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Stomach ulcer and duodenal ulcer (peptic ulcer)

The peptic ulcer , also called gastric ulcer is located in the stomach and is called duodenal ulcer as it forms in the duodenum (first part of the small intestine) are sort of wounds form erosion that penetrates deeply into the wall of the digestive tract.

These wounds are often painful: they come into direct contact with the acid present in the digestive tract. A situation comparable to the application of an alcohol swab on a scratch.

The term “peptic ulcer”includes, because of the similarity of their manifestations, gastric ulcer and duodenal ulcer

It is estimated that about 10% of the population in the industrialized world is likely to suffer from an ulcer at some time. People aged 40 and over are the most affected. The ulcers of the duodenum are 10 times more frequent than the ulcers of the stomach.

Causes of Stomach ulcer

The bacterium Helicobacter pylori (H. Pylori), a bacterium that survives acidity, is the leading cause of ulcers: it causes approximately 60% to 80% of stomach ulcers and 80% to 85% of stomach ulcers. Duodenal ulcers. These bacteria invade the mucus layer that normally protects the stomach and small intestine from acidity, and would disrupt this protective mechanism in some people. In industrialized countries, 20% of people aged 40 and under have these bacteria in their digestive tract. A proportion that reaches 50% among over 60s. About 20% of carriers of the bacteria will have an ulcer during their lifetime.

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Taking nonsteroidal anti-inflammatory drugs or NSAIDs (eg, aspirin, Advil, and Motrin) is the second most common cause of digestive tract ulcers. The combination of infection with H. pyloribacteria and the use of anti-inflammatory drugs increase the risk of ulcer in a synergistic manner. The risk is then 60 times greater.

Here are other causes:

  • Excessive production of acid by the stomach (gastric hyperacidity), attributable to smoking, excessive alcohol consumption, high stress, hereditary predisposition, etc. However, these may be aggravating factors rather than true causes of ulcers.
  • severe burn, the injury substantial or physical stress of a serious illness. It creates “constraint ulcers”, which are often multiple and are most often in the stomach, sometimes at the very beginning of the small intestine (the proximal duodenum).
  • More rarely, a stomach ulcer may be a stomach cancer that has ulcerated.
Acids and antacids in the digestive tract

In the lining of the stomach , glands secrete gastric juices that contribute to digestion  :

  • of digestive enzymes , such as pepsin , which fragment the proteins into smaller molecules, peptides;
  • Of hydrochloric acid (HCL), a strong acid which allows digestive enzymes to be active and destroys most of the microbes (parasites, viruses, bacteria, fungi) that would be introduced into the stomach.

The contents of the stomach are always acidic. Its pH varies from 1.5 to 5, depending on the food intake and also according to the individuals.

Other glands secrete mucus to protect the inner walls of the stomach:

  • This mucus prevents digestive enzymes and hydrochloric acid from destroying the stomach wall by forming a protective film.

The wall of the small intestine is also covered with a layer of mucus that protects it from the acidity of the chyme, a name given to the “food porridge” that comes from the stomach.

Evolution

Usually, an ulcer appears gradually in a few weeks. It can also manifest itself quickly after a few days of taking nonsteroidal anti-inflammatory drugs, for example, but this situation is not very common.

The rate of spontaneous healing could be around 40% (over a period of 1 month), especially if the ulcer was caused by taking NSAIDs and stopped taking them. Final spontaneous healing, without relapse, is however rare. Smokers are more likely to relapse than nonsmokers.

If the ulcer is not treated or the cause is not stopped, there is a strong possibility that the ulcers will reappear within one year. But even with good treatment, there is recurrence in 20-30% of cases.

Possible complications

Complications are relatively rare. The ulcer can cause bleeding, so the blood flows into the digestive tract. The hemorrhage is sometimes massive, with vomiting of red blood or similar to coffee beans, with blood in the stool that can be red or black. Bleeding can also be low noise and relatively slow. It will be noticed or not that the stools become black. Indeed, under the influence of digestive juices, the blood becomes black. Bleeding can cause anemia over time if it is not detected. The first symptom of the ulcer may be hemorrhage, with no previous pain, especially in older subjects. You must consult a doctor without delay.

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Another complication, much less common than haemorrhage, is the complete perforation of the digestive tract wall. This situation causes violent abdominal pain, which worsens rapidly in peritonitis . This is a medical and surgical emergency.

