The peptic ulcer, also called gastric ulcer if it is located in the stomach, is called a duodenal ulcer when it forms in the duodenum, that is to say, the first part of the small intestine.
They are sort of wounds formed by erosion that penetrates deep into the wall of the digestive tract.
What are its causes and symptoms? Can we prevent the appearance of an ulcer? How do we treat it? Here are our explanations.
Peptic ulcer disease: what is it?
A peptic ulcer is a deep sore that forms in the inner lining of the stomach or in the first part of the intestine called the duodenum.
Peptic ulcer wounds are often painful: they come into direct contact with the acid present in the digestive tract: a situation comparable to applying an alcohol swab to a scratch.
The expression “peptic ulcer” includes, because of the similarity of their manifestations:
- gastric ulcer;
- duodenal ulcer.
It is estimated that about 10% of the population of industrialized countries is likely to suffer from an ulcer one day or another. People aged 40 and over are the most affected. Duodenal ulcers are 10 times more common than stomach ulcers.
Acids and antacids in the digestive tract
In the wall of the stomach, glands secrete gastric juices which contribute to digestion:
- digestive enzymes, such as pepsin, which break down proteins into smaller molecules, peptides;
- hydrochloric acid or HCl is a strong acid that allows digestive enzymes to work and destroys most microbes, such as parasites, viruses, bacteria, and fungi, that have entered the stomach.
The contents of the stomach are always acidic. Its pH varies from 1.5 to 5, depending on the food ingested and also depending on the individual.
Other glands secrete mucus intended to protect the internal walls of the stomach. This mucus prevents digestive enzymes and hydrochloric acid from destroying the stomach wall by forming a protective film.
The lining of the small intestine is also covered with a layer of mucus that protects it from the acidity of chyme, the name given to the “food porridge” which comes from the stomach.
What are the causes of peptic ulcer disease?
Helicobacter pylori
The bacterium Helicobacter pylori, or H. Pylori, a bacterium that survives acidity, is the main cause of ulcers. It would cause approximately:
- 60 to 80% of stomach ulcers;
- 80-85% of duodenal ulcers.
These bacteria invade the layer of mucus that normally protects the stomach and small intestine from acidity, and may disrupt this protective mechanism in some people.
In industrialized countries, 20% of people aged 40 and under have this bacterium in their digestive tract. A proportion that reaches 50% among those over 60 years old. About 20% of carriers of the bacteria will suffer from an ulcer in their lifetime.
Nonsteroidal anti-inflammatory drugs
Taking nonsteroidal anti-inflammatory drugs or NSAIDs, such as aspirin, Advil, and Motrin, is the second most common cause of ulcers in the digestive tract. The combination of infection with H. Pylori bacteria and taking anti-inflammatories synergistically increases the risk of ulcers. The risk is then 60 times greater.
Other causes
Here are also other causes:
- excessive production of acid by the stomach, or gastric hyperacidity, attributable to smoking, excessive alcohol consumption, severe stress, hereditary predisposition, etc. However, these could be aggravating factors rather than true causes of ulcers;
- a serious burn, major injury, or the physical stress of a serious illness. “Constraint ulcers” are then created, which are often multiple and are most often located in the stomach, sometimes at the very beginning of the small intestine at the level of the proximal duodenum;
- more rarely, a stomach ulcer may turn out to be stomach cancer that has ulcerated.
Evolution of the ulcer
Usually, an ulcer appears gradually over a few weeks. It can also appear quickly, after a few days of taking nonsteroidal anti-inflammatory drugs, for example, but this situation is not very common.
The spontaneous healing rate could be around 40%, over a period of 1 month, particularly if the ulcer was caused by taking NSAIDs and you stopped taking them.
Spontaneous definitive cure, without relapse, is however rare. Smokers are more likely to relapse than non-smokers.
If the ulcer is not treated or the cause is not stopped, there is a strong possibility that the ulcers will reappear within a year. But, even with good treatment, there is recurrence in 20 to 30% of cases.
Possible complications of stomach ulcer
Complications from stomach ulcers are relatively rare.
Hemorrhage
The ulcer can cause hemorrhage: the blood then flows inside the digestive tract.
The hemorrhage is sometimes massive, with vomiting of red or coffee bean-like blood, with blood in the stools that may be red or black.
Bleeding can also be quiet and relatively slow. Whether or not the stools turn black will be noticed. Indeed, under the influence of digestive juices, the blood turns black. Bleeding can cause anemia over time if undetected.
It is possible that the first symptom of the ulcer is hemorrhage, without there having been pain before, especially in older subjects. You should consult a doctor without delay.
Perforation of the wall of the digestive tract
Another complication, much less common than hemorrhage, is the complete perforation of the wall of the digestive tract. This situation causes severe abdominal pain, which quickly worsens into peritonitis. This is a medical and surgical emergency.
