Ulcers: Diagnostics, Treatment and More

There is no clear evidence that modern life’s stress or a steady diet of fast food causes stomach and small intestine ulcers, but they are still common in our society: one out of every ten Americans will experience the burning, gnawing abdominal pain of a peptic (or gastric) ulcer at some point in their lives.

Peptic ulcers are holes or cracks in the protective lining of the duodenum (the upper section of the small intestine) or the stomach, which are in touch with stomach acids and enzymes. Duodenal ulcers occur more frequently than stomach ulcers.

Esophageal ulcers are very uncommon, forming in the oesophagus (or swallowing tube) as a result of pharmaceutical exposure, such as some antibiotics or anti-inflammatories, or alcohol addiction.

Until the mid-1980s, conventional thinking held that ulcers were caused by stress, a hereditary proclivity for increased stomach acid output, and bad living practises (including overindulging in rich and fatty foods, alcohol, caffeine, and tobacco). It was thought that such impacts lead to the accumulation of stomach acids, which destroy the protective lining of the stomach, duodenum, or oesophagus.

While increased stomach acid output undoubtedly contributes to the formation of ulcers, a relatively new viewpoint contends that bacterial infection is the major cause of peptic ulcers. Indeed, studies undertaken since the mid-1980s have revealed that the bacterium Helicobacter pylori (H. pylori) is present in more than 90% of duodenal ulcers and around 80% of stomach ulcers. However, new data show that such numbers are dropping.

Other variables appear to contribute to ulcer development, particularly in people infected with H. pylori:

• Overuse of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen)
• Heavy alcohol use
• Psychological stress
• Smoking

Other research indicates that stomach ulcers are more common in elderly persons. This might be due to:

• Arthritic is common among the elderly, and relieving arthritis pain may include taking aspirin or ibuprofen on a regular basis.
• The pylorus (the valve between the stomach and the duodenum) relaxes with age, allowing excess bile (a chemical generated in the liver to promote digestion) to leak into the stomach and erode the stomach lining.

People with type A blood are also more prone to develop malignant stomach ulcers for unknown reasons.

Duodenal ulcers are more common in patients with type O blood, presumably because they lack the material on the surface of blood cells that protects the duodenal lining.

DIAGNOSTICS

If your doctor suspects you have a peptic ulcer, they will most likely begin with a physical exam and certain tests:

• They’ll feel your stomach and ask whether you’ve had any soreness, pain, or bloating. They may use a stethoscope to listen for any noises coming from your stomach.
• The next step will be to conduct tests to search for H. pylori bacteria. For these, your doctor may collect blood, stool, or breath samples from you.
• In certain situations, especially if you’re older and your symptoms include weight loss or loss of appetite, they may use a long, flexible tube called an endoscope to examine your neck and stomach for indications of an ulcer. (You will be given sleeping medication.) A tiny sample of tissue from an ulcer can also be taken with an endoscope and examined in a laboratory.
• Before taking X-rays of your stomach, they may ask you to consume a milky liquid called barium. This drink covers your digestive tract, making issues like ulcers more visible.

TREATMENT

If you have a peptic ulcer, your doctor will propose a treatment strategy based on the source of the problem:

• The most frequent treatment is a combination of antibiotics to kill the H. pylori bacteria and medicines to reduce stomach acid. Proton pump inhibitors (such as Aciphex or Nexium) and antibiotics are common examples. PPIs will be prescribed to you for several weeks.
• You must stop taking over-the-counter pain relievers if they are the cause of your ulcer.
• They may also provide a protectant, which encapsulates ulcers to protect them from stomach acid.

Lifestyle changes can help, too. You might need to:

• Quit smoking.
• Drink less alcohol or caffeine.
• Stay away from foods that make your symptoms worse.

After treatment, your doctor may want to keep a close eye on you, depending on:

• The size of your ulcer and where it was
• How well the treatment worked
• If you had any other problems

If left untreated, an ulcer can lead to significant complications such as gastrointestinal haemorrhage. Untreated ulcers can potentially cause a hole in your stomach, which may require surgery to repair.