Peptic ulcer disease

Several factors increase the likelihood of developing PUD:

• H. pylori infection
• Advanced age
• Regular and unnecessary use of NSAIDs
• Long-term use of medications like glucocorticoids and anticoagulants
• Underlying health conditions such as lung, kidney, or liver disease
• Smoking
• Excessive alcohol consumption
• Family history of ulcers
• Hispanic or African American ethnicity

The doctor will begin by asking about symptoms and whether the patient has used NSAIDs. They may also test for H. pylori infection.

Tests for H. pylori infection:

• Urea breath test: The patient consumes a drink containing urea, and their breath is analyzed for the presence of carbon dioxide, which indicates the presence of H. pylori.
• Stool antigen test: A stool sample is tested for the bacteria.
• Helicobacter pylori IgG test: A blood test is conducted to detect antibodies against H. pylori.

Gastroscopy:

This procedure involves inserting a thin, flexible tube with a camera into the mouth to inspect the inside of the stomach and duodenum. This is usually an outpatient procedure, and it allows the doctor to observe the mucosal lining and take tissue samples for biopsy to check for malignancy or H. pylori infection.

Preventing peptic ulcers can be challenging due to the uncertainty surrounding how Helicobacter pylori spreads and why some individuals develop ulcers without the infection. Researchers and healthcare professionals are working towards developing a vaccine for PUD. However, there are several preventive measures that can help reduce the risk:

Avoid Irritants

The foods you consume directly affect your stomach. It's important to avoid foods that are known to irritate the stomach lining, such as spicy, oily foods and citrus fruits.

Quit Smoking

Smoking increases the risk of developing duodenal ulcers. If you're a smoker, quitting is crucial for your health. If you're finding it hard to quit despite efforts, consider seeking guidance from a counselor.

Control Alcohol Intake

Excessive alcohol consumption can lead to the formation of peptic ulcers and other serious health issues. It's advisable to limit alcohol intake, or ideally, stop drinking altogether.

Limit Painkiller Use

Many individuals take pain relievers, especially NSAIDs, unnecessarily. Taking these drugs without food increases the likelihood of developing ulcers. To protect your stomach's lining, always take NSAIDs with food and only when necessary.

Manage Stress

Engaging in regular exercise and practicing meditation can help reduce stress levels, which is important in preventing ulcers. Additionally, adopting a balanced lifestyle, including eating healthy meals at regular intervals, staying hydrated, and ensuring good sleep quality, can also reduce the risk.

Specialists to Consult

If you experience symptoms of peptic ulcers, it’s important not to ignore them. If you rely on acid blockers or over-the-counter antacids but still experience recurring pain, seek medical attention immediately.

Specialists to consult include:

• General physician
• Gastroenterologist
• Gastrointestinal surgeon
• Pediatrician (for children)

Upon diagnosis of peptic ulcer disease, the treatment approach will depend on the underlying cause. With proper treatment, ulcers typically take about one to two months to heal.

For ulcers caused by Helicobacter pylori infection and/or NSAID use, your doctor will likely prescribe antibiotics and proton pump inhibitors (PPIs). If NSAIDs are the sole cause, your doctor may recommend PPIs and, occasionally, H2-receptor antagonists. Antacids may also be prescribed for short-term relief from symptoms.

After treatment, a follow-up gastroscopy may be suggested, typically 4 to 6 weeks later, to ensure that the ulcer has healed.

Medications

Antibiotics

• If H. pylori is the cause of the ulcer, antibiotics will be prescribed to eliminate the infection. Possible side effects may include diarrhea, nausea, and a metallic taste in the mouth. Common antibiotics used are:
• Amoxicillin
• Clarithromycin
• Metronidazole
• Tetracycline
• Nitroimidazole
• Levofloxacin
• Doxycycline

Proton Pump Inhibitors (PPIs)

• These medications reduce stomach acid production to prevent further damage to the ulcer. Treatment usually lasts for 4 to 8 weeks. PPIs are generally well-tolerated, but they can cause side effects such as nausea, diarrhea, constipation, headache, stomach pain, and dizziness.
• Long-term use of PPIs can potentially lead to kidney problems, hypomagnesemia, or Clostridium difficile infections.
• Common PPIs include:
• Omeprazole
• Pantoprazole
• Rabeprazole
• Lansoprazole

H2-Receptor Antagonists

• H2 blockers, similar to PPIs, reduce stomach acid production. They are often prescribed when PPIs aren’t suitable. Possible side effects include stomach pain, dizziness, headaches, constipation, diarrhea, and rashes. Common H2 blockers include:
• Famotidine
• Nizatidine

Antacids

• For immediate relief from acidity, antacids can neutralize stomach acid. Some may contain alginate, which forms a protective coating on the stomach lining. However, antacids have side effects such as nausea, bloating, constipation (with aluminum-based preparations), diarrhea (with magnesium-based preparations), and stomach cramps.

If NSAID use is the cause of your ulcer, your doctor may suggest alternative painkillers like paracetamol, which does not affect the stomach lining. In some cases, a COX-2 inhibitor (a specific type of NSAID) may be recommended.

If you're on low-dose aspirin to prevent blood clots, consult your doctor to determine whether you should continue using it.

