A peptic ulcer is a wound (from 'ulcus' = ulcer), a lesion of the inner wall of the digestive canal, of its inner lining

Peptic ulcer: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Jun 19, 2023

Let’s talk about peptic ulcer. Peptic ulcers are open wounds that develop on the inner lining of the stomach or the upper part of the small intestine, the duodenum

Peptic ulcers include both gastric ulcers, which are located inside the stomach, and duodenal ulcers, which occur inside the upper part of the small intestine.

In each case, the most common symptom of this disease is pain in the stomach.

The most common causes of peptic ulcers are infection with Helicobacter pylori (H. pylori) and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium.

Stress and spicy foods can worsen symptoms.

Peptic disease

The term ulcer refers to a loss of substance in the most superficial layer of the mucous membrane of the stomach or duodenum.

In some cases, the wound may progressively worsen and go deeper, reaching the submucosa and the muscle layer.

Sometimes, it may even perforate a viscera.

It is important to know that under normal conditions, the mucous membrane has sufficient natural defences to protect it from the action of the gastric juices, which are intended to facilitate the digestive process of food but are highly acidic.

These defences are essentially: the mucus lining the inner walls of the stomach – combined with defence agents and mechanisms such as prostaglandins (special substances produced by stomach cells) – and blood flow (covers the superficial layer of tissue, counteracting acidity).

In the case of ulcers, these defences fail and/or function abnormally.

The result is that the mucous membrane is eroded by the corrosive action of the gastric juices.

In practice, the acids can create a painful open wound that can bleed.

Causes of peptic ulcer

Several causes may underlie this disease.

The most common one is Helycobacter pylori, a bacterium: if it gets into the stomach and manages to insert itself between the mucus and the gastric wall, thus avoiding the attack of the stomach acid, it spreads, ends up disrupting the balance of the mucous membrane and triggering a chronic infection.

The micro-organism insinuates itself into the cells lining the inside of the stomach and duodenum, releasing a series of substances that can damage the mucous membrane layer.

How H. pylori infection spreads is unclear.

It is speculated that the bacterium can be transmitted from person to person by close contact or even through food and water.

The regular use of certain drugs, such as some over-the-counter painkillers and non-steroidal anti-inflammatory drugs (NSAIDs), which can irritate or inflame the lining of the stomach and small intestine, is also under attack.

Peptic ulcer, risk factors

There are also a number of factors that contribute to the occurrence of the disease.

The main ones are:

smoking, which can increase the risk of peptic ulcer especially in people infected with H. pylori;
psychological stress,
alcohol abuse, since alcohol can irritate and erode the mucous lining of the stomach and increases the amount of gastric acid produced;
an overly fatty, spicy and/or spicy diet.

The disease can also be a consequence of gastritis.

Peptic ulcer, symptoms

The main symptoms of this disease are

burning in the stomach, which worsens when the stomach is empty;
feeling of fullness
bloating;
belching;
nausea.

The pain can often be relieved by eating foods that buffer the stomach acidity or by taking a medication that reduces the acidity, but then it can recur.

The pain may be worse between meals and at night.

Less often, ulcers can cause serious signs or symptoms such as: intolerance to fatty foods; vomiting, including of blood; dark blood in the stool or black or tarry stools; breathing problems; feeling faint; unexplained weight loss; change in appetite.

It must be said that many people with peptic ulcers do not even have symptoms.

Complications

If left untreated, peptic ulcers can cause

internal bleeding: bleeding may manifest itself as a slow loss of blood leading to anaemia or as severe blood loss that may require hospitalisation or a blood transfusion,
severe blood loss may cause black or bloody vomiting or black or bloody stools;
a perforation in the wall of the stomach or small intestine, which can trigger a severe infection of the abdominal cavity (peritonitis);
obstruction: peptic ulcers can block the passage of food through the digestive tract. As a result, the person may feel full easily, vomit and lose weight due to swelling due to inflammation or scarring;
gastric cancer: studies have shown that people infected with H. pylori have an increased risk of gastric cancer.

A gastroenterological examination may then be useful.

Treatment of peptic ulcer

Treatment of peptic ulcer generally involves the use of two types of drugs:

drugs that can significantly reduce gastric and dudodenal acid secretion. These are essentially proton pump inhibitors. The common antacids, usually based on aluminium hydroxide and magnesium, in fact only act against the symptoms and are of little use in treating Helicobapter pylori, so they should only be used in limited cases to ease the pain;
anti-ulcer drugs, also called anti-H2 antihistamines, which decrease the amount of hydrochloric acid present in the digestive system, thus relieving the pain caused by the ulcer and accelerating the healing process.

Both of these should be used in combination with antibiotics, which are needed to combat the Helycobacter pylori infection.

When surgery is needed

In some cases, surgery is necessary.

In particular, surgery is needed if the ulcer does not heal despite treatment, if repeated bleeding occurs, if the ulcer perforates or is at risk of perforating, if pylorus narrowing has occurred.

Generally, only the terminal portion of the stomach, located immediately before the pylorus (antrectomy), or 3/4 of the stomach is removed.

The remaining portion of the stomach is then connected to the intestine (gastroenterostomy).

Rules for preventing ulcers

To counteract the onset of an ulcer or to alleviate its symptoms, it is good to follow a few rules:

give up cigarettes: smoking is also harmful to the stomach and duodenum, because it slows down the healing of mucosal lesions;
avoid hard liquor, because it irritates the gastrointestinal mucosa;
do not abuse drugs: without a doctor’s advice, it is better to moderate the use of anti-inflammatory drugs;
eat meals at regular times,
avoid food excesses,
beware of foods that are overly seasoned, rich in spices or excessively hot or cold, so as not to damage the mucous membranes.

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