prove the mechanism of these.

3.1. Lifestyle Modifications

Modification is often made for longer periods of health benefits; it often needs consistency and constant attention. Improvements are often overlooked until people get sick.

Diet is a key factor in the formation of ulcers. Foods and drinks often tend to irritate the stomach and produce more stomach acid for better digestion. Anyone prone to digestive problems should avoid eating spicy, oily, high-sugar foods. People should consult a dietitian before incorporating new foods into their daily meals.

Alcohol and tobacco consumption is strongly prohibited, these products tend to weaken immune system, affect lungs and stomach strongly and provide no advantages for any person.

Stress management is also important because stress-induced ulcers indirectly affect human health.

Surprisingly, doctors typically do not provide strict diet guidelines to help prevent ulcers. However, discontinuing long-term NSAID consumption is helpful.

3.2. Real World Victories

As per NCBI, peptic ulcer affects four million people worldwide annually; any person who experiences burning stomach pain for long months and also suffers from sudden weight loss for several months, lesser sleep caused due to discomfort visit a doctor after consulting a doctor, their respective medical records and past medications provided indications about a peptic ulcer, a mild test showed anemia, which was revealed by a blood test, a urea breath test confirmed H. pylori bacterium presence.

At The End

To conclude, Oxford published an article stating that there was a significant reduction in peptic ulcer cases globally from 1990 to 2019, and the mortality rate has come down, too. However, more early detection and prevention are needed to treat and eradicate peptic ulcers completely.

A 2007 survey conveyed a decline in morbidity rates in European and non-European countries from gastric and duodenal ulcers. To suffice, as common as it has been, peptic ulcers are curable, and modern-day approaches are being invented as alternative sources to reduce the aftereffects of this disease. With proper cure, protection, interventions, and controlled living, any form of peptic ulcer can be avoided completely.

Last Updated on by Isha_Jash

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