Peptic ulcer disease is one of the ills plaguing our society nowadays and its prevalence rate is nothing to write home about. It has become a cankerworm that has eaten deep into the fabric of our great nation, affecting both old and young people. This disease has increased the level of morbidity and mortality in the country as most people prefer self-medication to visiting their doctors at an early stage.
- What is Peptic Ulcer Disease?
- Types of Peptic Ulcer Disease
- Who is at Risk of Getting Ulcer?
- What are the causes of Peptic Ulcer Disease?
- What are the signs and symptoms of Peptic Ulcer Disease?
- What are the different ways of diagnosing Peptic Ulcer Disease?
- How Does One Treat or Manage Peptic Ulcer Disease?
- The Epidemiology of Peptic Ulcer Disease
Peptic ulcer disease is a situation that involves the accumulation of acids in the stomach which causes open sores or holes in the stomach lining, esophagus, and the duodenum(upper part of the small intestine) resulting in inflammation or infection.
Significantly, in the stomach, a thick layer of mucus protects the stomach lining from any damage to its digestive fluid. However, when these protective layers are being tampered with by foreign objects, it alters the level of acid in the stomach which gushes into vital tissues in the body causing a lot of damage.
Again, when there is a bacterial infection in the body, it attacks many systems of the body especially the digestive and reproductive systems. These bacteria move to the digestive system to eat away those protective layers that prevent the acid from entering the stomach lining, this gives room to open sores or ulcers.
There are 3 main types of peptic ulcers found in the body:
• GASTRIC ULCER:
This type of ulcer is easily formed in the stomach. It developed as a result of too many gases in the stomach. When the level of stomach acidity increases, it destroys the protective layers thereby causing the proliferation of acids in the stomach which ultimately attacks the stomach lining causing holes. Gastric ulcers that didn’t heal during treatment might be an indication of cancer.
• ESOPHAGEAL ULCER:
This is rare but is seen in the esophagus. It occurs when there is a breakdown in the esophageal mucosa margin. Most people that take antibiotics regularly are liable to develop this type of ulcer. However, the symptoms come gradually (from mild to severe). This type of ulcer developed in the lower part of the esophagus lining, between the throat and the stomach.
• DUODENAL ULCER:
It develops in the first part of the small intestine, the duodenum. This is mostly seen in many people but when treated properly is eliminated from the body.
Recently, everybody is susceptible to getting ulcers as it affects both the elderly and juveniles. Some risk factors that can endanger one having an ulcer include:
• People with underlying health conditions like kidney, liver, or lung diseases
• Constant alcohol use
• Regular intake of pain-relieving drugs like NSAIDs(non-steroidal anti-inflammatory drugs). Examples: ibuprofen, aspirin, naproxen, etc.
• Genetics consideration(Family history of ulcer)
• Always skipping meals
• Stress(not often)
• A blood group O person
People do assume that the etiology of Peptic ulcer disease results from stress or taking spicy foods, but there is no evidence for that. Studies have proven that there are two major causes of peptic ulcer disease which are:
• Pain relieving drugs:
One of the major causes of peptic ulcer disease is the regular intake of NSAIDs(non-steroidal anti-inflammatory drugs) which damages the mucus layer in the gastrointestinal tract thereby making it vulnerable for ulcers to form. Examples of NSAIDs include;
– ibuprofen( Advil, Motrin, etc)
– naproxen( Aleve, Anaprox, etc)
– aspirin( especially those with special coating)
Note that, not everybody that takes NSAIDs gets ulcers but when abused(that is, taken frequently or more than prescription), the body becomes sensitive to ulcers.
Though, there are factors that increase the risk of getting Peptic Ulcer disease from NSAIDs use. They include:
An elderly person (70 years, and above) can develop ulcers because of low function of the digestive tract.
• Taking more than prescription
• Gender, 60% of women are liable to develop ulcers annually
• Once have a history of peptic ulcer disease in the family
• Long-term use of NSAIDs
• Mixing both drugs like cortisone, prednisone, etc( used in treating asthma, arthritis, etc) and NSAIDs simultaneously.
• Presence of Helicobacter pylori bacteria:
This is another cause of peptic ulcer disease. Studies have shown that about 49.5% of people globally have been infected with H.pylori bacteria. It infects the stomach thereby attacking the digestive tract or alimentary canal. It is contagious as people contract it through kissing, a handshake from a person who just defeated without thoroughly washing his or her hands, childhood, oral sex, food or drinking water that is contaminated, etc. When this bacteria is in the gastrointestinal tract, it causes an inflammation that damages the protective layers of the stomach.
The stomach has a strong acid called ‘hydrochloric acid’ secreted by the gastric gland which helps to kill some bacteria in the stomach and helps in enabling the mixing of food with digestive juices. But when it is being attacked by H.pylori bacteria, it damages the mucus layer that protects the stomach lining thereby allowing the passage of this acid into the stomach.
This acid then moves forward to eat away the vital tissues in the stomach which causes open sores or holes.
However, about 15% of people with H.pylori bacteria may not develop ulcers because of having a strong immune system.
Other minor causes of peptic ulcer diseases are:
• Regular consumption of corticosteroids tablets
• Chronic illnesses various infections or diseases
Some ulcers are asymptomatic which makes people find it difficult to detect that they have ulcers. Some of the clinical manifestations of peptic ulcer disease are:
• Lack of appetite
• Vomiting or nausea
• Unexplained weight loss
• Gastrointestinal bleeding resulting from dark or black stool
• Severe pain in the epigastric region(pain in the mid-to-upper quadrant of the abdomen)
• Burning pain in the stomach, especially at night or after meals
• Temporary pain that disappears when you eat something or take an antacid.
