Do you often feel a burning sensation in your stomach, a discomfort in your stomach? Many of us forget that this is a normal thing, perhaps thinking that it is "gastritis". However, sometimes this discomfort can be something a little more serious. That is the condition of stomach ulcers, or as doctors call it, `Peptic Ulcer Disease (PUD). So, today we will talk about this in a little more detail, as if we were telling a friend. Because being aware of this can be very important for you.
What is Peptic Ulcer Disease? Simply put...
Simply put, peptic ulcer disease is an open sore that forms on the lining of our digestive system, the part of the digestive tract where we digest food and drink. The word "peptic" means "related to digestion." It comes from the word "pepsin," which is a major digestive enzyme produced in our stomach.
Imagine, in our stomach we have stomach acid and this enzyme called pepsin. These two are what help us chemically break down the food we eat and digest it. This juice is very acidic, to be precise, it is corrosive. This juice sometimes goes into the first part of our small intestine (duodenum).
Now look, our entire digestive tract is lined with a protective mucous membrane, like a shield that protects the walls from the harsh things inside. This protective membrane is very strong in the stomach and the first part of the small intestine. However, in a person with peptic ulcer disease, this protective system is weakened . Then those harsh digestive juices can eat away at the walls.
An ulcer is an erosion deep enough to penetrate all three layers of the lining of the stomach. Most often, these ulcers occur in the stomach or the first part of the small intestine (duodenum), because that's where digestive juices are most active. But rarely, they can occur in other places.
Where can these wounds occur? Are there any types?
Yes, these ulcers mainly occur in our stomach and the first part of the small intestine (duodenum).
- Duodenal ulcers: These are the most common, accounting for approximately 80%.
- Stomach ulcers: These are seen in about 20% of cases.
However, in very rare cases, stomach acid can leak into other areas, causing ulcers. For example:
- Esophageal ulcer: Some people have chronic acid reflux, which is when stomach acid comes up into the throat. If this continues, the lining of the esophagus can gradually wear away, causing an ulcer. This is because the lining of the esophagus is not as resistant to acid as the lining of the stomach.
- Jejunal ulcer:The jejunum is the middle part of our small intestine. Some surgeries (e.g., gastrojejunostomy - a surgery that connects the stomach directly to the jejunum) can cause injuries to this part.
How common is this condition?
Worldwide, between 5% and 10% of people will develop peptic ulcer disease (PUD) at some point in their lives. Although it can occur at any age, it is more common in middle-aged people and men.
What are the symptoms of this? How do you recognize it?
Surprisingly, about 70% of people with this condition do not show any symptoms . However, the most common things people who do have symptoms say are:
- Epigastric pain: To be precise, it is pain that comes from the middle of the stomach , below the chest.
- Dyspepsia: A collection of digestive discomforts that occur after eating. This includes pain in the upper abdomen, a burning sensation , a feeling of fullness after eating, and a persistent feeling of fullness.
This burning sensation is like the feeling of stomach acid and enzymes eating away at the lining of the stomach. Some people describe it as "like something is digging into the inside of the stomach." You may even be able to pinpoint the exact location of the pain.
Although it's difficult to tell exactly whether the ulcer is in the stomach or the small intestine, there are some clues:
- If you have a stomach ulcer , the pain may worsen shortly after eating (within 30 minutes), because that's when the most gastric juice is secreted.
- In the case of a duodenal ulcer , the pain may subside after eating. However, after two to three hours, the pain may increase again as food and digestive juices pass into the small intestine. Some people mistake this for hunger, as eating provides relief. Waking up at night due to pain is also common in people with these small intestine ulcers.
In addition to this, you can also see other features like:
- Bloated stomach
- Frequent burping or belching
- Loss of appetite
- Nausea and vomiting
What happens if left untreated? What are the complications?
Some people develop symptoms after the condition has developed other complications. This happens if it is left untreated for a long time. Otherwise, the wounds can start to bleed , or the wall can become even deeper and form a hole .
If you have upper gastrointestinal bleeding, you may experience symptoms such as:
- Blood in the stool ( black, tarry stool )
- Coffee ground vomitus
- Dizziness or faintness
- Paleness of the skin (Pallor)
- Rapid heart rate
If a hole in the digestive tract (gastrointestinal perforation) occurs, symptoms such as:
- Sudden, severe, sharp stomach pain
- Abdominal swelling and unbearable pain
- Fever and chills
If left untreated for a long time, the ulcers can heal and then recur. In some people, scarring and swelling in the digestive tract can increase, leading to gastrointestinal obstruction . This can lead to symptoms such as:
- Bloating, swelling, and pain
- Nausea and vomiting
- Loss of appetite and weight loss
- Incontinence and constipation
Why do we get these stomach ulcers? What are the main causes?
