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Understanding peptic ulcers

By Admin

Added 7th May 2019 03:20 PM

Peptic ulcers are wounds that occur within the stomach and the duodenum (the first part of the intestines)

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A population survey conducted by Dr. Siraji Obayo in 2015 found a prevalence of peptic ulcers at 11%, translated as 11 people having ulcers out of every 100 sampled.

Peptic ulcers are wounds that occur within the stomach and the duodenum (the first part of the intestines)

Of late, we have been getting many questions from readers about (peptic) ulcers. While some ask about the cause, others want to know whether they can be cured or whether they should stop eating certain foods.
We got in touch with Dr. Darius Owachi, a physician (specialist in internal medicine) at Paragon Hospital in Kampala to have all your questions answered.
What are peptic ulcers?
An ulcer is a wound that occurs on the surface on the body. It can occur on the skin (the exterior surface) or internally along the lining of the digestive system.
The digestive system is a long tube within the body that is responsible for digestion and absorption of food.
It starts from the mouth, going through several parts such as the oesophagus, stomach, intestines before ending at the anus.
Peptic ulcers are wounds that occur within the stomach and the duodenum (the first part of the intestines)
 abbages are said to help with ulcers ile photo Cabbages are said to help with ulcers (File photo)


The stomach produces acid, which is important in digesting food and killing bacteria within the food. Digested food is then released into the duodenum where further digestion occurs before the food can be absorbed further downstream along the intestines.
Why do peptic ulcers occur only in the stomach and the duodenum?
The acid produced by the stomach (gastric acid) is corrosive and burns body tissues. However, the body has defense mechanisms to protect the stomach and duodenum from being injured by the acid.
In the stomach, special cells produce mucous that forms a protective barrier separating the lining of the stomach from the acidic environment.
In the duodenum, alkaline fluids are produced to neutralize the acidic pH of contents entering the intestines from the stomach.
Peptic ulcers arise when there is a breakdown in the defences of the stomach and duodenum against the gastric acid.
Some types of infections and chemicals react with the mucous barrier, weakening it and exposing the underlying vulnerable tissues to the corrosive environment.
What causes peptic ulcers?
Several factors may cause an imbalance between the defenses of the stomach against the acidic environment, for example:
H. pylori infection
80% of all cases of peptic ulcers are caused by a germ/bacterium called Helicobacter pylori (H. pylori).
This germ thrives within the acidic environment of the stomach, producing chemicals that destroy the mucous barrier of the stomach, resulting in formation of ulcers.
The mode of transmission of the infection is unknown, but generally believed to be acquired by eating or drinking contaminated food or water.
Unlike most bacterial infections which cause symptoms such as fever and body weakness, majority of people infected with H. pylori remain asymptomatic (symptom free). So, one cannot tell that they have H. pylori infection unless they develop symptoms of ulcers.
Drugs like painkillers
Painkillers, such as diclofenac, ibuprofen, and aspirin, are widely available to many people. However, these drugs are the second most important cause of peptic ulcers after H. pylori infection.
These drugs cause ulcers by inhibiting the production process of the stomach’s mucous barrier.
Ulcers caused by painkillers develop when a person takes these drugs for relatively long periods of time. Therefore, it is important that these drugs are taken with caution and under the supervision of a medical doctor.

Excessive alcohol can also bring about gastritis . (File Photo)