Symptoms of stomach ulcer and duodenal ulcer (peptic ulcer)

GENERAL SYMPTOMS

  • A recurrent burning sensation in the upper part of the abdomen.
    In case of stomach ulcer, the pain is aggravated by eating or drinking.
    In case of duodenal ulcer, the pain subsides at mealtime, but increases from 1 to 3 hours after eating and when the stomach is empty (overnight, for example).
  • The feeling of being quickly satiated.
  • Belching and bloating.
  • There is sometimes no symptom before the occurrence of bleeding.

Signs of aggravation

  • Nausea and vomiting.
  • Blood in vomiting (coffee color) or stool (black).
  • Fatigue
  • A loss of weight.

Note. In pregnant women with ulcers, symptoms tend to go away during pregnancy because the stomach is less acidic. However, burningnausea, and vomiting can occur late in pregnancy due to the pressure of the fetus on the stomach. In this regard, see our report Gastroesophageal reflux.

People at risk for Stomach ulcer

  • The women aged 55 and older, for stomach ulcers.
  • The men aged 40 and over, for duodenal ulcers.
  • Some people may have a hereditary predisposition to peptic ulcers.

Risk factors

Some factors may aggravate or delay the healing of ulcers by making the stomach more acidic:

  • smoking;
  • excessive alcohol consumption;
  • the stress ;
  • The coffee does not appear to be involved, according to a study conducted in Japan in 2013.
  • In some people, eating may make the symptoms worse
    – drinks: tea, milk, cola drinks;
    – foods: fatty foods, including chocolate and meat concentrates;
    – spices: black pepper, mustard seeds and nutmeg.
  • Some drugs like anti-inflammatory, cortisone, bisphosphonates (used for osteoporosis), and potassium chloride.
The hot pepper: to banish?

People with stomach ulcers or duodenum have long been advised not to consume hot peppers because of their pungent and “hot” effect, which could exacerbate their pain.

However, studies seem to show that hot peppers do not cause additional damage to the digestive tract. They could even have a protective effect. In addition, using spiced cayenne pepper, even in large quantities, would not aggravate ulcers. However, caution should be exercised with capsaicin capsules (the substance that gives chilli its pungent taste) and other concentrates, which may contain much higher amounts of capsaicin than the food.

Prevention of stomach ulcer and duodenal ulcer (peptic ulcer)

Measures to prevent ulcers

It is important to use nonsteroidal anti-inflammatory drugs or NSAIDs (aspirin, Advil®, Motrin, etc.) appropriately. Otherwise, they may cause heartburn, or even a peptic ulcer, the first symptom of which may be haemorrhage. Sensitivity to these drugs varies from person to person, including age, dose and duration of use.

Here is some useful information. For more information, ask your doctor or pharmacist for advice.

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  • Sometimes, to relieve pain (headache, muscle pain, joint pain, etc.); it is better to take acetaminophen (Tylenol ) or another medicine that your doctor will suggest.
  • If you must take anti-inflammatory, observe the recommended dosage and duration of treatment. NSAIDs should not be used for several weeks without a clear medical prescription.
  • It may be advisable to use anti-inflammatory together with an antacid drug, which prevents heartburn, or with a cytoprotective , such as misoprostol (Cytotec). The latter is however contraindicated during pregnancy.
  • Anti-inflammatories are divided into 2 main categories: the classics (Advil, Motrin, Naproxen …) and coxibs (Celebrex, Mobicox). These have a more specific action and have less risk of adverse effects on the stomach.
  • Beware of taking Alka-Seltzer (containing aspirin) and Pepto-Bismol (containing bismuth subsalicylate) to relieve the symptoms of ulcers, which can sometimes make them worse, in some individuals.
  • Bisphosphonates (such as Actonel, Fosamax), medicines to treat osteoporosis, can sometimes cause ulcers.

Note that currently there is no way to prevent infection with Helicobacter pylori bacteria.

Measures to decrease symptoms

  • Take several small meals at regular intervals, eat slowly and chew each bite. Do not leave the stomach empty for a long time helps to reduce the symptoms.
  • Avoid drinking while eating.
  • Avoid eating before going to bed.
  • It is important not to smoke, as tobacco use delays and may even prevent the healing of gastric mucosal lesions.
  • If necessary, be sure to reduce your stress level by understanding the origin and making the appropriate changes to your life (work, a specific situation, a relationship, etc.). Although stress does not cause ulcers, it is believed to be an important aggravating factor. See our report Stress and anxiety.
  • Be aware of foods and drinks that make your symptoms worse. Alcohol, tea, milk and dairy products, chocolate, cola drinks, some spices (black pepper, mustard seed, nutmeg), as well as high- fat foods cause pain in many people. Avoid them or consume a small amount with other foods.
  • The consumption of yogurt and honey contributes to the healing of peptic ulcers.
  • Before you consume a natural health product orally, make sure it does not aggravate your ulcer. The devil’s claw, for example, is contraindicated in cases of gastric or duodenal ulcers.