The protective lining of our digestive tract is designed to withstand harsh acids and enzymes and to repair itself if damaged. This is especially true in the stomach and the first part of the small intestine. However, ulcers occur when something interferes with these natural defenses.
For this protection to be reduced and for an ulcer to become deep enough to penetrate the mucosa, a long-term or ongoing condition must occur. Scientists have identified two main causes that are responsible for the majority of these PUDs:
1. H. pylori (Helicobacter pylori) Bacterial Infection: This bacterium lives in the stomach and/or small intestine of nearly half the world's population. For most people, it doesn't cause any problems. However, if the bacteria become too large, it can upset the balance of other microorganisms there and trigger an inflammatory response . This long-term inflammation weakens the wall and reduces its ability to repair itself. Sometimes, the bacteria can even attack the wall directly.
2. Overuse of nonsteroidal anti-inflammatory drugs (NSAIDs): These are the painkillers we buy from the pharmacy without a prescription, such as aspirin and ibuprofen. Because they are taken without medical advice, many people take them more often than they need. This affects the chemical balance in our stomach and small intestine. NSAIDs work by reducing the production of chemicals called prostaglandins, which repair damage to the lining of the digestive tract.
In addition to these two main reasons, there are other less common reasons:
- Other infections
- Reduced blood supply (`Ischemia`)
- Severe physical stress (often from a life-threatening illness or accident)
- Chemotherapy or radiation therapy
- Zollinger-Ellison syndrome - a condition in which the stomach produces too much acid
- Crohn's disease - an inflammatory condition of the digestive tract
- Stomach cancer
Who is at higher risk of developing this condition?
If you have an H. pylori infection or are a frequent user of NSAIDs, you are more likely to develop these stomach ulcers. The risk is especially high if you have both of these risk factors.
In addition, smoking, alcohol consumption, and some other medications you take can also contribute to this. While these things alone are not strong enough to cause ulcers, when combined with an H. pylori infection or NSAID use, they increase the likelihood of developing stomach ulcers.
How do doctors diagnose this?
If your doctor suspects a stomach ulcer based on your symptoms and risk factors, they will first check your esophagus for ulcers. They will also test for H. pylori infection.
For many people, an upper esophageal endoscopy (EGD test) is the final diagnosis. This involves inserting a thin tube with a small camera at the end through the mouth and examining the esophagus, stomach, and first part of the small intestine. At this time, a small piece of tissue (a biopsy) may also be taken from the stomach to check for the presence of H. pylori.
Endoscopy is very useful because it not only allows you to see images, but also allows you to pass instruments through the tube if necessary and perform treatment. For example, if a wound is bleeding, you can treat it right away to stop it.
Other tests:
- A `CT scan (Computed Tomography scan)` or `GI series X-ray exam` may be done to detect larger lesions.
- A ``Urea breath test`` or a ``stool test`` can be done to detect ``H. pylori`` infection.
What are the treatments?
The main treatment for stomach ulcers is a combination of medications that reduce stomach acid, protect the lining, and help it heal . If you have an infection, you may also need antibiotics . The most important thing is to find and treat the cause of the ulcer.
Most of the time, wounds can be healed with medication alone. However, if there are complications, such as a bleeding wound or a perforated wound, additional treatment may be needed. Many of these complications can be managed with simple medical procedures, such as endoscopy.
Medications
- Antibiotics: If you have an infection with H. pylori or another bacteria, your doctor will prescribe a combination of antibiotics to kill the bacteria. (Example: Amoxicillin, Clarithromycin, Metronidazole)
- Cytoprotective agents: These medications work by coating and protecting the stomach lining until it heals. (Ex: `Sucralfate`, `Misoprostol`, `Bismuth subsalicylate`)
- Histamine receptor blockers (H2 blockers): These medications reduce acid by blocking the chemical that signals the stomach to produce acid. (Ex: `Famotidine`, `Cimetidine`)
- Proton pump inhibitors (PPIs): These medications reduce stomach acid and help the lining of the stomach to heal by protecting it. (Ex: Omeprazole, Pantoprazole, Esomeprazole)
- Alternative painkillers instead of NSAIDs: If you usually take NSAIDs, you may want to talk to your doctor about an alternative. Acetaminophen (paracetamol) is a non-NSAID and does not have the same effect on the stomach lining.
