I always imagined an ulcer to be an irritated and inflamed stomach caused by a flood of acid swishing around after dealing with a huge amount of stress. When I was undergoing diagnostic tests for digestive issues, my doctor gave me a breath test to assay for the bacteria Helicobacter pylori. I learned that H. pylori is one of the main causes of peptic ulcers, not stress or even spicy foods. I realized that my understanding of ulcers was inaccurate so I decided to find out what exactly is a peptic ulcer. First, let’s define the words peptic and ulcer. Peptic refers to a substance promoting digestion, specifically pepsin, a digestive enzyme that breaks down protein and ulcers are defined as sores in the inside lining of one’s digestive system. Peptic ulcers are sores that form when the mucous membrane, designed to protect the internal digestive system from stomach acids, decreases resulting in the erosion of the exposed lining by digestive acids. Peptic ulcers are found in the stomach (gastric ulcers), in the top of the small intestine also known as the duodenum (duodenal ulcers), and although rare, they can also be found in the esophagus (esophageal ulcers).
According to the Center for Disease Control and Prevention, 15.9 million (6.7%) adults in the United States have been diagnosed with peptic ulcers and the chance of forming an ulcer increases as one ages. Although there are some who do not experience symptoms, for most it is painful and uncomfortable and they can experience abdominal pain, bloating, heartburn, belching, nausea, and vomiting. No wonder it is so difficult to diagnose digestive issues…so many of them have similar symptoms. More severe ulcers can lead to bleeding, which manifests as bloody stools and/or bloody vomit, infections stemming from the perforation of the stomach or small intestine, and the swelling or scarring that can prevent food moving from the stomach to the small intestine.
As mentioned above H. pylori is a main contributor to the formation of ulcers. 30-40% of people are infected with H. pylori through potentially unclean food, water, and utensils, and passed to other people via saliva (i.e. kissing). H. pylori can remain in the digestive tract and have no effect, however for some, it can ruin the protective lining of the digestive tract making it susceptible to the stomach acid. Other causes for ulcers include certain medications, smoking, excess alcohol, and Zollinger-Ellison syndrome.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen are designed to reduce enzymes that cause pain, inflammation, and fever. However, they also decrease an enzyme with the role to protect the lining of the stomach from digestive acids.
- Smoking and high consumption of alcohol. Smoking and alcohol can decrease the mucous membrane of the digestive tract and elevate the production of stomach acid.
- Zollinger-Ellison Syndrome is when the pancreas and duodenum form gastrinomas, a tumor that leads to an increase in the secretion of gastrin, a hormone that leads to the production of stomach acid.
The current treatments include staying away from cigarettes, reducing alcohol consumption and NSAIDs, and if you need to take an aspirin, take as low a dose as possible and with meals. Antibiotics are used to treat H. pylori and surgery or chemotherapy may be used to treat Zollinger-Ellison syndrome. Additionally, being that ulcers are caused by acid eroding the internal lining of the digestive tract, one would want to decrease the amount of acid present. Proton pump inhibitors (PPIs) and histamine blockers both decrease the amount of acid, which gives the time for the ulcer to heal. Antacids and cytoprotective agents, like Pepto bismol allow for immediate relief because they neutralize the acid present in the stomach and coat the lining of the digestive tract, respectively. And although stress does not cause ulcers, managing stress and eating a high fiber diet filled with fruits and veggies has been shown to help prevent the formation of them.
I now have a better understanding of ulcers but I did prefer my old idea of acid splashing around much more then my new image. Hence, the title of this post….
Photo taken by jschofield on Pixabay