Excessive alcohol
The recommended daily intake of alcohol for an adult is two units for men and one unit for women. One unit of alcohol is defined as 14 grams of pure alcohol. Different alcohol drinks contain varying amounts of alcohol to volume ratio.
One unit of alcohol is equivalent to one bottle (300ml) of beer (5% alcohol) or one glass (150ml) of wine (12% alcohol) or one shot (45ml) of whiskey/gin/spirit/vodka (40% alcohol).
Heavy/excessive alcohol consumption is defined as taking more than eight units per week for women and 16 units per week for men.
Alcohol (ethanol) is easily absorbed from the stomach and small intestines, especially when taken on an empty stomach.
Excessive alcohol destroys the mucous barrier and burns the inner lining of the stomach, causing a condition called gastritis. An inflamed “burnt” stomach lining cannot produce enough mucus to protect itself, thus predisposing it to ulcers.
Cancer of the stomach
Cancer of the stomach is the third most important cause of cancer-related deaths globally.
The cause of stomach cancer is not well understood but research points towards long term H. pylori infection playing a role.
Stomach cancer tends to manifest in people above the age of 50 years. Thus, it is recommended for people above 50 years of age who experience symptoms relating to ulcers, to obtain an endoscopy procedure to rule out the likelihood of cancer.
Other factors which cause peptic ulcers include smoking, stress, some rare infections and autoimmune conditions.
How common are peptic ulcers?
A population survey conducted by Dr. Siraji Obayo in 2015 found a prevalence of peptic ulcers at 11%, translated as 11 people having ulcers out of every 100 sampled.
The same study found a high prevalence of H. pylori infection, at 76% (76 out of 100 people having the infection).
The very high prevalence of H. pylori infection does not correlate with the prevalence of ulcers, confirming the fact that not everyone with H. pylori infection will develop peptic ulcers. Majority of people remain asymptomatic and disease free[DD4] .
Signs and symptoms
Peptic ulcers tend to be chronic and cause symptoms over varied periods of time. The common signs and symptoms include:
Pain due to peptic ulcers is felt in the upper half of the tummy area above the level of the navel.
The pain is of varied intensity and is often described as sharp (like knives cutting) or fire/heart burn.
There is a close relation between onset of the pain and food/meal time; sometimes occurring when a person is hungry (possibly duodenal ulcers) or when someone is eating (possibly gastric ulcers).
Nausea and vomiting
Nausea and vomiting are common symptoms, occurring in 40% of patients. Prolonged persistent vomiting is a bad sign that indicates a possible obstruction to the passage of food exiting the stomach to the intestines and warrants urgent medical investigations.
Passing dark coloured stools
Most ulcers tend to bleed, and the patient will notice black stools. Continuous bleeding from the ulcers results in low blood volume (anaemia) that may present as tiredness, headaches, feeling of a racing heart (palpitations) and shortness of breath when doing an intense activity.
Very few people die of peptic ulcer disease unless they experience significant complications such as perforations, bleeding, anemia and stomach cancers. If these complications are not managed quickly, they may result in death in about 10-30% of cases.
Perforation of the stomach wall
This occurs when the ulcer erodes through the stomach wall, causing the acidic contents of the stomach to leak into the abdominal cavity.
The gastric acid can burn other body organs in the abdominal cavity, causing severe abdominal pain, internal bleeding and death.
This complication is a medical emergency requiring immediate surgery to close the leaking stomach wall and minimize further damage to other body organs.
Vomiting of blood
Peptic ulcers are the most common cause of vomiting blood. It occurs when an ulcer erodes into a blood vessel, causing variable amounts of bleeding.
Sometimes the bleeding is minimal and will only be realized when one’s blood drops so low (anaemia).
Other times the bleeding is massive, causing a rapid loss of blood that quickly progresses to low blood pressure, loss of consciousness and death. This is a medical emergency, requiring urgent medical intervention and resuscitation.
Persistent vomiting
Persistent prolonged vomiting indicates an obstruction to the food outlet from the stomach, a condition called gastric outlet obstruction.
This is common in stomach cancers that grow as masses and obstruct the movement of food or due to the chronic inflammation and scarring of the gastric outlet. Patients who have persistent vomiting should see a doctor urgently.
Early satiety
Early satiety is an abnormal sensation of ‘feeling full’ (early satisfaction) even after eating a small amount of food. Early satiety is a feature of gastric cancers because the growing mass within the stomach gives a false signal to the brain that the stomach is full. 
Are Peptic ulcers treatable?
Yes, peptic ulcers are treatable and curable. Your doctor will carry out tests to investigate possible causes. Remember to disclose all medications that you may be taking (currently or in the past), as these could contribute to the development of ulcers.
In some individuals, a  procedure called endoscopy performed by a gastroenterologist is recommended. This procedure involves swallowing a small plastic tube that has a light and camera at its tip. It allows the doctor to see the interior of the stomach or perform a procedure to stop bleeding from the stomach.
Ulcers are managed with a course of anti-acid treatments combined with treatment directed towards the cause. For example, if H. pylori infection is confirmed, a course of antibiotics is prescribed in combination with anti-acid medication. Avoid risk factors that cause peptic ulcers.
Should everyone with H. pylori infection be treated for ulcers ?
Despite the very high prevalence of H. pylori infection in the community, a small proportion of people develop ulcers.
Majority of people remain asymptomatic because of the strong defense systems of the stomach against the infection.
Therefore, treatment of H. pylori without evidence of ulcers becomes unnecessary, wastes health resources and increases chance of drug resistance. Treatment of H. pylori should be given to individuals who develop symptoms of peptic ulcers.
Do herbal medicines treat ulcers?
Some herbal products have medicinal properties that can relieve symptoms. However, symptom relief does not mean the cause of the disease has been dealt with.
If the causative agent has not been addressed, the individual will continue experiencing symptoms of ulcers. Therefore, we recommend that one seeks proper medical evaluation from well-trained health personnel.
Can ulcers be prevented?
Some measures can be taken to prevent oneself from developing ulcers. For example, avoid taking painkillers over a long period of time (longer than a week) without the prescription and supervision of a medical doctor.
If you have a condition that requires long-term treatment with painkillers, your doctor will prescribe an anti-acid medication.
Smoking and drinking excessive alcohol should be avoided. Do not drink beyond the recommended daily allowance.
Individuals aged 50 years and older should regularly visit a gastroenterologist for screening of stomach and colon cancers through endoscopy.
Stomach and colo-rectal cancers are both aggressive cancers that occur in people aged 50 years and older. Catching the cancers early greatly improves one’s chance of survival.
Always observe proper hand hygiene and sanitation when handling food or after visiting the toilets. Washing hands with soap before or after handling food, before eating and after visiting the toilet are  effective ways of preventing most water-borne diseases such as typhoid, some viral hepatitis and possibly ulcers.
Twitter @DrDariusOwachi

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