Stomach inflammation? Not gastritis! Let's learn exactly about stomach ulcers (Peptic Ulcer Disease)

Do you also often experience stomach pain, upper abdominal pain, similar to gastritis? This is a problem that many people in our country have. Although we often call this "gastritis", sometimes it can be something that needs a little more attention. That is the condition we are talking about today, Peptic Ulcer Disease (PUD). Simply put, this is when ulcers form on the inner wall of our digestive system.

Simply put, what is a peptic ulcer?

Imagine, in our stomach, that is, in the stomach, very strong acids and enzymes are produced to digest the food we eat. One of the main ones is pepsin. The word "peptic" is also derived from this pepsin. These acids and pepsin work together to break down the food we eat and help us digest it. These are so strong that even if they fall on normal skin, they can cause injury.

Then you might think, "If there are such harsh things, how come our stomach walls are not damaged?" The reason is that the inner wall of our stomach and duodenum is covered with a thick mucous lining, like a protective shield. This is the shield that protects the stomach walls from those harsh acids.

However, in peptic ulcer disease (PUD), this protective shield, the mucous membrane, becomes weak for some reason. Then, the harsh acid and pepsin can directly damage the stomach wall. Over time, those areas start to become sore. That's what we call ulcers or stomach ulcers.

Where can these ulcers occur?

These ulcers mainly occur in two parts of our digestive system.

1. Duodenal Ulcers: The duodenum is the first part of our small intestine. Food goes here after the stomach. Almost 80% of peptic ulcers occur in this area.

2. Stomach Ulcers / Gastric Ulcers: These are ulcers that form in the walls of the stomach. This type occurs in about 20% of cases .

In addition to these two main locations, very rarely, such injuries can occur in other locations.

• Esophageal Ulcers: The esophagus is the tube that carries food from our throat to our stomach. When we have acid reflux (GERD) for a long time, stomach acid can come up and damage the walls of this tube.
• Jejunal ulcers: These ulcers can develop after some stomach surgeries (e.g. gastrojejunostomy).

How do you know if you have this condition? (Symptoms)

Surprisingly, about 7 out of 10 people with peptic ulcers do not show any symptoms. However, if symptoms do occur, these are the most common symptoms.

Why do stomach ulcers develop like this? Two main reasons!

As we discussed earlier, stomach ulcers occur when the protective lining of the stomach is weakened. There are two main reasons why this protective lining is weakened. These two reasons are responsible for more than 90% of stomach ulcers.

1. Helicobacter pylori bacterial infection

• What is H. pylori?

This is a special type of bacteria that can live in our stomachs and intestines. More than half of the world's population has this bacteria in their stomachs. But most people don't have any symptoms. But in some people, this bacteria grows too much and starts to damage the protective lining of the stomach. Over time, this can cause stomach ulcers.

2. Use of non-steroidal anti-inflammatory drugs (NSAIDs)

• What are these NSAIDs?

This is a type of painkiller that we often use. For example, medicines like Aspirin, Ibuprofen (e.g. Brufen), and Diclofenac Sodium (e.g. Voltaren) . We use these for things like joint pain, back pain, and headaches.

• How do these cause stomach ulcers?

When these drugs are taken for a long time or in high doses, the balance of chemicals that help build the protective lining of the stomach is disrupted. As a result, the protective lining becomes thinner, making it easier for acids to damage the wall.

Other less common causes

In addition to the two main causes above, peptic ulcers can also develop due to other, very rare, causes.

• Some other infections
• Chemotherapy for cancer
• Radiation therapy
• Conditions such as Crohn's disease
• Rare conditions such as Zollinger-Ellison syndrome
• Severe physical stress (e.g., after major surgery, severe burns)

Could this be dangerous if left alone? (Complications)

Yes. Peptic ulcers are not something to be taken lightly. If not treated properly, they can lead to dangerous complications.

1. Gastrointestinal Bleeding: If the wound is deep and a blood vessel there ruptures, bleeding will begin to flow into the stomach.

2. Gastrointestinal Perforation: This is even more dangerous. The ulcer goes through the wall of the stomach or duodenum, creating a hole. This allows stomach acid and food to leak into the abdominal cavity, causing a severe infection (peritonitis). This is a very serious emergency that requires immediate surgery.

How does the doctor diagnose this disease exactly?

After listening to your symptoms, if the doctor suspects that this could be a peptic ulcer, he will order several tests.

1. H. pylori tests: There are easy ways to check for the presence of this bacteria.

• Urea Breath Test: You are given a special liquid to drink, and your breath is tested after a short period of time.
• Stool Antigen Test: A stool sample is taken to check for the presence of this bacteria.

2. Endoscopy (Upper Endoscopy):

This is the best way to confirm whether you have a stomach ulcer. This involves passing a thin, flexible tube with a camera attached through your mouth into your stomach and esophagus, where you can see what's inside on a screen. You'll be given painkillers to numb the pain while you're doing this.

• Advantages: You can see exactly if there are ulcers, where they are, and how big they are. You can also take a small piece of tissue (biopsy) right away to check for H. pylori.

What are the treatments for this?

The good news is that peptic ulcers are a disease that can be almost completely cured with medication . Treatment depends on what is causing your ulcers.

• Treatment of H. pylori infection:

If you have H. pylori infection, your doctor will prescribe you a combination of two or three antibiotics and a proton pump inhibitor (PPI) for 1-2 weeks. It is very important to take these medications exactly for the full duration.

• If due to NSAID use:

If your ulcers are caused by painkillers, the first thing to do is stop taking them. Then, you may need to take a PPI medication for a month or two to reduce stomach acid and help the ulcers heal.

• Other medications:
• H2 Blockers: These are also a type of medication that reduces the production of acid in the stomach.
• Cytoprotective agents: These create a protective coating on the stomach wall and help the wound heal.

It usually takes about two months for the ulcers to heal completely. After treatment, your doctor may test again to see if the ulcers have healed and the H. pylori bacteria has been eliminated.

How can you escape this situation?

It's much more important to reduce your risk of developing a peptic ulcer than to suffer from it. There are two main things you can do to do that.

1. Awareness about H. pylori infection:

If you have frequent stomach problems, see a doctor and get tested for H. pylori. If you do, get the proper treatment to cure it.

2. Be careful with painkillers (NSAIDs):

• Use only when necessary. Don't take such strong medicines for minor pain.
• Never take this medication for a long time without consulting a doctor.
• If you have had stomach ulcers before, you may need to stop taking these medications altogether. Or, your doctor may advise you to take them with another medicine that protects your stomach.

Stomach ulcers, peptic ulcers, gastritis, stomach inflammation, stomach pain, H. pylori, NSAID, Peptic Ulcer Disease in Sinhala