BN Doctors’ Lounge: Peptic Ulcer Disease

What is Peptic Ulcer Disease?
Breaking down your eba and edikaikong (or steak and mashed potatoes) into the basic nutrients that can be used by your body is pretty hard work and is the job assigned to an impressive array organs collectively referred to as the Gastrointestinal Tract (GIT).

This breakdown of food requires the use of powerful ‘digestive juices’ which are produced throughout the gastrointestinal tract. One of these juices- Gastric Acid is mostly comprised of pure concentrated hydrochloric acid and at its maximum secretion the acidity in the stomach is at least 3 million times greater than the surrounding tissues and organs.

Gastric acid in conjunction with the enzyme Pepsin (not to be confused with the cola drink) is so powerful that it is capable of liquefying a solid slab of beef within minutes.

Have you ever wondered what stops the stomach from digesting itself? Well, the stomach and duodenum (the first few inches of the small intestines) cleverly protect themselves from auto digestion by:

• Using a thicker reinforced kind of cell in their inner lining (tall columnar cells instead of flat epithelial cells)
• Coating their inner walls with an acid resistant layer of mucus
• Tightly regulating the concentration of the acid produced in the stomach
• Limiting the duration of contact time between the acid and the organs
• And in the case of the duodenum producing an ‘alkaline’ solution to neutralize the acid coming from the stomach

Peptic ulcer disease occurs when these protective mechanisms fail and gastric acid begins to digest the walls of the stomach or duodenum. *Ouch!* :’(

What Causes PUD
Anything that strips away the acid resistant mucus coating of the stomach will most likely lead to ulcer formation. The most implicated substances are Aspirin (and other aspirin like drugs called NSAIDs), Cigarette smoke and Alcohol. In addition any condition that causes gastric acid to stay in contact with the stomach lining for longer than necessary (delayed gastric emptying) will also predispose a patient to ulcers.

Some people produce more acid in their stomachs than others. If you have a genetic predisposition to hyperacidity, you could be more likely to develop ulcers.

The most common cause of ulcers in the stomach and small intestine is an infection with the bacteria called Helicobacter pylori. Once in the host’s body, the bacteria burrow past the stomach’s protective lining in search of food and as it digs in, it takes with it pools of acid. Over 90% of patients with duodenal ulcer and 70% of patients with gastric ulcer have a confirmed infection with H. pylori.

Symptoms of a PUD
It is important to know that each patient will have their own peculiar set of symptoms and severity. In some patients symptoms may last for an hour or two while in others it can go on for days or weeks. Generally however, patients describe a burning, peppery or chewing pain anywhere in their tummy but usually between the navel and the breastbone. Depending on how deep the ulcer has eaten, the patient may also feel pain at the back or shoulder.

Acid is released into the stomach when a person is about to eat and throughout the time they are eating, and so some patients feel pain just before they eat, during meals or immediately after eating. But acid can also collect in the stomach if a person has gone for hours without food so others feel pain only when they are hungry.

Patients in the first category may loose appetite for food completely in a bid to avoid the pain and as a result present with weight loss. Patients in the second category may tend to over eat to prevent the onset of pain and as a result present with excessive weight gain.
Some patients feel bloated or nauseated and may vomit.
More serious symptoms include –
• Vomiting blood or passing brownish-red stool and this occurs when the acid erodes into a blood vessel causing intestinal bleeding.
• Sudden severe abdominal pain and abdominal rigidity sometimes accompanied by loss of consciousness. This is caused by the ulcer perforating the entire thickness of the gastrointestinal wall and causing spillage of gastric contents into the abdominal cavity.

Did that sound like you? Oya, Hospital! Quick!

How Can the Doctor Be Certain I Have PUD?
In addition to symptoms and signs elicited on physical examination, your doctor will want to confirm the diagnosis of PUD by requesting a test for H.pylori. Also, your doctor can request for an Endoscopy which is a test where a small camera on a flexible tube is put into the stomach through the mouth to visually inspect the ulcer.

Can It Be Treated?
Most uncomplicated ulcers can be treated fairly easily and with proper care should heal within a week or two. Your doctor will prescribe an antibiotic to clear out the H.pylori infection, give you a drug that covers the stomach and small intestine with a protective acid resistant coating and then another drug to reduce the activity of the acid producing cells in the stomach. This is called the ‘Triple Therapy’
Other drugs that neutralise the hydrochloric acid in the stomach (antacids) are also useful.
Complicated ulcers that have begun to bleed or have perforated the stomach or intestinal wall would require surgical repair.

How Do I Prevent Further Episodes?
The most common cause of relapse in my experience is FAILURE TO COMPLETE THE DRUG DOSE. It doesn’t matter if you feel better after two days on your triple therapy. Keep taking it for the duration prescribed by your doctor.

Common Triggers
Some of the most commonly reported triggers in no particular order are:
Peppery or spicy foods
Cigarette smoking
Alcohol
Plantain
Cassava based foods
Gym workouts
Anger
Stress
Hunger
Aspirin and NSAIDs like Feldene™, Ibuprofen™ etc.

Patients ask me about drinking milk to stop an acute ulcer attack, in my opinion it does not work as well as an antacid would. Carry a small bottle of antacid with you for those unexpected episodes of ulcer pain.

In a Nutshell
Peptic ulcer disease is caused by a disruption in the auto-digestion protective mechanisms in the stomach and duodenum. The most common cause is an infection with Helicobacter pylori which burrows into the gastrointestinal walls taking digestive juices with it. The standard treatment for uncomplicated cases is the ‘triple therapy’ while complicated cases may require surgery.

If you suspect you have PUD, please see a physician.

Did You Know?
Intensely emotional people are said to be more likely to have ulcers. The vagus nerve which originates in the brain is responsible for acid secretion in the stomach and it can also be triggered by feelings of intense emotion including anger, jealously and believe it or not love (ever heard of butterflies in the tummy?). These strong emotions trick the vagus into activating acid secretion in the stomach causing transient or persistent hyperacidity.

Disclaimer: This article is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.
Photo Credit: 123rf.com
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David Olamide Craig is a Physician, Pastor, Photographer, Poet and Playwright. He graduated Bachelor of Medicine and Bachelor of Surgery from the University of Ibadan and holds a Masters in Occupational Health from the Institute of Occupational and Environmental Medicine, University of Birmingham. He is passionate about healthy living and sustainable energy.
When he is not seeing patients, Dr. Craig spends his time stretched out on his favourite couch, reading books, magazines, and blogs.
Catch him on www.ijgb.com.ng and follow him on twitter @RevDrCraig