Peptic ulcer

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Causes
Symptoms
Diagnosis
Treatment
Prevention

Causes

The most important function of your stomach is to digest the food you eat with the help of acids and a substance called pepsin, produced by the cells lining of the stomach. Unfortunately, these acids along with pepsin are strong enough to attack your stomach and duodenal lining. Normally, the lining is protected by a sticky layer of mucus covering it. But, certain factors can result in invasion of the mucus layer causing the lining to break open. Once the lining breaks open it causes the tissue to become inflamed (gastritis) and forms a deep sore or ulcer.

Dr. Mehul Choksi from S.L. Raheja, Mahim says, ‘The two most important causes of peptic ulcer are infection of the stomach lining caused by bacteria Helicobacter pylori, regular use of non-steroidal anti-inflammatory (NSAIDs) drugs like ibuprofen, naproxen and ibuprofen for pain.’

‘Contrary to popular belief, there is no good evidence that a specific diet causes or worsens peptic ulcers,’ he adds.

Symptoms

Mild inflammation due to small ulcers may not cause any major symptoms and may heal on their own like mouth ulcers do. However, some ulcers can cause serious symptoms. Stomach pain is the most common symptom. The type of pain can vary from mild to severe and may occur typically at night. It may become severe as the stomach empties and in some cases may be relieved after having food. In some cases, pain may disappear for a few days and then reappear. Other less common signs include:

Nausea

Vomiting

Loss of appetite

Vomiting

‘You person should visit a specialist, preferably a medical gastroenterologist, when the symptoms are bothersome of if symptoms include weight loss, blood in the stools or black tarry stools, feeling full quickly after eating and difficulty in swallowing food.’

‘It’s better to go to a doctor in case abdominal pain worsens or if there is a constant feeling of discomfort. Also, individuals more than 40 years of age having abdominal pain should consult a gastroenterologist as the likelihood of stomach cancer increases after you cross 40s,’ explains Dr Choksi.

Diagnosis

If your doctor suspects peptic ulcer, you may have to undergo the following tests:

Blood test: A test to check the presence of antibodies produced by your immune system can detect and confirm H.pylori infection.

Endoscopy: ‘The gastroenterologist may choose to perform an upper gastrointestintal endoscopy (Gastroscopy) which examines the esophageal, stomach and duodenal lining for presence of ulcers, esophagitis or gastritis. This is done by passing a thin, flexible tube having camera at its end; through the mouth down the throat,’ says Dr Choksi.

Tissue Biopsy: ‘Also, at the same time a spot test for H. pylori can be done by taking a small amount of tissue from the stomach (biopsy). Biopsies can also be sent for reporting to the pathologist to rule out abnormal cells or cancer if a suspected lesion is seen at the time of endoscopy,’ he adds further.

Latest advances in the diagnosis

Dr Choksi explains some latest, advanced non-invasive methods to diagnose H. pylori infection without doing endoscopy like:

Urea breath test: In this test, the patient has to swallow a capsule containing urea, a carbon and nitrogen containing compound. H. pylori when present in the stomach lining acts on the urea capsule and carbon dioxide is released which gets absorbed in the blood and is exhaled from the lungs. The patient has to exhale into a breath analyser. If H. pylori bacteria are present in stomach then exhaled carbon dioxide is sensed by the analyser and the test is reported positive.

Stool antigen testing: In this test, a stool sample is tested for the presence or absence of H. pylori with the help of a specific antibody against H. pylori. This is an immunological test.

Narrow band imaging: As long standing H. pylori infection can cause gastric cancer, nowadays we have special imaging and magnifying methods to detect cancer of the gastrointestinal tract early. Narrow band imaging is a novel endoscopic technique which can be incorporated during gastroscopy especially if there is a lesion suspected to be malignant or pre-malignant. It uses special filters and magnifying methods to diagnose early cancerous or pre-cancerous lesions.

Treatment

Peptic ulcers caused due to H. pylori infection is treated with a course of antibiotics like amoxicillin and metronidazole. If it caused by NSAIDs then proton pump inhibitors like omeprazole and lansoprazole are prescribed. These drugs block the production and release of stomach acids, allowing the ulcer to heal naturally. ‘Today’s anti-secretory drugs, proton pump inhibitors are very potent in healing of peptic ulcers and in today’s era with the use of these drugs the ulcer healing rates are very high and complication rates are extremely low. These drugs have reduced the need for surgery and the risk of resulting complications that occurred quite frequently in the past few decades,’ says Dr Choksi.

‘As 80-90 % of the Indian population is infected with H. pylori, upto 10-15 % of the patients may have recurrence of the ulcer after successful eradication of H. pylori due to recurrence of infection,’ says Dr Choksi.