Gastric ulcer also known as the peptic ulcer is a break in the inner lining of the stomach and in upper parts of the small intestine. They can also be referred to as sores that develop in the inner lining of the stomach. The ulcer that occurs in the stomach is known as gastric ulcer, while the ulcer that is present in the first part of the intestine is also referred to as duodenal ulcer. Gastric ulcer is a common disease and presents with symptoms such as nocturnal abdominal pain, and also abdominal pain that gets better after eating, however, the pain usually worsens with a gastric ulcer after eating. The pain associated with peptic ulcer is usually described as “heartburn” because the pain feels like it’s around the heart region. Other symptoms that peptic ulcer disease presents with are vomiting, weight loss and reduced appetite. There are two types of peptic ulcer, they are;
- Gastric ulcer: This is the ulcer that occurs in the stomach
- Duodenal ulcer: This is the ulcer that occurs in the duodenum
The causes of a gastric ulcer include the bacteria known as Helicobacter pylori and the long-term use of Non-steroidal anti-inflammatory drugs. Other causes of peptic ulcer are Zollinger Ellison syndrome and Crohn’s disease. Peptic ulcer disease can be diagnosed by making the individual take the urea breath test. A confirmatory test can be done by using endoscopy or doing a biopsy. A gastric ulcer can be well managed, through medications and a change in diet. However, stem cells can also be used for the treatment of this disease. Transplanted stem cells were noted to be capable of repairing and replacing the damaged digestive tract lining in mice. Exosomes can also be used in the management of this disease.
What are the Causes of Peptic Ulcer Disease?
Peptic ulcer disease when the gastrointestinal acid eats away at the lining of the digestive tract. This often leads to the formation of sores, that may bleed. This bleeding if uncontrolled can lead to anemia, due to blood loss. The stomach has a mucous covering that reduces the effect of the acid on its inner lining, however, some drugs, such as NSAIDs usually depletes prostaglandin, that enhances the production of the mucus in the stomach. Below are some of the causes of peptic ulcer;
- Helicobacter pylori: These bacteria live in the mucous layer that protects the stomach and intestine. Usually, these bacteria do not cause any damage to the digestive tract, however, they do sometimes cause inflammation of the gastric lining, leading to the formation of sores, and leading to an ulcer. The mechanism through which these bacteria causes ulcer is not quite clear. H. pylori are mostly concentrated in the antral part of the stomach.
- Non-steroidal anti-inflammatory drugs: NSAIDs are an important and common cause of peptic ulcer disease. The gastric mucosa secretes a layer of mucus that protects the stomach from the effect of the gastric acid. Prostaglandin stimulates and enhances the production of this mucus. However, NSAIDs such as aspirin blocks the activity of cyclooxygenase 1 and cyclooxygenase 2. Cyclooxygenase 1 is primarily responsible for the production of prostaglandin. The production of this stomach protective mucus layer is reduced when an individual uses NSAIDs. This increases the risk of having an ulcer. In addition, the risk of developing ulcers becomes increasingly higher when NSAIDs are used for the treatment of chronic diseases, and used for a long time. There are some NSAIDs that can be safely used, without depleting the stomach protective mucus layer. An example of such NSAIDs is celecoxib.
- Stress: Stress is also a common cause of peptic ulcer. Stress can be a result of a traumatic event such as an accident, divorce, and physical stress. In addition, prolonged stress has also been implicated as a major cause of the ulcer.
- Nutrition: There are some food substances, that increases the chance of having an ulcer. Some of them are caffeine and spicy food. Studies have also shown that alcohol also increases the risk of having an ulcer, especially those who consume an excessive amount of the drink.
What are the Risk Factors for Peptic Ulcer Disease?
The risk factors for peptic ulcer disease are the factors that increase the chances of developing the disease.
- Prolonged stress: Been consistently stressed increases the risk of having peptic ulcer disease
- Alcohol consumption: Alcohol also makes people prone to having peptic ulcer disease, especially when an individual consumes the highly concentrated type of alcohol. Alcohol causes the irritation of the mucous lining of the stomach and also surges gastric acidity.
- Smoking has also been implicated as one of the risk factors for peptic ulcer disease
What are the signs and symptoms of peptic ulcer?
Below are some of the signs and symptoms of peptic ulcer;
- Abdominal pain: Peptic ulcer patients’ experiences pain around the epigastric region. The pain usually shows up about 3 hours before eating in duodenal ulcer
- Nausea and vomiting
- Hematemesis: This term refers to the bleeding that is associated with an ulcer. Patients often vomit substances that are bloodstained. The amount of blood vomited is directly proportional to the severity of the ulcer.
- Patients might experience abdominal bloating.
- Anaemia: This occurs when the blood loss associated with hematemesis is not well managed or controlled. The chronic blood loss will eventually lead to anemia due to chronic blood loss.
- Severe cases of ulcer can lead to perforation. This can lead to peritonitis and a feeling of stabbing pain in the epigastric region. This kind of condition is usually an emergency and usually requires surgery.
How is Peptic Ulcer Diagnosed?
- Urea breath test: Your physician may prescribe a Urea breath test to check if the bacteria is present in the blood or feces of the patient.
- Endoscopy: This is usually the first line diagnostic procedure in old people and a confirmatory diagnostic procedure in people below the age of 50
How is peptic ulcer treated now?
- Physicians usually administer the triple therapy which includes 2 antibiotics and a proton pump inhibitor.
- Surgery can also be done for the treatment of complications
Stem cell therapy for peptic ulcer
Stem cell therapy has a lot of potential in the treatment of peptic ulcer. According to the experiments performed on some mice, gastric stem cells can be extracted from young mice and transferred to old mice with gastric ulcer. The transplanted cells were noted to repair and replace the damaged digestive tract lining. A lot of research is ongoing, to replicate this kind of feat in humans soon.
References
Abe, N., Takeuchi, H., Yanagida, O., Sugiyama, M. and Atomi, Y. (2010). SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCER. Digestive Endoscopy, 22, pp.S35-S37.
Jainan, W., Mahachai, V. and Vilaichone, R. (2013). Su1814 CYP2C19 Genetic Polymorphisms in Patients With Peptic Ulcer Bleeding, Peptic Ulcer Disease and Non-Ulcer Dyspepsia in Thailand. Gastroenterology, 144(5), p.S-480.
Sonnenberg, A. and Baron, J. (2010). Rising trends in gastric cancer and peptic ulcer in the 19th century. Alimentary Pharmacology & Therapeutics, 32(7), pp.901-907.
Vakil, N., Perdomo, C. and Barth, J. (2003). The density of Helicobacter pylori (Hp) organisms does not affect eradication rates in peptic ulcer disease (PUD) and non-peptic ulcer disease (PUD). Gastroenterology, 124(4), p.A180.
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