It is paramount to visit your physician once you keep having symptoms of an ulcer to confirm the exact type of ulcer and starts treatment immediately.
These are the various ways of diagnosing ulcers:
• Physical Examination and Medical History:
This involves a condition where the health practitioner had a dialogue with the ulcer patient discussing the symptoms being experienced. The healthcare provider thoroughly examined the patient by asking if the person takes NSAIDs or over-the-counter medication regularly.
When the person’s answer becomes “NO”, it signifies that the cause of this ulcer is an H.pylori infection that has entered the stomach but needs to run a test to confirm it.
• Using samples like blood, breath, or feces for diagnosis:
The blood or feces are taken from the individual to diagnose the presence of H.pylori bacteria. For a breath test, which is the simplest and most accurate way of detecting an ulcer, a fluid or capsule containing urea will be given to the patient to swallow and release his or her breath inside a bag, which is sealed instantly.
After culturing the sample, if there is an increase in the normal level of carbon(iv)oxide, it indicates the presence of H.pylori bacteria which causes ulcers.
This type of test involved inserting a thin, lighted tube (endoscope) with a small camera through the mouth, down to the throat, and into the esophagus, stomach, and first portion of the small intestine, duodenum to check for ulcers, and damaged tissues, or bleeding. This is commonly used for elderly people. To make the process easier and faster, the patient might be given little sedative drugs before carrying out the test, and local anesthesia is sprayed on the person’s throat to enable the passage of the endoscope. Most times, a tissue sample is taken from the stomach(biopsy) for further analysis in the laboratory. This kind of test is done at the hospital and does not require the patient to be admitted to the hospital because it is carried out the same day the patient visited.
• X-rays series:
During X-rays and CT scans, the patient is given a white liquid called “Barium” to swallow which coats the upper gastrointestinal tract and enables the doctor to see the stomach and small intestine and locate the ulcers easily using the imaging machines.
Most times, ulcers heal on their own, but allowing the ulcer to go on its own without receiving appropriate treatments aggravates your health conditions, causing bleeding, a hole, and pyloric obstruction (obstruction in the gastric gland).
The various ways to manage or treat ulcers include:
• Most bleeding ulcers are healed during an endoscopy test. The doctor does that by injecting medicines into the body or by using a clamp to seal off the ulcer to stop bleeding tissue.
• Antibiotics use: Some antibiotics like metronidazole, amoxicillin, and clarithromycin, kill the H.pylori bacteria, therefore when taken appropriately, enhance the quick recovery of the patient. The patient is advised to take the drugs for two weeks.
• Use of Proton Pump Inhibitors:
These include; Omeprazole, Protonix, Prevacid, etc which helps in curtailing stomach acidity to prevent the escalation of the ulcer and heal it as well.
• Taking drugs that block the production of acids:
Examples of medications are Histamine H2 -Antagonist(H2 blockers) which include; Pepcid(Famotidine), Zantac(Rantidine), and Axid(Nizatidine), etc can be used to minimize the production of acid in the esophagus, stomach, and small intestine.
• Medications used for protecting the stomach lining, esophagus, and duodenum to avoid further damage are necessary. Those drugs help to prevent the spread of ulcers by covering the ulcer in a protective layer, which stops more damage to the gastrointestinal tract acids and enzymes. Some of the drugs include bismuth subsalicylate (pepto-Bismol).
Ulcers are life-threatening but can be prevented by:
• Have a conversation with your doctor about other drugs you can take in replacement of NSAID medications (like acetaminophen) to lessen pain.
• Know the measures to be taken if you can’t stop taking NSAIDs to protect your body from ulcers.
• Take the lowest active dose of NSAID and ensure good eating habits.
• Avoid smoking.
• Reduce the intake of alcohol
• Minimize the way you skipped meals, especially breakfast
Peptic ulcer disease affects up to 70% of people globally yearly, and its approximate prevalent rate is 4.5 – 9.8% of the total population. It affects both adolescents and adults ranging from 13-70 years.
Globally, peptic ulcer affects approximately four million people with a high prevalence rate. According to research being made, it was proven that duodenal ulcer affects up to 50% of the population, more than any other type of peptic ulcer.
An esophageal ulcer is barely seen in the human population, but about 20% of people who take antibiotics daily tend to develop that easily. It is a gastrointestinal disease that affects up to 60% of people living in developing countries like Africa, Central America, Central Asia, and Eastern Europe.
Also, about 50% of people with the type O blood group who have Lewis B antigens were reported of having gastric ulcers. In Iran, it was notably diagnosed that the ratio of peptic ulcer in both men and women, is 5:1. This means it mostly affects women more than men. Again, in Nigeria, duodenal ulcers usually affect men more than women but occur between 30-50 years old.
However, gastric ulcers affect women more than men and usually develop around 60 years of age.
A bacterial infection, Helicobacter pylori, was also seen as a factor that causes peptic ulcer, and about 66.7% of the total population have been infected, especially in Africa.
Another study pinpointed that 30% of people that take NSAIDs and smokes as well are susceptible to getting an ulcer because of the presence of cyclooxygenase -1 inhibitor. 50% of people with ulcers, especially the one caused by H.pylori infection, were able to recover. Other ulcers were given the appropriate treatment at an early stage, and the patients became well again.
Ulcers are easily treated once diagnosed at an early stage. It is advisable to visit your doctor immediately after you noticed any symptoms as this enhances the quick recovery of the patient.
Julia Fasher, MD, and Alfred C. Gitu, MD. Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection. (https://www.aafp.org/afp)
Perry S, Sanchez Md, Yang S, et al. Gastroenteritis and Transmission of _Helicobacter pylori _Infection in Households. Emerging Infectious Diseases. (https://wwwnc.cdc.gov/eid/article)
Cleveland Clinic Medical Professional
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