Peptic Ulcers are very common and affect nearly 4 million americans, every year. They are more common in adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their life. They occur in the stomach or duodenum (upper part of the small intestine). A peptic ulcer is an erosion in the mucous membrane of the gastro-intestinal tract. When we eat, our stomach produces hydrochloric acid and an enzyme called pepsin. This enables the food to get partly digested in the stomach itself. The acid and pepsin are generally stopped from corroding the intestinal walls by a protective mucous layer that lines the whole digestive tract. But sometimes, this delicate balance between gastric juices and the protective mucous layer gets disturbed and it results in an inflammation of the tissues. This is how an ulcer is formed.
Causes of Peptic Ulcers
The underlying pathophysiology of peptic ulcers is the destruction of the gastric or intestinal mucosal lining of the stomach by hydrochloric acid, an acid normally present in the digestive juices of the stomach.
There are many factors known to cause disruption between stomach acid and mucosal protection balance. The most common cause is a bacterium known as Helicobacter pylori, which is responsible for causing more than 75% of peptic ulcers.
‘Helicobacter’ is a genus of spiral bacteria that amazingly, is able to survive the severe acidity of the stomach. This bacterium secretes an enzyme called urease, which neutralizes HCl secreted by the stomach to digest food. Low levels of acids trigger the stomach to produce more acid, in turn leading to an imbalance.
H. pylori bacteria spread through infected stools and may be transmitted from person to person through contaminated food and water.
H. pylori attach to the epithelial cells of the stomach and duodenum, which stops it from being washed out. Once attached, the bacteria start to cause damage to the cells by secreting enzymes and toxins and initiating a self-destructive immune response.
Another causative factor is the regular use of non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin and ibuprofen). These medications interfere with the normal digestive process and create an imbalance between the stomach acid and mucosal protection balance.
Medical research indicates that ulcers are not caused by lifestyle habits like stress. But at the same time, it does not rule out the fact that some factors may be responsible in supporting the ailment. These are:
- Regular consumption of alcohol
- Stress – Physical stress (severe injuries) or emotional stress
- High intake of caffeine
- Cigarette smoking
- Radiation therapy
- Rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.
Peptic Ulcer Symptoms
When an Ulcer is formed in the gastro-intestinal tract, it damages the nerves in that area. This causes pain, which is the most common symptom of peptic ulcers. The pain is usually above the navel and below the breastbone. It is a typical burning type of pain and can last from a few minutes to several hours. In some individuals, the pain occurs immediately after eating while in others, it may not occur until hours after eating. The pain frequently awakens the person at night. There may be episodes of pain followed by intervals without pain.
The other accompanying symptoms are:
- Nausea and vomiting
- Loss of appetite
- Loss of weight. However, people with duodenal ulcers may experience weight gain, if they eat more in order to ease the discomfort.
- In prolonged and untreated cases of ulcer, there may be bleeding. There may be vomiting of blood or it may be present in stools. In the long run, this may cause anemia, weakness and pallor.
Diagnosis of Peptic Ulcers
When a patient presents the typical ulcer picture, the healthcare provider first takes a complete history to know the exact time, duration, character and modalities of pain. He may also advise some tests to confirm the diagnosis. They are:
- Barium X-ray- The patient is given barium liquid to drink which coats the inner membrane of the gastro-intestinal tract. The barium particles are visible on an X-ray. This study thus, enables the doctor to outline the presence of any erosion.
- Endoscopy: Here, a thin, flexible tube with a tiny camera on the end called an endoscope is passed into the stomach through the mouth. The doctor then inspects the lining of the stomach to diagnose a peptic ulcer. Samples of tissue may be collected during the procedure to detect the bacteria.
- Blood tests: These are done to detect the H. pylori bacteria.
- Breath test: This test detects H. pylori by measuring carbon dioxide in the breath of a person. H. pylori bacteria break down the liquid, increasing the amount of carbon in the blood. The body gets rid of this carbon by breathing it out as carbon dioxide. This test is more accurate than the blood test, but is more difficult to carry out.