Peptic ulcer disease

Peptic ulcers most commonly occur in the duodenum or the stomach. Ulcers occur as a result of an imbalance between the amount of acid secreted and the amount or quality of the protective mucus secreted by the lining of the stomach/duodenum.

Causes of peptic ulcer disease include the following:

• Helicobacter pylori (a Gram-negative bacterium) is a causative factor in up to 90% of all peptic ulcers. H. pylori are present in 50% of people and asymptomatic in the vast majority. It can, however, lead to chronic gastritis (inflammation of the lining of the stomach). This inflammation can allow stomach acid and the digestive enzyme pepsin to overwhelm the mechanisms that protect the stomach and duodenal mucous membranes and cause ulcers to develop.
• Another major cause is the use of non-steroidal anti-inflammatory drugs (NSAIDs) and steroid treatment. The stomach lining usually protects itself from acid exposure by secreting mucus. NSAIDs can severely diminish the amount of mucus secreted, leading to ulcers forming. Peptic ulcers are common in older adults who regularly take pain medications to ease pain or for osteoarthritis.
• Smoking, alcohol, diet and caffeine could also be contributing factors.

What are the symptoms of peptic ulcers?

Peptic ulcer symptoms can vary greatly from patient to patient. Typical symptoms can include any of the following:

• Epigastric pain (gnawing or burning in nature)
• Can either relieve or worsen with food intake depending on the site of the ulcer
• Bloated
• Nausea
• Vomiting
• Haematemesis (vomiting of blood)
• Melena (black, tarry stools)
• Loss of weight or appetite
• Fatty food intolerance
• Heartburn

The diagnosis of peptic ulcers is usually suspected based on the patient's history and can be confirmed by doing a gastroscopy. During the gastroscopy procedure, Dr Cooper will take a tissue sample of your stomach’s lining to determine whether Helicobacter pylori needs to be eradicated and to exclude the presence of cancer if clinically indicated.

How are peptic ulcers treated?

Even though in some cases, peptic ulcers can heal on their own, left untreated, the ulcers may reoccur. Treatment of peptic ulcers has been revolutionized with the introduction of proton pump inhibitors (a specific class of drugs that effectively inhibit gastric acid secretion) and understanding the role of Helicobacter pylori. Medical treatment (1 month of a PPI and 2 of the following antibiotics: Amoxicillin 1gm bd, Clarithromycin 500mg bd or Metronidazole 400mg bd) will heal >90% of all ulcers. Dr Cooper may perform emergency surgery to treat peptic ulcers if the ulcers have created a hole in the stomach’s wall (perforation) or if they cause serious bleeding. Elective (planned) surgery for peptic ulcers is rarely performed these days and is mostly reserved for the complications of peptic ulcers such as:

• Bleeding (where endoscopic therapies have failed)
• Perforation
• Obstruction (the outlet of the stomach can close up due to fibrosis)
• Fistula (the ulcer can erode into another organ, i.e. the colon)
• Non-healing / persistent ulcers (raises the possibility of cancer)