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Last week I saw an elderly lady from Gumare who presented to me with what I assessed as probable peptic ulcer disease. This incident highlighted two things for me; one that our health care system is overstretched in terms of human resources as well as the fact that peptic ulcer disease though common is often not appropriately treated. My encounter with this lady provided inspiration for this week’s article.
Peptic ulcers are open sores that develop in the lining of the stomach as well as the first part of the small intestines. They are classified as gastric (stomach) and duodenal (first part of small intestines) ulcers.
The commonest cause of peptic ulcer disease is long-term use of a group of medications that we refer to as non-steroidal anti-inflammatory drugs (NSAIDs). Some examples of this drugs include; ibuprofen, naproxen and celecoxib. These medications can cause the lining of the stomach and intestines to be weak and prone to injury. However not everyone who takes NSAIDs will develop ulcers. Ulcers are more likely to develop with prolonged use, in elderly females and if NSAIDS are taken with other medications like corticosteroids.
Another common risk factor for developing ulcers is infection with a bacteria called Helicobacter Pylori (H. pylori). The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissue and cause ulcers.
Other risk factors for the development of ulcers are a family history of ulcers, smoking , regular alcohol drinking, liver and kidney disease and excessive stress.
The commonest symptom of ulcers is burning pain in the middle or upper part of the stomach. This pain is usually worse at night, and depending on the type of ulcer this pain may be relieved by eating or made worse by food. Other symptoms include nausea, vomiting and bloatedness. When severe it can result in dark or black stools due to bleeding and weight loss.
The diagnosis of peptic ulcers involves taking a detailed history. It is difficult to differentiate between gastric and duodenal ulcers based on history however they are features that can be suggestive of each. They must be testing done for H pylori which I mentioned is a bacteria that can predispose one to ulcers. In patients with severe symptoms or concerning symptoms then they must be referred for a procedure called an endoscopy. An endoscopy is a procedure where by a small flexible camera connected to a tube is inserted via the mouth in order to visualise the stomach and intestines lining.
The management of peptic ulcers involves mitigation of modifiable risk factors such as smoking, alcohol use and use of NSAIDs. Patients with ulcers should use alternative painkillers that will not cause or make ulcers worse. They are also usually given medications to eradicate the Pylori infection. In addition to this patients are also given medications that reduce acid levels in the stomach in order to give ulcers a chance to heal.
