Facts on Peptic Ulcer Disease
With Kemi Olatunde
Peptic Ulcer Disease affects the stomach, duodenum and Gastrointestinal tract (GIT). It is a disease characterised by hyperacidity and subsequent erosion (ulceration) of the affected part of the gastrointestinal tract. The true prevalence of the disease in Nigeria is not known.
You have a peptic ulcer if you get open sores in the lining of your stomach or the upper part of the small intestine. That happens when your stomach acids etch away your digestive tracts protective layer of mucus. You may have no symptoms, or you may feel discomfort or burning pain. Peptic ulcers can lead to internal bleeding, which sometimes can mean you’ll need blood transfusions in the hospital.
One can have ulcers at any age, but the chances go up as one gets older.
– Family history: some families are noted to have a strong history of PUD. Someone whose father, mother or grandparents have might come out with the disease later in life.
– Recurrent fasting: this is commonly due to religious indoctrination. During the common fasting periods among Christians for instance, a lot of Christians develop PUD.
– Drugs: excessive use of drugs such as Non – Steroids/Anti-Inflammatory Drugs (NSAIDS) which are common pain killers can result in PUD. Steroids can also cause PUD. Examples of NSAIDs are Ibuprofen, Diclofenac, Naproxen, Meloxican. Example of steroids is prednisolone
Pregnancy: some pregnant women develop reflox oesophagitis during pregnancy which in some cases may result to full blown PUD during or after pregnancy
– Eating of very spicy and peppery food, consumption of carbonated drinks.
– Excessive alcohol intake
– Consumption of herbal consumption that is mixed with local gin.
– Smoking of tobacco
Symptoms & Signs
According to the Deputy Director, Medical Services, Ondo State Primary Health Care Development Agency, Dr Tolu Ademujimi the commonest symptom of PUD is upper abdominal pain which may sometimes be referred to the chest(chest pain). The pain may also be refered to the back. The severity of the pain determines other clinical manifestations.
– Blood stain stool
– Occasional vomiting
– There can be signs of internal bleeding (bleeding into the peritoneum) in case of perforation of the affected part of the gastrointestinal tract
An untreated or poorly managed PUD can lead to;
– Perforation of the gastrointestinal tract
– Bleeding into the peritoneum (internal bleeding)
– Passage of blood in the stool
– Drugs: use of H2-receptor blockers e.g Omeprazole, Rabeprazole, Lansoprazole
use of Antacids
– Surgery: in case of perforation of the gastrointestinal tract.
Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping your ulcer to heal with medication.
Medications can include:
- Antibiotic medications to kill H. pylori. If H. pylori are found in the digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).
The antibiotics used will be determined by where you live and current antibiotic resistance rates. You’ll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol).
- Medications that block acid production and promote healing. Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix).
Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk.
- Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.
Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR).
- Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients.
Antacids can provide symptom relief, but generally aren’t used to heal your ulcer.
- Medications that protect the lining of your stomach and small intestine. In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine.
Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).
Smoking cigarettes and drinking alcohol also can make you more likely to get ulcers. But stress and eating a lot of spicy food don’t cause ulcers, as experts once thought. But they can make ulcers worse and harder to treat
Persons prone to PUD should avoid the following;
– Spicy and peppery food
– NSAIDs and steroids
– Excessive fast
– Tobacco smoking
Ulcers form when digestive juices damage the walls of the stomach or small intestine. If the mucus layer gets too thin or your stomach makes too much acid, your gut will feel it. The two major causes are:
Bacteria. It’s called Helicobacter pylori (H. pylori), and as many as half of us carry it. Most people infected with H. pylori do not get ulcers. But in others, it can raise the amount of acid, break down the protective mucus layer, and irritate the digestive tract. Experts aren’t sure how H. pylori infection spreads. They think it may pass from person to person through close contact, like kissing. You may also get it from unclean food and water.
Certain pain relievers. If you’ve been taking aspirin often and for a long time, you’re more likely to get a peptic ulcer. The same is true for other nonsteroidal anti-inflammatory drugs (NSAIDs). They include ibuprofen and naproxen. NSAIDs block your body from making a chemical that helps protect the inner walls of your stomach and small intestine from stomach acid. Other types of pain meds, such as acetaminophen, won’t lead to peptic ulcers.
You’ll most likely feel a burning pain or discomfort between your belly button and breastbone. You might especially notice it on an empty stomach — such as between meals or at night. The pain may stop for a little while if you eat or take an antacid, but then return. The pain can last for a few minutes or a few hours, and may come and go for many days or weeks.
Other symptoms may include:
- Bloated feeling
- Lack of appetite or weight loss
- Bloody or dark poop
Small ulcers may not cause any symptoms. But if you notice any of these signs, talk to your doctor.
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