In the case of duodenal ulcers and stomach ulcers, symptoms appear and can be spotted.
Duodenal ulcer: what are the symptoms?
General symptoms of a duodenal ulcer include:
- a recurring burning sensation in the upper abdomen. With a stomach ulcer, the pain is made worse by eating or drinking. In the case of duodenal ulcer, the pain subsides at mealtimes, but worsens 1 to 3 hours after eating and when the stomach is empty during the night, for example;
- the feeling of being quickly satiated;
- belching;
- bloating;
Sometimes there are no symptoms before a hemorrhage occurs.
Signs of worsening duodenal ulcer
Signs of worsening duodenal ulcer include:
- nausea ;
- vomitings ;
- blood in coffee-colored vomit;
- black blood in the stool;
- tiredness;
- weight loss.
In pregnant women who suffer from ulcers, the symptoms tend to disappear during pregnancy, because the stomach is less acidic. However, towards the end of pregnancy, due to the pressure exerted by the fetus on the stomach, sensations may occur:
- burning;
- nausea;
- vomiting.
Some people have a higher risk of developing a duodenal ulcer, just as certain risk factors can promote its appearance.
People at risk of duodenal ulcer
People at risk of developing a duodenal ulcer are:
- women aged 55 and over, for stomach ulcers;
- men aged 40 and over, for duodenal ulcers;
- some people may have a hereditary predisposition to peptic ulcers.
Duodenum, duodenal ulcer: risk factors
Certain factors can aggravate or delay the healing of ulcers by making the stomach more acidic:
- smoking;
- excessive alcohol consumption;
- the stress ;
- coffee does not seem to be involved, according to a study carried out in Japan.
In some people, food can make symptoms worse:
- drinks: tea, milk, cola drinks;
- foods: fatty foods, including chocolate and meat, concentrates;
- spices: black pepper, mustard seeds, and nutmeg.
Some medications can also be risk factors such as:
- anti-inflammatories;
- cortisone;
- bisphosphonates used to treat osteoporosis;
- potassium chloride.
Hot pepper: to banish?
People with stomach or duodenal ulcers have long been advised not to consume hot peppers because of their pungent and “burning” effect, which could exacerbate their pain.
However, studies seem to show that hot peppers do not cause additional damage to the digestive tract. They might even have a protective effect.
Also, using the spice cayenne pepper, even in large amounts, would not aggravate ulcers.
However, caution should be exercised with capsaicin capsules, the substance that gives peppers their pungent taste, and other concentrates, which may contain much higher amounts of capsaicin than the food.
In order to prevent the appearance of duodenal ulcers, it is possible to put in place some measures:
- basic preventive measures;
- measures to lessen the symptoms and reduce the risk of aggravation.
Measures to prevent ulcers
It is important to properly use non-steroidal anti-inflammatory drugs or NSAIDs such as aspirin, Advil, Motrin, etc. Otherwise, they may cause heartburn or even an ulcer. the gastroduodenal whose first symptom may be hemorrhage.
Sensitivity to these drugs varies from person to person, depending on, among other things:
- age;
- the dose;
- the duration of use.
Here is some useful information. To find out more, ask your doctor or pharmacist for advice:
- sometimes, to relieve pain, such as a headache, muscle pain, joint pain, etc., it is better to consume paracetamol, such as Tylenol, or another medicine that your doctor will suggest;
- if you must take anti-inflammatories, follow the recommended dosage and duration of treatment. NSAIDs should not be taken for several weeks without a clear medical prescription;
- it may be advisable to use anti-inflammatories in conjunction with an antacid medication, which prevents heartburn, or with a cytoprotector, such as misoprostol or Cytotec. However, the latter is contraindicated during pregnancy;
- anti-inflammatories are divided into 2 main categories: the classics such as Advil, Motrin, Naproxen, etc., and coxibs such as Celebrex, and Mobicox. The latter has a more specific action and carries less risk of adverse effects on the stomach;
- be careful when taking Alka-Seltzer containing aspirin and Pepto-Bismol containing bismuth subsalicylate to relieve ulcer symptoms and which can sometimes make them worse in some individuals;
- bisphosphonates, such as Actonel and Fosamax, drugs to treat osteoporosis, can sometimes cause ulcers.
Note that currently there is no way to prevent Helicobacter pylori infection.