Surgery

In cases where medications don’t work or if you're non-compliant with treatment, surgery may be necessary. Surgical options include:

• Vagotomy: Cutting branches of the vagus nerve to reduce gastric acid production.
• Antrectomy: Removal of part of the stomach to help prevent ulcers.
• Pyloroplasty: Widening the stomach’s exit to allow food to move more freely into the small intestine.
• Artery Tying Off: If the ulcer is bleeding, an artery supplying the ulcer may be tied off to stop the bleeding.

In most cases, peptic ulcer disease (PUD) does not lead to any complications. However, if left untreated or undiagnosed, it can cause serious complications. Below are the potential complications associated with PUD:

Internal Bleeding

Internal bleeding is the most common complication of peptic ulcers. It typically occurs when the ulcer is located near a blood vessel. There are two types of internal bleeding:

• Chronic, slow bleeding: This can lead to anemia, pale skin, shortness of breath, rapid heart rate, and fatigue.
• Rapid bleeding: This may result in vomiting blood or passing black stools.

Perforation

Although rare, a perforation can be extremely painful. It occurs when the protective lining of the stomach is breached, allowing bacteria to enter the abdominal cavity and cause an infection known as peritonitis. If untreated, peritonitis can spread to the bloodstream, leading to sepsis and potentially multiple organ failure.

Gastric Outlet Obstruction

A scarred or inflamed ulcer can obstruct the passage of food through the digestive tract, leading to gastric outlet obstruction. Symptoms may include:

• A constant feeling of fullness or bloating
• Vomiting undigested food
• Unexplained weight loss

Cancer

Helicobacter pylori infection increases the risk of stomach cancer in individuals with peptic ulcers.

Here are some natural remedies that may help in managing peptic ulcers:

• Fenugreek (Methi): Fenugreek seeds contain antioxidants that can help reduce the severity of gastric ulcers. Boil a cup of fenugreek leaves in water, add salt to taste, and drink this solution twice a day.
• Cabbage (Bandha Gobi) Juice: Cabbage juice can strengthen the stomach lining and support healing. Drinking fresh cabbage juice regularly before bedtime can be beneficial.
• Banana (Kela): Bananas have antibacterial properties that slow the progression of peptic ulcers. Eating a banana every morning after breakfast may help.
• Honey (Shehed/Madhu): Honey has antimicrobial properties and can reduce inflammation, promoting stomach health. Consume a tablespoon of honey before breakfast, or add it to your meals.
• Garlic (Lehsun): Garlic is known for its antibacterial and antimicrobial benefits. Eating 2 to 3 cloves of garlic each morning may provide relief.
• Slippery Elm (Indian Elm): The bark of the slippery elm plant can soothe the stomach's mucus membranes. Grind the bark into powder, mix it with warm water, and drink it three times a day.

Yoga for Peptic Ulcers

Certain yoga poses can improve blood circulation to the digestive organs, promoting healing of stomach ulcers. Some recommended yoga asanas for peptic ulcers include:

• Mandukasana
• Sasakasana
• Yoga Mudrasana
• Ardhamatyendrasana
• Vakrasana
• Pawan Muktasana
• Gomukhasana

Diet and eating habits play a significant role in managing peptic ulcers at home. Below are some dos and don'ts for people with peptic ulcer disease:

Do’s

• Eat small meals regularly, every 3 hours.
• Allow 2 to 3 hours after eating before going to bed.
• Chew food and fluids thoroughly.
• Consume fresh fruits and vegetables.
• Drink plenty of water.

Don’ts

• Avoid excessive consumption of sour, fried, and spicy foods.
• Limit caffeinated beverages like tea and coffee.
• Do not drink alcohol, chew tobacco, or smoke.
• Never self-medicate.
• Avoid taking painkillers such as NSAIDs.

With proper treatment and care, PUD can heal over time. However, it’s essential to maintain healthy habits and monitor your diet to reduce the risk of recurrence.

Determine Your Personal Tolerance

There’s no definitive evidence linking spicy or citrus foods to the development of ulcers. However, some people report worsened symptoms after consuming these foods. It’s important to identify what works for you and avoid specific foods that may trigger symptoms, but don’t eliminate entire food groups from your diet.

Take Care of Your Mental Health

Stress, anxiety, and depression can indirectly contribute to the development of peptic ulcers. Furthermore, mental health issues may lead to unhealthy eating habits or lifestyle choices that exacerbate ulcer symptoms.

Modify Your Diet

In addition to medications, doctors often recommend lifestyle and dietary changes for ulcer patients. While bland diets were once suggested, current research doesn’t support this as a helpful strategy. Spicy foods may irritate ulcers in some people, but a high-fiber diet rich in vegetables and fruits is encouraged. Foods that can benefit your diet include:

• Fiber and Vitamin A-rich foods: Liver, carrots, sweet potatoes, kale, spinach, and collard greens are good sources.
• Flavonoid-rich foods and green tea: Garlic, onions, and a variety of colorful fruits and vegetables like cranberries, blueberries, strawberries, and broccoli.
• Cranberry Juice: Drinking two 250 ml cups of cranberry juice daily may reduce the growth of H. pylori and help prevent inflammation by preventing bacterial adhesion to the stomach lining.

People with ulcers should limit or avoid coffee and alcohol:

• Coffee: Both caffeinated and decaffeinated coffee can increase stomach acid production, worsening ulcer symptoms.
• Alcohol: Alcohol can damage the mucosal lining of the stomach, leading to further irritation and bleeding.