Medical treatment of stomach ulcer and duodenal ulcer (peptic ulcer)

It is necessary to treat energetically as soon as the diagnosis is made. Usually, the medical treatment of the ulcer does not differ, whether it is gastric or duodenal.

The therapeutic approach aims to:

  • reduce the acidity of the stomach , to relieve pain;
  • Treat infection by the bacterium Helicobacter pylori, which also help to prevent recurrences.

Before treating, the doctor must still determine if it is a stomach ulcer or a duodenal ulcer. If the ulcer is in the stomach, a tissue sample (near the ulcer) will be made to rule out the small possibility that it is stomach cancer. Duodenal ulcer, for its part, is almost always benign. The examinations consist of a barium meal (an ingestion of barium, a chalky liquid), followed by an X-ray of the abdomen to visualize the ulcer, or a gastroscopy. Gastroscopy involves inserting a long flexible tube with a minicamera through the mouth to observe the walls of the stomach and duodenum.

Pharmaceuticals

The following drugs, often used in combination, lead to the healing of more than 90% of ulcers in 4 to 8 weeks.

To decrease the acidity

H2 antihistamines. These drugs reduce the amount of acid produced by the stomach. This helps protect the affected area to give it time to heal. H2 refers to histamine receptors. The drug binds to histamine receptors to prevent their activation. Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac) belong to this class of drugs. It is possible to buy them over the counter in a pharmacy.

Inhibitors of the proton pump. These medications (omeprazole (Losec), lansoprazole (Prevacid), pantoprazole (Pantoloc), rabeprazole (Pariet) and esomeprazole (Nexium) reduce the acidity of the stomach even more effectively H2-based antihistamines, which work by inactivating the “pumps” that produce hydrochloric acid, also inhibit the growth of H. pyloribacteria .

Antacids. Antacids (Maalox, Mylanta, Gaviscon, etc.) do not reduce acid secretion, but neutralize acid in the stomach, which relieves pain. They take longer to act than H2 blockers and proton pump inhibitors.

To treat the infection

Blood, stool or breath tests, and sometimes a gastric wall biopsy made during the gastroscopy will allow the doctor to know whether or not there is infection with H. pylori bacteria.

Antibiotics. If the ulcer is caused by H. pylori infection, the doctor usually prescribes 2 antibiotics for a period of 7 to 14 days. The most commonly used antibiotics are amoxicillin (Amoxil), clarithromycin (Biaxin) and metronidazole (Flagyl). The 2 antibiotics are often combined with another acidity drug (see above) or even with bismuth (Pepto-Bismol), this antacid can also help fight infection. This treatment helps to eradicate the bacterium and heal the ulcer in about 80% of cases. If symptoms return, a second treatment is usually recommended. Unfortunately, even when peptic ulcer is well healed, it can reappear a few months later (this is the case about 1 time out of 5).

Important. Take the full antibiotic medication as prescribed, even if the symptoms are no longer present.

In case of ulcers caused by anti-inflammatories

The doctor will probably recommend that you stop taking nonsteroidal anti-inflammatory drugs (NSAIDs). This is usually enough to make the ulcer disappear, but an H2 antihistamine or a proton pump inhibitor is usually prescribed for a few weeks.

Other drugs that are less harmful to the stomach may be used to replace NSAIDs, as appropriate.

Life habits

In addition to taking the drugs, it is also very important to change some lifestyle habits, for example, smoking and drinking alcohol, which damage the lining of the digestive tract. There is usually no special diet to follow except to avoid foods that seem to cause irritation.

The medical treatment of the ulcer may require a specific diet prescribed by the doctor, advocating, excluding or limiting certain foods.

Surgery

Only in case of failure of the drug treatment or in case of complications , such as a complete perforation of the gastrointestinal wall by the ulcer or a gastrointestinal obstruction refractory to the drugs, or a serious haemorrhage which does not respond to the treatment.

Followed

At the end of the treatment, ulcer healing can be ensured by endoscopy (direct visualization of the digestive tract by means of a fiberscope).

A maintenance treatment lasting 4 to 6 months can be prescribed to prevent the appearance of a new ulcer.

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Updated: September 26, 2018 — 1:49 pm

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