A peptic ulcer is a breach in the mucosal lining of the stomach. It could also affect the first part of the small intestine (duodenum), and a reflux of stomach (gastric) content could further affect the lower part of the oesophagus (gastro-oesophageal reflux). A collective term describing these ulcers is Peptic Ulcer Disease (PUD). In human physiology, a specific amount of gastric acid is normally secreted by the cells in the stomach which helps to activate digestive enzymes and digestion (breakdown) of food substances to a simpler form that can be easily absorbed by the body. Excessive secretion of this acid and pepsin (a digestive enzyme), which could override the normal gastric mucosa protective function, may lead to damage and ulceration of the mucosa lining of the stomach, duodenum and/or oesophagus. In recent times, especially in Africa and many low- and middle-income countries, an infective agent (helicobacter pylori bacteria) has been indicated as the main cause of PUD. Consequently, with the development of painful sores in the stomach or duodenum (and a commonly associated reflux into the oesophagus), patients often complain of moderate to severe mid-upper-abdominal (epigastric) pains.
According to experts, PUD occurs in about 25-40% of the population, with about 2-5% presenting to standard health facilities. Epidemiologists have reported that duodenal ulcer is about 10 times more common in men than in women, while gastric ulcer has a male to female ratio of 3 to 2. However, due to better antibiotic regimen targeting helicobacter pylori infection, this sex frequency now appears to be even in both sexes.
Causes of PUD and Risk Factors
Gastroenterologists have reported that in some patients, no specific cause was found in the development of PUD. However, as noted above, the basic pathogenesis in the development of peptic ulcers is the imbalance between digestive fluids in the stomach and duodenum, and the mucosa protective mechanism. Meanwhile, several research findings have shown that most peptic ulcers are caused by helicobacter pylori infection, associated with about 85-95% of duodenal ulcers and 70-80% of gastric ulcers.
Some factors that may increase risk of developing peptic ulcers include: missing meals (or not eating at the right time), use of nonsteroidal anti-inflammatory drugs (NSAIDS) like aspirin, ibuprofen (Ibucap®), piroxicam (Feldene®), naproxen (Naprosyn®), diclofenac (Cataflam®), among many others. Other risk factors include alcohol and tobacco consumption, family history of peptic ulcers, co-existing body illness such as liver, kidney, or lung disease, and elderly persons (aged ≥ 50 years).
Symptoms of PUD and How to Stay Healthy
Some people may present with non-specific symptoms, there may be need for detailed history, physical examination and investigations to arrive at diagnosis. However, as noted above, PUD patients present with epigastric pains (pain in the mid-upper-abdominal quadrant (epigastrium)). Patients may sometimes wake up in the middle of the night with severe pains, which may subside after taking food. In some patients, especially those with gastric (stomach) ulcers, pain may actually commence after meals. Pain may also radiate to the back if the ulcer is posteriorly located. Some patients may present with pains just beneath the sternum (mid-chest), which many refer to as heartburn. This is usually associated with gastro-oesophageal reflux. Other symptoms include nausea, vomiting, oral flatulence, abdominal distension and intolerance of fatty foods. Sometimes, complications may result from ulcers necessitating urgent medical attention. We should seek immediate medical help if any of the following develops: a sudden sharp abdominal pain that gradually gets worse and does not improve, vomiting blood (hematemesis), and passage of black tar-like stools (this is also due to bleeding in the stomach or duodenum). We should not ignore these symptoms as it may point to an ongoing perforation of the stomach or duodenal wall. Meanwhile, ulcers may heal on their own, it is however important we seek appropriate medical care early enough as stomach ulcers may lead to gastric outlet obstruction (resulting from repeated swelling or healing scars, which blocks the passageway leading from the stomach to the duodenum), and stomach cancer.
Behavioural and lifestyle modification is very vital to preventing peptic ulcers. Stop consumption of alcohol and tobacco (smoking increases risk of peptic ulcers and delays wound healing). Avoid NSAIDS and the use of over-the-counter medications (try to get doctor’s prescription). Antacids are useful immediate relief for epigastric pains (see your family physician for appropriate prescription). Lastly, it is impossible to examine PUD in detail on this column. I implore us to read more and be mindful of the specific points highlighted.
Dr. Davies Adeloye is a medical doctor and epidemiologist. He currently lectures at Covenant University, Ota, Nigeria