Measures to reduce ulcer symptoms
To reduce the symptoms of the ulcer, it is recommended to:
- eat several small meals at regular intervals;
- eat slowly and chew each bite well;
- not leaving the stomach empty for a long time helps reduce symptoms;
- avoid drinking while eating;
- avoid eating before going to bed;
- it is important not to smoke because the use of tobacco delays and can even prevent the healing of lesions of the gastric mucosa;
- if necessary, take care to reduce your level of stress by fully understanding its origin and making the appropriate changes to your life: work, a specific situation, a relationship, etc. Although stress does not cause an ulcer, it is believed to be a significant aggravating factor;
- be aware of foods and drinks that make your symptoms worse: alcohol, tea, milk and dairy products, chocolate, cola drinks, certain spices such as black pepper, mustard seeds, or nutmeg, as well as foods high in fat cause pain in many people. Avoid them or eat a small amount with other foods;
- the consumption of yogurt and honey contributes to the healing of gastroduodenal ulcers;
- before consuming a natural health product by mouth, make sure that it does not risk aggravating your ulcer. Devil’s claw, for example, is contraindicated in gastric or duodenal ulcers.
The ulcer should be aggressively treated 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:
- decrease the acidity of the stomach, to relieve pain;
- treat infection with Helicobacter pylori bacteria, which also helps prevent recurrences.
Drugs to treat ulcer
Before treating, the doctor must still determine whether it is a stomach ulcer or a duodenal ulcer.
If the ulcer is in the stomach, a sample of tissue from near the ulcer will be taken to rule out the slight possibility of stomach cancer.
Duodenal ulcer, on the other hand, is almost always benign. The exams consist of:
- in a barium meal, that is to say, ingestion of barium, a chalky liquid;
- followed by an x-ray of the abdomen to visualize the ulcer or a gastroscopy.
Gastroscopy consists of inserting, through the mouth, a long flexible tube equipped with a mini-camera, in order to observe the walls of the stomach and duodenum.
The following drugs, often used in combination, lead to the healing of more than 90% of ulcers in 4 to 8 weeks.
To decrease acidity
H2 antihistamines
H2 blockers reduce the amount of acid the stomach makes. This protects the affected part to give it time to heal. The term H2 refers to histamine receptors. The drug binds to histamine receptors in such a way as to prevent their activation.
This category of drugs includes:
- the cimetidine or Tagamet;
- famotidine or Pepcid;
- la nizatidine ou Axid?
- the ranitidine or Zantac.
It is possible to obtain them over the counter in pharmacies.
Proton pump inhibitors
Proton pump inhibitors reduce stomach acid even more effectively than H2 blockers. They understand :
- omeprazole or Losec;
- le lansoprazole ou Prevacid;
- le pantoprazole ou Pantoloc?
- rabeprazole or Pariet;
- the esomeprazole or Nexium.
They are obtained by prescription. They work by inactivating the “pumps” that produce hydrochloric acid. They would also inhibit the multiplication of H. pylori bacteria.
Antacids
Antacids, such as Maalox, Mylanta, Gaviscon, etc., do not decrease acid secretion but neutralize the acid present in the stomach, which relieves pain. They take longer to work than H2 blockers and proton pump inhibitors.
To treat infection
Blood, stool, or breath tests, and sometimes a biopsy of the stomach wall taken during gastroscopy, will tell the doctor whether or not there is an H. pylori infection.
Antibiotics
If the ulcer is caused by an H. pylori infection, the doctor usually prescribes 2 antibiotics for a period of 7 to 14 days. The most commonly used antibiotics are:
- amoxicillin or Amoxil;
- clarithromycin or Biaxin;
- metronidazole or Flagyl.
The 2 antibiotics are often combined with another medicine against acidity or even with bismuth or Pepto-Bismol, this antacid can also help fight the infection. This treatment eradicates the bacteria and heals the ulcer in approximately 80% of cases.
If symptoms return, a second treatment is usually recommended. Unfortunately, even when the peptic ulcer is well healed, it can reappear a few months later. This is the case approximately 1 time out of 5.
| Note: Take the entire antibiotic medication as prescribed, even if the symptoms are no longer present. |
In 2013, a new drug called PYLERA was launched. With its innovative galenic formulation and its 3 active substances, PYLERA is indicated, in combination with omeprazole, in:
- the eradication of Helicobacter pylori ;
- the prevention of recurrences of peptic ulcers in patients with an active ulcer or a history of ulcers associated with H. pylori.
Its formulation is based on the development of a patented 3-in-1 capsule, containing both:
- potassium bismuth subcitrate;
- tetracycline hydrochloride;
- metronidazole.
In case of ulcers caused by anti-inflammatories
The doctor will likely recommend that you stop taking nonsteroidal anti-inflammatory drugs or NSAIDs. This is usually enough to make the ulcer go away, but an H2 blocker or proton pump inhibitor will usually also be prescribed for a few weeks.
Other medications that are less harmful to the stomach can be used instead of NSAIDs, as appropriate.
