peptic ulcer disease

Peptic Ulcer Disease: Everything You Need To Know About It

What is stomach ulcer?

One thing we should note is that peptic ulcers can be grouped into gastric ulcers (stomach ulcers) and duodenal ulcers.  It is basically the development of sores in your digestive tract (normally the stomach and duodenum) due to increased production of acid or decreased protection by the mucosal layer in the stomach and or duodenum.

This acid is produced by the stomach to help in the digestion of food but in excess amounts can lead to sores or ulcers in the stomach or small intestine.

Basically, the factors that lead to ulceration cause an imbalance between the protective barriers (mucous lining, bicarbonate) and the destructive factors (stomach juices and enzymes). Some of these include:

  • Increase in the production of acid
  • Increase in pepsin activity
  • Wearing off of the protective layer of the stomach 
  • Decrease in some protective mechanisms used by the body like the release of bicarbonate

What are the symptoms of stomach ulcer?

The symptoms include but not limited to

  • Stomach pain
  • Nausea 
  • Vomiting (may include blood)
  • Weight loss generally due to reduced appetite
  • Heartburns due to acid irritation
  • Pain at the epigastrium (above the navel) 
  • Chest discomfort
  • Bloating
  • Intolerance to fatty food
  • Early satiety
  • Difficulty swallowing

What causes stomach ulcers?

As we have addressed, stomach ulcers or duodenal ulcers result when there is an increase in the production of acid in your stomach. However, there may be normal production of acid but the lining of your stomach (that prevents direct interaction between the acid and the stomach tissues) may have been worn off and this can cause irritation to the stomach walls leading to ulcer.

Another cause is infection with a bacteria called Helicobacter pylori that destroys the mucus layer of the stomach.

Disruption of the lining of the stomach too can be caused by the continuous use of drugs that belong to the class ‘Non-steroidal antiinflammatory drugs’.

Examples are diclofenac, aspirin, ibuprofen, naproxen, mefenamic acid and others.

Also some of these drugs come in the form of combination drugs so you have to be on the lookout for them too.

Common combination medications containing NSAIDs include ones available include:

– Gebedol (contain diclofenac)

– Efpac (contain aspirin)

– APC (contains aspirin)

Also, there are other classes of medications that can exacerbate ulcers.

Examples of drugs in those classes include:

– Prednisolone (usually taken by people with asthma or other inflammatory conditions)

– Caffeine

– Alcohol

Also most of the drugs that ladies use in managing menstrual pains are NSAIDs and can also lead to ulcerations.

Does aspirin alone cause peptic ulcer disease?

Yes, Aspirin has that effect. If taken at a high dose for pain or taken for a long time.

How are stomach ulcers treated?

Ideally, stomach ulcers should be diagnosed by a physician. The treatment depends on the cause of the ulcer. If the ulcer is caused by the H. pylori organism, then antibiotics treatment will be needed to eradicate the organism. 

As well as acid suppressive medications that is either proton pump inhibitors (like omeprazole) or H2 receptor antagonists (like ranitidine). If the ulcer is due to the use of medicines (NSAIDS), stopping those medicines and then treatment with the appropriate medications is very important.

Lifestyle changes are equally important. Antacids like Magnesium trisilicate, Nugel, Gastrone, Aludrox and the rest can also be given for short-term and immediate relief of the pain.

Do antacids cure ulcers?

No! Antacids do not cure ulcers. They just soothe the pain associated with ulcer since they neutralize the acid produced by the stomach. Most of the acid-suppressive agents that are used in the management of peptic ulcer disease prevent the further secretion of acids. This means that those agents do not have any effect on the already released acids.

The pain associated with the ulcer is usually as a result of the acids in the presence of the ulcers. So the antacids reduce the acidity and therefore the pain associated with it at the early stages.

What foods are not good for people with ulcers?

There’s no particular dieting rule for ulcer patients however, dieticians suggest that avoiding these foods can help improve the recovery of ulcer. 

These foods include;

  • Spicy foods
  • Diary products
  • Acidic fruits (tomatoes and citrus fruits eg. orange)
  • Coffee
  • Chocolate
  • Alcohol
  • Caffeine

They rather recommend the intake of foods rich in fiber (like whole-grain meals, oats, wheat, etc and fruits like strawberries, apples which have high antioxidant content).

How long should I treat ulcers to get complete cure?

Let us note that the treatment for ulcers is not for just a week duration. Imagine having a wound that is constantly exposed to acids, the healing may take time. As we have learned, the treatment choice depends on the cause of the ulcers.

However, in almost all cases, you need to take drugs that suppress acid production for a minimum of 1 month for the ulcer to heal completely (sometimes you may even need to continue beyond one month).

