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Peptic Ulcer

INTRODUCTION

Peptic ulcer is an ulcer either in the stomach or the first part of the small bowel called duodenum. Peptic ulcer is a common disease among Malaysians as well as the rest of the world. Commonly peptic ulcer will become chronic if it is not treated and may harm the general health of patients. Therefore it is important that patients with peptic ulcer to get an early treatment from the specialist specializing in the care and treatment of peptic ulcer.

Our stomach produces acid that is called hydrochloric acid that may damage the lining of the stomach. In a normal healthy individual there is a thin protective that layer that protect the stomach from the damaging effect of the acid. If there is any damage to this protective layer or increase in the production of the acid stomach wall will easily damage and eventually form an ulcer.

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Commonest symptom among peptic ulcer patients is pain or discomfort at the epigastric area. The pain or discomfort may or may not be related to meal. Occasionally patient may experience pain in the middle of the night that frequently awakens them. Other symptoms include bloatedness, nausea and vomiting. Some chronic ulcers may bleed leading to blood vomiting or blackish stool or fresh blood at defecation. Serious symptoms like this warrant an early admission to the Emergency Department.SYMPTOMS

CAUSATIVE FACTORS

Contrary to common believe spicy food and depression does not relate to the formation of peptic ulcer. However it may delay the healing process and worsen the condition. The commonest cause of peptic ulcer is Helicobacter pylori infection. Other common causes are local erosions to the stomach wall caused by non-steroidal anti-inflammatory pain killers and aspirin. Zollinger-Ellison syndrome is a condition where there is tumour either in the duodenum or the pancreas that is called gastrinoma stimulates the stomach to produce an extremely high acid thus leading to the formation of peptic ulcer.

COMPLICATIONS

The most dreaded complication from peptic ulcer is bleeding. In the usual manner bleeding peptic ulcer is managed by endoscopic means. However if endoscopy failed to arrest the bleeder, surgery is unavoidable. A non-healing peptic ulcer should be suspected for a malignant ulcer. Recurrent ulcer of severely scarred ulcer may lead to an obstructed stomach. Thus they usually presented with feeling of easily full after small amount of meal and vomiting. Some of these peptic ulcers may end up with perforation of the stomach or duodenum depending on its location. This will ultimately lead to sepsis and septic shock. Early treatment and compliance to medication will prevent such complications from happening.

TREATMENT

Treatment for peptic ulcer does not depend on compliance to medication only but a holistic approach towards total healing. There are a few category of medication for the treatment of peptic ulcer disease. Patient has to know them well and follow the medication routine accordingly.

  • Antacids – has a role to neutralize the acid in the stomach and protect the lining of the stomach from the damaging effect of the acid
  • Prostaglandin analogue – helps to improve the protective layer in the stomach thus protecting the stomach from the damaging effect of the acid
  • Histamine receptor blocker (H2 blocker) – helps to reduce acid secretion in the stomach
  • Proton pump inhibitor – totally blocks the acid secretion in the stomach
  • Antibiotic – certain group of antibiotics in combination of two of them with any type of proton pump inhibitor to eradicate the Helicobactor pylori infection

PREVENTIVE MEASURES

Proper eating habits with healthy lifestyle help to prevent the development of peptic ulcer. Abstinence from smoking and alcohol definitely helps to reduce the risk from developing peptic ulcer disease.

Since majority of peptic ulcer disease is caused by Helicobacter pylori infection, screening test for this infection can be done for a proper pre-emptive treatment to be started. There are several ways how screening for Helicobacter pylori infection can be done. They can be either with endoscopic biopsy, serum blood test and urea breath test. Eradication regimen can be started almost instantaneously if the test is positive.

Patients who are long term dependent on pain killers for any illnesses, should discuss with their doctor for a more effective pain killers that is more tolerable and less damaging to the stomach.

PEPTIC ULCER AND FASTING MONTH

During fasting acid secretion in the stomach is much less compared to normal days. Therefore there is no absolute restriction from fasting among patients with peptic ulcer disease. Not all symptoms related to peptic ulcer are due to empty stomach or fasting.

The common symptoms that occur during fasting are due to non-healthy approach at breaking of fast. A few good eating habits will definitely help to reduce the symptoms during fasting.

  1. While you are adviced to delay your meal at dawn (sahur) on the other hand you should delay your breaking of fast. After your meal at dawn (sahur) restrict yourself from sleeping as this will make exacerbate the risk of acid or food reflux into the oesopahgus. Thus you will experience epigastric pain or discomfort in the early morning.
  2. Eat moderately during breaking of fast. It is a good habit to start your breaking of fast with food that is easily digested and a fast energy provider. It will enhance the secretion of the protective layer in the stomach that makes your stomach well prepared for the next course of meal.
  3. Avoid taking caffeinated drinks like coffee and tea. These drinks increase the secretion of acid in the stomach.
  4. Seek an early treatment for Helicobacter pylori infection before the start of fasting month.
  5. Try to avoid heavily spiced food to help reduce the irritation in the already diseased stomach.
  6. Prevent yourself from taking too much food with high content of carbohydrates and fats.

REFERENCES

  1. Joo, T.H.(2010, Oktober 2010). Mengenali Ulser Peptik. Utusan Malaysia.
  2. http://www.nlm.nih.gov/medlineplus/ency/article/007501.htm
  3. www.mayoclinic.org/diseases-conditions/pepticulcer/…/con-20028643
  4. www.nhs.uk/conditions/Pepticulcer/Pages/Introduction.aspx
Last Reviewed : 23 November 2015
Translator : Dr. Mohamad Shukri b. Jahit
Accreditor : Dr. Salina bt. Ibrahim