Life habits
In addition to taking the medication, it is also very important to modify certain lifestyle habits, for example, smoking and drinking alcohol, which damage the lining of the digestive tract. There is generally no special diet to follow except to avoid foods that seem to cause irritation.
The medical treatment of the ulcer may require a particular diet prescribed by the doctor, advocating, excluding, or limiting certain foods.
Surgery for an ulcer
Surgery is indicated only in case of failure of drug treatment or in case of complications, such as:
- complete perforation of the digestive wall by the ulcer;
- drug-resistant gastrointestinal obstruction;
- severe bleeding that does not respond to treatment.
Followed
At the end of the treatment, we can ensure the healing of the ulcer by endoscopy, that is to say, live visualization of the digestive tract made by means of a fibroscope.
A maintenance treatment lasting 4 to 6 months can be prescribed to prevent the appearance of a new ulcer.
In addition to medical treatment, certain complementary approaches can relieve the symptoms of gastric ulcers or duodenal ulcers.
Complementary approaches in case of ulcers
Probiotics against H. pylori infection
Probiotics are useful bacteria naturally present in the intestinal and vaginal flora. Several studies on people with peptic ulcer disease suggest that they can improve the effectiveness of conventional antibiotic treatment while reducing digestive disorders such as diarrhea and bloating, associated with taking these drugs..
Dosage: take 125 million to 4 billion CFU of Lactobacillus jonhnsonii per day, in addition to conventional treatment.
Licorice or Glycyrrhiza glabra
In vitro and animal studies have shown that deglycyrrhizinated licorice, or DGL, stimulates the production of mucus by the stomach. It thus reinforces its natural protection against the action of hydrochloric acid or certain medications, in particular acetylsalicylic acid or Aspirin.
Other studies have also shown that licorice also helps fight Helicobacter pylori infection . Commission E recognizes the use of licorice to prevent and treat stomach and duodenal ulcers.
German chamomile or Matricaria recutita
German chamomile has long been used to relieve digestive disorders, including stomach ulcers and duodenal ulcers. No clinical studies have yet been conducted in humans.
According to Rudolf Fritz Weiss, physician and herbal medicine expert, chamomile tea is especially effective in preventing ulcers. In adjuvant treatment, it can also relieve the symptoms.
Curcuma or Curcuma longa
Turmeric has traditionally been used to treat peptic ulcers. In vitro and animal studies indicate that it has protective effects on the gastric mucosa and that it can destroy or inhibit the bacterium Helicobacter pylori.
Nopal or Opuntia ficus indica
The flowers of this plant were traditionally used in Latin America for:
- treat colic;
- prevent the formation of gastric ulcers.
The beneficial effects of the nopal on the digestive system are explained, at least in part, by its high content of pectin and mucilage. Animal test results have demonstrated that the nopal has anti-ulcer and anti-inflammatory action.
Dosage: Traditionally, it is recommended to use a 1:1 flower extract at the rate of 0.3 to 1 ml, 3 times a day.
Orme rouge or Elm red or Elm yellow
The slippery elm is native to all of eastern North America. Its bast, or inner part of the bark, has long been used by Native Americans to treat:
- sore throat;
- cough ;
- irritation;
- ulcerations of the digestive tract.
Dosage :
- mix 15 to 20 g of bast powder in 150 ml of cold water;
- bring to a boil;
- simmer gently for 10 to 15 minutes;
- drink this preparation 3 times a day.
Marigold or Calendula officinalis
Marigold is a medicinal plant widely used in the world, especially for skin care.
In the 19th century, the Eclectics, a group of American doctors who used plants in conjunction with official medicines, used marigolds to treat stomach and duodenal ulcers.
Cabbage juice and potato juice
These 2 juices were formerly part of the therapeutic arsenal.
Cabbage juice concentrate is obtained by squeezing a white cabbage or Brassica oleracea. This juice was used to accelerate the healing of peptic ulcers, although its taste may seem off-putting.
The juice of raw common potato or Solanum tuberosum would reduce stomach pain.
Stress management
Dr. Andrew Weil suggests the following measures, especially when ulcers respond poorly to treatment or come back:
- set aside time slots devoted to relaxation;
- doing deep breathing or visualization sessions;
- if necessary, identify their main sources of stress and then seek a solution to eliminate them or reduce their scope.
Chinese pharmacopoeia
There is a preparation specially intended for gastric hyperacidity disorders: Wei Te Ling. It is used, among other things, to strengthen and restore the stomach. Wei Te Ling relieves pain and helps to regenerate ulcerated tissues of the gastric mucosa, without however treating the cause of the disease.
| Note: In some people with stomach ulcers or duodenal ulcers, taking strong mint lozenges or peppermint essential oil may irritate the mucous membranes of the mouth or exacerbate an ulcer. |
Image Credit: Image by jcomp on Freepik
