Peptic ulcer disease is a break in the inner lining of the stomach or first part of small intestine. An ulcer in the stomach is called gastric ulcer while in the first part of the intestine is called a duodenal ulcer. About 5-10% of the general population develops peptic ulcer disease at some point during their lifetime, and so this being one of the common gastrointestinal diseases. The incidence of ulcer increases with age. According to a recent WHO report published in 2017, peptic ulcer disease is responsible for 0.66% of total deaths in India.
The most common symptoms are pain upper abdomen, decreased appetite, vomiting, abdominal fullness and weight loss. Pain in gastric ulcer usually worsens with eating while in duodenal ulcer its increases 60-120 minutes after meals. This pain also needs to be differentiated from other causes of upper abdominal pain like pancreatitis, gall bladder stone disease, acute myocardial infarction (heart attack) etc. Some patients present with its complication, most commonly bleeding which can be either blood vomiting or passage of fresh blood or black coloured stool. Other complications include perforation or blockage of the stomach which require surgery. Some patients may not have initial symptoms and they present with one of these complications directly. These complications can be life-threatening and so initial symptoms should not be ignored if present and medical attention should be sought upon. In later stages, gastric ulcers can lead to stomach cancers also, especially elderly individuals more than 45-50 years. So any elderly individual with above-mentioned symptoms should be evaluated properly and treated accordingly.
Common causes of peptic ulcer disease include Helicobacter pylori infection – a type of bacteria or use of analgesics. Some other rarer causes include Crohn’s disease and tuberculosis. Factors like tobacco chewing, smoking and consumption of alcohol increases the risk of ulcer disease. The incidence of ulcer disease increases more than two folds in individuals with smoking and alcohol consumption and also the complication rate increases. Stress and anxiety have also been associated with an increased risk of ulcer disease and its complications. Older patients are more sensitive to the effects of analgesics and particularly if they are taking blood-thinning cardiac drugs.
Peptic ulcer disease can be diagnosed easily on upper GI endoscopy which is usually an OPD procedure. H. pylori infection can be confirmed by rapid urease test (bedside small biopsy test) during endoscopy. Sometimes biopsy is required to rule out cancer. Sometimes breath test or stool examination can also be done for H.pylori infection.
Treatment includes stopping of analgesics and other risk factors like smoking, tobacco and alcohol and taking medications to reduce the acid level in the stomach. A course of antibiotics is required for Helicobacter pylori infection. Complications of peptic ulcer disease like bleeding can be tackled most often during endoscopy and bleeding stops in around 95 % of the cases. Few cases may require surgery for uncontrolled bleeding, perforation and stomach blockage. Avoidance of spices in the diet has a minor beneficial effect.
Recurrence of disease can be prevented by avoidance of analgesics, smoking, alcohol and tobacco. A proper hygienic home-based diet is recommended. Individuals with upper abdominal symptoms should take medical advice for early detection of disease and to avoid complications.