Medical procedures
If you have a complicated, bleeding wound, your doctor will need to treat it directly. This can often be done during the endoscopy. The bleeding is stopped by cauterizing the wound or injecting medication. If there is a hole, it is stitched shut.
Rarely, if an ulcer has blocked the esophagus, interventions may be needed to reopen it. This may involve suctioning the contents of the stomach or, very rarely, surgery.
What should we do to protect ourselves from this situation? (Prevention)
The most important things you can do to protect yourself from peptic ulcer disease are:
1. Get tested for H. pylori infection and treated: Many people have H. pylori infection but don't know it. You can find out if you have it by doing a simple urea breath test. If you do, get treated before problems occur. Even if you've been treated before, it's a good idea to get tested again, because it can sometimes come back.
2. Use NSAIDs only as directed: If you are used to taking NSAIDs for minor aches and pains every day, be careful not to take more than the recommended dose. If you have a history of stomach ulcers, it is best to avoid using them. If necessary, take them with another medicine that protects the stomach lining.
Will these wounds heal without medicine?
If the cause of the ulcer is removed, the ulcer may heal. However, a medical examination is usually needed to determine the cause. If the cause is an H. pylori infection or another medical condition, treatment will be needed to eliminate it.
If the cause is simply NSAIDs, the ulcer may heal on its own if you stop taking them. However, you should see a doctor to confirm this. You may also have an H. pylori infection, and NSAIDs can worsen a previously harmless infection.
What happens after treatment? How long does it take to recover?
Most stomach ulcers heal within a few weeks . Most people need to take the medication for about two months. This medication is very effective. However, people with long-term conditions like Zollinger-Ellison syndrome may need to take the medication for the rest of their lives.
After treatment, the doctor will do follow-up tests to make sure the ulcer has completely healed and the infection is gone. H. pylori is a tricky bacteria and can sometimes come back. Also, if the conditions that caused the ulcer continue, the ulcer can come back.
Very rarely, some people may have persistent stomach ulcers that do not heal with treatment. These can cause complications such as long-term pain and extensive scarring. In such cases, surgery may be necessary (e.g., to remove scar tissue (pyloroplasty), or to cut a nerve that controls stomach acid production (vagotomy)).
Do you need to make changes to your diet and lifestyle?
Food and drink do not cause stomach ulcers, but if you have ulcers, certain foods and drinks (especially spicy, sour foods) can make them worse . If you have symptoms or have previously had stomach ulcers, you should completely avoid alcohol and smoking .
Talk to your doctor about all medications you take (especially NSAIDs). Some medications can cause problems when taken together.
Can't this be cured by using antacids at home?
Antacids work by neutralizing acid and reducing symptoms such as heartburn, heartburn, and indigestion. They may temporarily make an ulcer feel better, but they do not heal the ulcer . If you have had stomach ulcers before, antacids may help prevent them from coming back.
What are the best times to see a doctor?
If you suspect you have a stomach ulcer, be sure to see a doctor . While over-the-counter medications can temporarily control your symptoms, they will not cure the ulcer. The underlying cause must be identified and treated.
An untreated ulcer, even if you don't have severe symptoms, can lead to serious complications. Infection with H. pylori, which is the main cause of stomach ulcers, can also lead to other complications (such as a risk of developing stomach cancer).
If you see signs of serious complications like these, go to an emergency room immediately:
- A constant, severe pain.
- Signs of blood in the stool (black stools) or vomiting blood.
- Signs of severe blood loss (pallor, fainting).
The most important things we need to remember (Take-Home Message)
Peptic Ulcer Disease is a serious condition that affects your digestive system. It occurs when your natural defense system is weakened. This condition takes time to develop and usually requires medical treatment to heal.
Stomach ulcers are a common and treatable condition. However, it is important to seek treatment even if you do not have severe symptoms.If left untreated, the wounds can become deeper and more serious. So, don't delay in talking to a doctor about your symptoms. Your health is worth it!
` Stomach ulcers, peptic ulcers, stomach inflammation, H. pylori, NSAID, gastritis, indigestion
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