Ask whoever is choosing the drugs for you about how long you are to take them and make sure to take them for that long to ensure eradication of the ulcer. The relief of pain does not guarantee complete treatment so do adhere to the regimen given.

What foods heal ulcers?

Foods rich in fibers are best for ulcer patients as it helps reduce the production of stomach acid. Foods rich in antioxidants too are good. Examples are vegetables and fruits like berries.

How do you identify if you are an ulcer patient?

If you have any of the signs and symptoms

  • 1. Heartburns due to acid irritation
  • 2. Pain at the epigastrium (above the navel) 
  • 3. Chest discomfort
  • 4. Bloating
  • 5. Intolerance to fatty food
  • 6. Vomiting (may include blood) 
  • 7. Early satiety
  • 8. Difficulty swallowing

These signs and symptoms point to it and their presence leads to a suspicion of Peptic ulcer disease. Also, your history (use of medicines, lifestyle) can also point to it.

But to confirm it, we have to do some tests.

1. A test for the presence of the bacteria known to cause ulcers

2. Endoscopy (which goes to visualize the inside of your stomach to see if there are ulcers)

Answers to commonly asked questions about peptic ulcers

Do stomach ulcers affect the color of stools?

Yes. This is due to the associated bleeding from the ulcers. So patients with ulcer may have dark colored stools.

How about the colour of urine, will it affect it too?

No. Bleeding in the stomach should not affect the color of your urine. If this happens, prompt medical attention should be sought. 

However, medications for ulcer like cimetidine and ranitidine can change the color of your urine and the pharmacist or dispenser will make you aware of this before giving you your medication. This post gives you a list of medicines that can change the color of your urine

What causes back pain in an ulcer patient?

This is not consistent with an ulcer, however, if the pain is referred to these regions such as the back, shoulders, entire abdomen, it might indicate complications of the ulcer where it begins to penetrate into the walls of the stomach or duodenum and enter adjacent spaces or other organs (perforations). Such would require further investigation.

Can you differentiate the signs and symptoms of gastric and duodenal ulcer?

The symptoms are similar with both types of ulcers. Just that with duodenal ulcer, usually the stomach pain is relieved when you eat unlike in gastric ulcer. And in duodenal ulcer, you may have your pain waking you up at night more often than in stomach ulcer.

Is there any form of ulcer that cannot be treated?

All forms of ulcer should be able to be treated unless some complications set in. For example, if left for a long time without treatment, it could lead to stomach cancer. Also when there is complete wearing off of the stomach lining, it may be difficult to treat it. Hence, it is advisable to see your clinician early when you start having the symptoms of ulcer.

Can ulcers be managed with herbal medicines?

I know of people who take Palm kernel oil to manage their ulcer

There are some herbal remedies which help in reducing the severity of ulcers. And palm kernel oil happens to be one as it happens to contain the right chemicals to cure the sores that develop with stomach or duodenal ulcer. 

However, most of the herbal drugs that are advertised for ulcer treatment and not approved by the FDA may just worsen the ulcer. So it’s best to always see your doctor or pharmacist for the best treatment to be given.

Does intake of local banana or foreign banana good for ulcer patients?

Bananas are considered to be alkaline fruits and as such are good for ulcer patients. You can check the top six health benefits of banana in this post.

Top 6 health benefits of banana

Where is stomach ulcer pain located?

Ulcer pains are usually felt in the upper middle part of the abdomen. So the portion between the navel and the breastbone.

Why is it that people with ulcers usually experience constipation?

There are different possible causes. 

The antacids (aluminum-containing ones) used to relieve pain associated with ulcers cause constipation. So as often as you take these drugs to ease the pain, you put yourself at risk of getting constipation. Also, normally, due to the pain, there is reduced motility in these patients and that can result in constipation.

Is Paracetamol good for Peptic ulcer disease (PUD) patients?

Paracetamol is one of the safest painkillers in patients with Peptic Ulcer Disease. It does not have the ulcerative side effects of most pain killers and can therefore be used safely in ulcer patients.

Is Peptic Ulcer Disease hereditary?

Family history has been noted in about 60 percent of kids with peptic ulcers, especially duodenal ulcers. So yes there is some genetic connection with PUD. More research is being conducted in this field though.

Can Clarithromycin cure ulcers? And is it better than Omeprazole?

Clarithromycin is an antibiotic used in the eradication of the bacteria that causes ulcers. So if the ulcer is caused by that organism then, it would be used with another antibiotic or other antibiotics will be given. 

Omeprazole is a different class of drug and is always given either in addition to the antibiotics or alone depending on the cause of the ulcer.

WRITTEN AND EDITED RESPECTIVELY BY:

Chief Editor at Wapomu.com

MPSGH, MRPharmS, MPhil.

Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.

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