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Peptic Ulcers: Causes, Symptoms, and Management
Peptic ulcers occur when the protective lining of the stomach is eroded by stomach acid, resulting in open sores. These ulcers can cause stomach pain, bleeding, and other complications. Peptic ulcers are common, treatable, but should be taken seriously to avoid complications.
What Are Peptic Ulcers?
Peptic ulcers are open sores that form in the lining of the stomach (gastric ulcers) or the first part of the small intestine (duodenal ulcers). These ulcers are caused by the digestive juices in the stomach, primarily pepsin and acid, eroding the protective mucosal lining.
When the mucosal lining is compromised, stomach acid and digestive enzymes damage the stomach or intestinal walls, leading to persistent irritation and open sores. If left untreated, peptic ulcers can result in severe complications like internal bleeding or perforation of the stomach wall.
What Causes Peptic Ulcers?
The two most common causes are:
H. pylori Infection
- Helicobacter pylori is a common bacterial infection affecting up to half the world’s population.
- For many, it doesn’t cause symptoms, but in some, it leads to chronic inflammation and ulcers by damaging the stomach lining.
- H. pylori is linked to about 60% of duodenal ulcers and 40% of gastric ulcers.
Overuse of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
- Common pain relievers like ibuprofen, naproxen, and aspirin can irritate the stomach lining.
- Regular use can impair the stomach’s ability to repair itself, leading to ulcers.
- NSAIDs are responsible for up to 50% of peptic ulcers.
Less Common Causes
- Zollinger-Ellison Syndrome: A rare condition where excessive stomach acid production leads to ulcers.
- Severe Physiological Stress: Illness, burns, or injuries can trigger stress ulcers by altering the body's pH balance and increasing stomach acid.
Symptoms of Peptic Ulcers
While some ulcers may be asymptomatic ("silent ulcers"), common symptoms include:
- Burning stomach pain.
- Bloating or fullness.
- Indigestion, especially after eating fatty foods.
- Nausea and vomiting.
Ulcer Pain vs. Heartburn
- Ulcer pain is localized in the stomach or upper small intestine, while heartburn typically affects the chest area.
- Acid reflux and heartburn can coexist with ulcers and exacerbate symptoms.
Complications of Untreated Peptic Ulcers
Internal Bleeding
- Most common complication.
- Slow bleeding can cause anemia, while severe bleeding may lead to significant blood loss.
Perforation
- Persistent acid erosion can create a hole in the stomach or intestinal wall.
- This allows bacteria to enter the abdominal cavity, causing a potentially fatal condition called peritonitis.
Stomach Cancer
- Chronic H. pylori infections are associated with an increased risk of gastric cancer.
How Are Peptic Ulcers Treated?
Treatment aims to heal the ulcer, alleviate symptoms, and prevent complications. Common treatments include:
- Antibiotics: To eradicate H. pylori. Common options include amoxicillin, clarithromycin, tetracycline, or metronidazole.
- Proton Pump Inhibitors (PPIs): Reduce stomach acid and promote healing (e.g., omeprazole, esomeprazole).
- H2 Receptor Blockers: Reduce acid production by blocking histamine (e.g., famotidine, cimetidine).
- Antacids: Neutralize stomach acid and provide symptom relief.
- Cytoprotective Agents: Protect the stomach lining (e.g., sucralfate, misoprostol).
Dietary Recommendations for Ulcer Management
A diet tailored to minimize irritation can help manage symptoms and support healing.
Foods to Avoid
- Dairy: Full-fat milk, cream, and certain cheeses.
- Spicy Foods: Chili, black pepper, and mustard seeds.
- Acidic Foods: Tomato products, citrus juices.
- Caffeinated and Carbonated Beverages: Coffee, cola, and chocolate drinks.
- Alcohol and Smoking: Both increase stomach acid and delay healing.
Foods to Include
- Fruits and Vegetables: Opt for non-acidic options like bananas, apples, and leafy greens.
- Whole Grains: Brown rice, oatmeal, and whole-grain bread.
- Lean Proteins: Skinless poultry, fish, eggs, and legumes.
- Healthy Fats: Olive oil, nuts, and seeds.
| Other Foods | Spices and Seasonings | Beverages |
|---|
| Full-fat dairy products (e.g., cream, milk) | Black and red pepper | Whole milk and chocolate milk |
| Chocolate | Chili powder | Hot cocoa and carbonated drinks |
| Spicy or strongly flavored cheeses (e.g., jalapeño, pepper jack) | Mustard seeds | Any beverage containing caffeine |
| High-fat or seasoned meats (e.g., sausages, salami, bacon, cold cuts) | Nutmeg | Regular and decaffeinated coffee |
| Spicy chili peppers | – | Peppermint and mint tea |
| Tomato products (e.g., tomato paste, sauce, juice) | – | Green and black tea, with or without caffeine |
| – | – | Orange and grapefruit juices |
| – | – | Alcoholic beverages |
Lifestyle Tips for Managing Ulcers
- Avoid eating right before bedtime. Stop meals at least 2 hours before sleeping.
- Eat smaller, more frequent meals to reduce stomach irritation.
- Minimize stress through relaxation techniques, as stress can exacerbate symptoms.
Conclusion
Peptic ulcers are common and treatable, but they require prompt attention to prevent complications. A combination of medication, dietary changes, and lifestyle adjustments can effectively manage ulcers and support recovery.
If you suspect you have an ulcer, consult a healthcare provider for diagnosis and treatment. Taking proactive steps can prevent further complications and improve your quality of life.
References:
https://my.clevelandclinic.org/health/diseases/22314-stomach-peptic-ulcer