Peptic Ulcers: They are subtle but can be dangerous if untreated

Jun 02, 2019 Dr Zulfikar Bux, Features / Columnists

By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine

A peptic ulcer is a sore that forms when digestive juices wear away the lining of the digestive system. A peptic ulcer can occur in the lining of the stomach (gastric ulcer), duodenum (duodenal ulcer), or lower part of the esophagus (esophageal ulcer). Symptoms can include indigestion-like pain, nausea, and weight loss.
Globally, it is estimated that up to 10 percent of adults are affected by peptic ulcers at least once in their lifetime. It is also very common in Guyana and can lead to serious long term complications if left untreated.
Today we will discuss this condition and will refer to it as “ulcer” in the rest of this article for convenience sake.

WHAT ARE SYMPTOMS OF AN ULCER?
Common ulcer symptoms include:
• Discomfort between meals or during the night (duodenal ulcer)
• Discomfort when you eat or drink (gastric ulcer)
• Stomach pain that wakes you up at night
• Feel full fast
• Bloating, burning or dull pain in your stomach
• Comes and goes days or weeks at a time
• The discomfort lasts for minutes or hours
If your ulcer becomes perforated, it becomes a bleeding ulcer. This can cause the following symptoms:
• Nausea
• Vomiting blood
• Unexpected weight loss
• Blood in your stool
• Pain in your back

WHAT CAUSES AN ULCER?
Most ulcers are cause by Heliocobacter pylori (H. pylori) bacterial infection. It lives in the affected area and slowly eats away the lining and walls of the intestine. Acids from the foods we eat can make the pain and discomfort worse. Long-term use of aspirin or anti-inflammatory medicines (ibuprofen, diclofenac etc.) can cause ulcers. Smoking, constant alcohol and/ caffeine consumption are also causative factors for peptic ulcers. Stress and spicy foods can make an ulcer worse.
HOW IS AN ULCER DIAGNOSED?
Your doctor will ask you about your symptoms. He or she may do an endoscopy. This procedure involves inserting a thin, flexible tube attached to a camera down your throat and into your stomach. Your doctor will test your blood, breath or stool for H. pylori. He or she also can test a sample of your stomach lining. Your doctor also will ask you if you regularly take aspirin or anti-inflammatory medicines.
CAN AN ULCER BE PREVENTED OR AVOIDED?
It is very difficult to prevent an ulcer caused by an H. pylori infection. However, you can reduce your risks by limiting aspirin and anti-inflammatory medicines. Avoid foods that are acidic (orange juice) and spicy to reduce discomfort. Avoid caffeine and alcohol.
HOW IS AN ULCER TREATED?
Your doctor will give you an antibiotic medicine to treat an H. pylori infection if its present. You will have to take it for two to three weeks. Your doctor also might suggest triple therapy. This is a combination of an antibiotic and an antacid. Your doctor might also suggest medicines to reduce stomach acids. You may have to take these for up to 8 weeks. Several other medicines can be used to help treat ulcers. Two types of medicines known as H2 blockers and proton pump inhibitors, reduce the amount of acid that your stomach makes. Over-the-counter antacid medicine provides temporary relief. Smoking and alcohol make the discomfort worse. In severe cases, you may need surgery. Ulcers get worse without treatment. If aspirin and anti-inflammatory medicine irritates your stomach, your doctor may suggest a medicine to help alleviate this.
WHAT ARE COMPLICATIONS OF ULCERS?
If untreated, ulcers can result in the following complications:
• Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
• Infection. Peptic ulcers can eat a hole through the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity that can kill you.
• Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight through either swelling from inflammation or scarring.
As you can see, leaving an ulcer untreated can have dire long term consequences. If you are having symptoms that are suggestive of an ulcer, get checked out and prevent these long term complications.

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