Peptic Ulcers: Types, Symptoms and Treatment

What is a Peptic Ulcer?

A peptic ulcer occurs in the lining of the stomach or on the upper section of the small intestine (duodenum). They are defined as:

• Gastric ulcers: ulcers that occur on the inside of the stomach;
• Duodenal ulcers: ulcers that occur on the inside of the small intestine.

(Mayo Clinic 2019; American College of Gastroenterology n.d.)

Normally, the lining of the stomach and intestines has defences against acid produced by the stomach. When something interferes with those defences the acid may cause damage. A peptic ulcer is a product of this damage; it is an open and inflamed sore.

While ulcers are common and treatable, it’s crucial that they are diagnosed early to avoid severe complications (MSD Manual 2019; Mayo Clinic 2019).

Ulcers vary in size, ranging from millimetres to centimetres. Peptic ulcers can be differentiated from erosions by the depth of penetration. Erosions are typically more superficial (Vakil 2018).

If left untreated, serious complications may occur.

Causes of Peptic Ulcer

• Helicobacter pylori bacterium (H.pylori);
• Nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin.

(Healthdirect 2019; Queensland Government 2017; Vakil 2018)

Symptoms of Peptic Ulcer

Often peptic ulcers will not present with any symptoms. It is estimated that up to three-quarters of people do not experience symptoms (Mayo Clinic 2019).

If symptoms do occur, the most common of these is burning or gnawing pain in the upper abdomen. This pain can travel to the chest, neck, belly button or back (Healthdirect 2019). The pain often comes and goes in intervals (Vakil 2018).

Other less-common symptoms include:

• Indigestion (heartburn);
• Loss of appetite;
• Vomiting;
• Feeling full and bloated, or belching;
• Not being able to tolerate fatty foods; and
• Nausea.

(Heatlhdirect 2019)

Eating food may dull the symptoms of duodenal ulcers but will often worsen the symptoms of gastric ulcers (Vakil 2018).

What are the Complications?

Peptic ulcers can cause the following:

• Gastrointestinal heamorrhage:
  • Passing bloody stools or black, tarry stools;
  • Vomiting blood, or blood that looks like coffee ground.
• Perforation through the wall of the stomach or small intestine, which can cause severe infection and pain;
• Stomach cancer risk increases 3- to 6-fold in patients with H. pylori-related ulcers.

(MSD Manual 2019; Vakil 2018)

Who is at Risk?

Peptic ulcers are common and can affect anyone of any age. However, they mostly occur in people over 60 and men are more commonly affected than women (NHS 2018).

Previously, stress, diet and smoking were thought to be the leading causes of stomach ulcers. It is now known that H. pylori bacteria is the main cause of ulcers (Queensland Government 2017).

H. pylori infection is present in 50 to 70% of patients with duodenal ulcers. In gastric ulcers, it accounts for 30 to 50% of patients (Vakil 2018).

If H. pylori has been removed, only 10% of patients experience a recurrence of peptic ulcers, compared with 70% recurrence in patients treated with acid suppression alone. Nonsteroidal anti-inflammatory drugs account for less than 50% of peptic ulcers (Vakil 2018).

Smoking is still considered a risk factor for the development of ulcers and the complications they cause. Additionally, smoking is known to impede healing and increase the chance of a recurrence. For children with duodenal ulcers, in 50 to 60% of cases, there is a family history (Vakil 2018).

Treatment of Peptic Ulcer

Treatment of gastric and duodenal ulcers involves removing the cause, which may require:

• Antibiotics;
• Acid-suppressing medications;
• Antacids.

(Queensland Government 2017; MSD Manual 2019; MacGill 2018)

How is Peptic Ulcer Diagnosed?

A general practitioner may suggest an examination if a person has stomach pain characteristic of ulcers.

Tests are needed to confirm the diagnosis if:

• Symptoms do not resolve following multiple weeks of treatment.
• When symptoms first appear in someone over 45.
• A person is presenting with other symptoms such as weight loss.

(Vakil 2018)

An upper endoscopy is the method most commonly used to diagnose, during which, a biopsy looking for H. pylori bacterium or cancer will be taken. This combined with a patient history will form the diagnosis (Vakil 2018).

Prevention

• Protect from infection by washing hands well, practising good hygiene, and avoiding eating foods that have not been properly cooked.
• Not overusing painkillers: and if pain killers are required, they should be taken with meals.

(Mayo Clinic 2019)

References

• American College of Gastroenterology n.d., Peptic Ulcer Disease, American College of Gastroenterology https://gi.org/topics/peptic-ulcer-disease/
• Healthdirect 2019, Stomach Ulcers, Healthdirect, viewed 13 November 2019, https://www.healthdirect.gov.au/stomach-ulcers
• MacGill 2018, ‘Everything You Need to Know About Stomach Ulcers’, Medical News Today, viewed 18 November 2019, https://www.medicalnewstoday.com/articles/312045.php
• Mayo Clinic 2019, Peptic Ulcer, Mayo Clinic, viewed 18 November 2019, https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229
• MSD Manual 2019, Peptic Ulcer Disease, MSD Manual, viewed 18 November 2019, https://www.msdmanuals.com/en-au/home/quick-facts-digestive-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease
• NHS 2018, Overview: Stomach Ulcer, NHS, viewed 13 November 2019, https://www.nhs.uk/conditions/stomach-ulcer/
• Queensland Government 2017, Peptic Ulcer, Queensland Government, viewed 13 November 2019, http://conditions.health.qld.gov.au/HealthCondition/condition/9/212/503/peptic-ulcer
• Vakil 2018, ‘Peptic Ulcer Disease’, MSD Manual, viewed 18 November 2019, https://www.msdmanuals.com/en-au/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/peptic-ulcer-disease?query=Peptic%20Ulcer%20Disease

(Answers: b, a, b)