Peptic Ulcer Disease

What is Peptic Ulcer Disease?

Peptic ulcer disease occurs when painful sores develop on the lining of your stomach or upper part of your small intestine (duodenum). The stomach contains a strong acid that is necessary for the breakdown of food, and usually, a layer of protective mucus lines the stomach and duodenum to prevent it from being affected by those strong acids. If this protective mucus reduces, the stomach or duodenum lining will be damaged and painful sores will develop.

There are two types of peptic ulcers:

Gastric ulcers: sore develop on the stomach lining
Duodenal ulcers: sores develop on the duodenum lining

Since the stomach and duodenum are close in proximity, the causes, symptoms, diagnosis, and treatment are the same.

What are the common causes?

There are two main causes of peptic ulcer disease:

Helicobacter Pylori (H.Pylori) bacterial infection: A common infection affecting approximately 50% of the population worldwide and individuals are usually infected during their childhood. The main site of infection is the stomach where the H.Pylori bacteria adhere to the protective mucus layer and colonise the area, which results in a reduction in the protective mucus. This exposes the stomach lining to the harsh acids present, resulting in an ulcer.
Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs): Long-term use of NSAIDs (such as aspirin and ibuprofen) can wear away at the protective mucus layer of the stomach, leaving the stomach exposed to the harsh acids, and resulting in an ulcer.

Other minor causes of peptic ulcer disease include:

Other medications: Steroids and immunosuppressive drugs may cause the protective mucus layer to reduce thus making the stomach susceptible to peptic ulcers5.
Zollinger-Ellison syndrome: A rare medical condition where tumours form in the duodenum or pancreas; these tumours secrete gastrin which then stimulates the stomach to produce more acid, eventually resulting in a peptic ulcer.
Medical stress: Studies have shown that burn patients or patients in the intensive care unit (ICU) have an increased chance of peptic ulcer disease.
Viral infections: infections by the Epstein-Barr Virus (EPV) and the Herpes Simplex Virus-1 (HSV-1) have been shown to cause peptic ulcer disease in some individuals.
Crohn’s disease: Characterised by an inflammation of the gastrointestinal tract, Crohn’s disease often results in peptic ulcer disease too.
Radiation and chemotherapy: These work by killing all rapidly dividing cells with no discrimination between cancer cells and others, this causes the protective mucus layer to disintegrate thus resulting in a peptic ulcer.

What are the common symptoms of Peptic Ulcer Disease in Singapore?

Not everyone with peptic ulcer disease will experience symptoms – only about 1/3 of individuals are symptomatic.

The symptoms of peptic ulcer disease are:

Burning pain in your stomach in between meals or a night when your stomach is empty
Feeling bloated
Heartburn
Nausea or vomiting
Bloody stools
Weight loss
Feeling full after a small meal

Bloody stools are a sign of internal bleeding and must be checked out by a gastroenterologist as soon as possible.

Is Peptic Ulcer Disease painful?

Yes, peptic ulcer disease causes abdominal pain particularly between meals or at night when your stomach is acid. This pain may last for a few minutes or hours. You may feel temporary relief after consuming food or an antacid, but the pain usually returns.

Who is at risk of Peptic Ulcer Disease in Singapore?

Peptic ulcer disease is a painful medical condition that can lead to other complications such as stomach cancer or even death. If you have any of the following risk factors, you may want to visit a gastroenterologist to prevent your peptic ulcer disease from progressing further:

Family history of peptic ulcer disease
Long-term user of NSAIDs
Have been infected by the H.Pylori bacteria
Over the age of 65
Smoker
Drink alcohol
Consume corticosteroids together with NSAIDs

How is Peptic Ulcer Disease diagnosed?

Since peptic ulcer disease occurs in the gastrointestinal tract, diagnosis must be done using the following methods3:

Gastroscopy: A thin and flexible tube with a light and camera attached at one end is inserted into the mouth and slowly guided through the oesophagus and into the stomach and duodenum. If there are any peptic ulcers or other complications there, your gastroenterologist will be able to spot and potentially treat them.
Tests for H.Pylori: Since peptic ulcer disease is commonly caused by an infection of the H.Pylori bacteria, laboratory tests will be conducted to check for its presence. These may include a stool, blood, breath test, or testing with an endoscopy and biopsy which is likely to be the most accurate method.

What are the treatment options for Peptic Ulcer Disease in Singapore?

The treatment for peptic ulcer disease depends on the severity of it, most of the time, they are treated using medications such as:

Proton pump inhibitors (PPIs)

These help to reduce the amount of acid present in the stomach, making it easier for your stomach lining to heal.

Histamine receptor blockers (H2 blockers)

These prevent the stomach from producing too much acid which makes it easier for the stomach or duodenum lining to heal.

Antibiotics

Since the majority of peptic ulcers are caused by the H.Pylori bacteria, antibiotics are used to kill them off, thus allowing the protective mucus layer to thicken, giving better protection to your stomach and duodenum.

These treatments may be given individually but they are often given in combination. Peptic ulcer disease may result in complications such as cancer and internal bleeding, both of which can lead to death. Therefore, it is important to administer treatment for your peptic ulcer disease early to stop its progression.

Frequently asked questions

Does spicy food and work-related stress cause peptic ulcer?

No, this has been a misconception passed down through generations but there has been no scientific evidence. Spicy foods may aggravate or worsen your symptoms, but they are not the cause of it.

Can peptic ulcer disease go away without any treatment?

Peptic ulcers may heal by themselves if they are small enough. However, if the peptic ulcer was caused by a H.Pylori infection, the ulcer will recur since the bacteria is still there. Hence, treating the H pylori is important in preventing repeat ulceration.

Do i need a repeat endoscopy to confirm healing of ulcers?

Usually with Oesophageal and Gastric Ulcers your doctor will recommend a repeat scope to confirm healing as there is a small chance chronic ulceration and possibility of cancer.

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal