Peptic Ulcer Disease (PUD) is an inflammatory condition of the stomach and duodenum. It affects up to one in every 10 people.
What is an ulcer?
A coating of mucus protects the lining of your stomach and gut from the effects of stomach acid and enzymes which digest the food you eat. When a weakness in this normal mucus layer occurs, the acid and enzymes can wear away the lining. This may cause an ulcer to form.
An ulcer is like a graze or a cut that forms on the lining of your stomach or duodenum. Ulcers in the stomach are called gastric ulcers. Those in the duodenum are called duodenal ulcers. In general both these ulcers are called “peptic ulcers”.
Ulcers can develop at any age but they are more common in adults as they get older. Duodenal ulcers usually occur between the ages of 30 and 50. Stomach ulcers are more likely to occur in people over 60.
What causes ulcers?
In earlier days, it was thought that stress and stomach acid caused ulcers. It is now known that acid and enzymes of the stomach alone do not actually cause the ulcers, but make the symptoms worse by adding to the inflammation.
In recent years, bacteria called Helicobacter pylori (known as H. pylori), have been found to be linked with almost all peptic ulcers. H. pylori are found in the gut of almost all people suffering from Ulcers. H. pylori affect men and women equally.
The non-steroidal anti-inflammatory drugs (NSAlDs), e.g. aspirin, are the second most common cause of PUD. They cause most of the ulcers that are not caused by H. pylori. NSAlDs make the stomach more sensitive to acid and enzymes, which leads to an increased chance of developing stomach ulcers.
What is h. pylori?
H. pylori is a kind of bacteria found in the gut. It is able to survive in acid conditions and produces substances that damage the lining of the stomach. This makes it easier to get an ulcer.
H. pylori infection varies with age and race. Most people seem to get the infection during childhood. The infection usually lasts a lifetime without them even knowing they have it. H. pylori does not always cause symptoms. Only a small nun1ber of people who have it may actually get an ulcer from it.
Symptoms of ulcers
Ulcers may not always cause symptoms. However some symptoms people may experience are:
- Gnawing or a burning pain in the upper to middle stomach is usually the most common symptom (between the bottom of the breast bone and navel). Pain often occurs between meals and in the early hours of the morning. It may last from a few minutes to a few hours. It may be relieved by taking medicines or by eating.
- Other symptoms can include nausea, vomiting, loss of appetite and loss of weight.
- If your ulcer bleeds, your stools may appear tarry or black in colour. Your vomit may be dark (like coffee grounds).
See your doctor if you have any of these symptoms.
There are different tests that can be done to find an ulcer. The main one is called endoscopy. Endoscopy is when a long thin tube with a small camera attached to it is inserted down your throat into the stomach and intestine to look for any damage or ulcers. When doing an endoscopy it is also possible to take samples of tissue from the inside of the stomach to check if H. pylori are present. Other tests for H. pylori include a blood test or a breath test.
Your doctor will decide which test is best for you.
The main aim of medicines used to treat PUD is to:
- reduce the acid in the stomach.
- cover the damaged lining to protect it from further attack by the acid.
Until recently if you had an ulcer, you would have had to take medicines frequently and for a long time to keep your ulcer pain from returning. Now it is possible to cure ulcers, especially duodenal ulcers, by killing the H. pylori and getting rid of the ulcer.
To kill H. pylori, it is necessary to take a combination of medicines, usually two antibiotics plus another medicine to reduce acid levels in the stomach. This combination of medicines is called “triple therapy”.
Triple therapy is usually 7 or 14 days long. It includes an acid reducing, or a site protective medicine, plus two antibiotic medicines. Some people may feel unwell with side effects of these medicines. There are various combinations of triple therapy.
A highly recommended example is omeprazole triple therapy.
The advantage with this therapy is that it is easy to take. There are fewer tablets and it is a shorter 7day course. You will have fewer side effects.
An effective acid-reducing medicine is important for several reasons:
H. pylori can live in acid. By reducing the acid, it is easier to get rid of H. pylori.
Antibiotics work better when there is less acid.
Acid worsens your ulcer pain so it is important to decrease its production.
The good news is that getting rid of H. pylori heals your ulcer. This means in most cases you will not need to continue taking medicines long term for your ulcer. The chances of catching the infection again are very small.
- Stop smoking. Smoking slows down the healing of your ulcer.
- Avoid alcohol. Alcohol worsens your ulcer pain. It can also interact with some ulcer medicines.
- Speak to your Life Pharmacist if you need pain relievers - some are less damaging to the stomach lining than others.
- Avoid NSAIDs, eg aspirin, ibuprofen, diclofenac if you have an ulcer. Ask your LIFE Pharmacist about these.
- Check with your LIFE Pharmacist before buying any new medicine.
- Eat correctly. See the Indigestion fact card about foods that may worsen your ulcer.
- Learn about Peptic Ulcer Disease and try to understand why you must take the medicines.
- Take your medicines every day as advised by your doctor. If you have medicines to get rid of H. pylori, stick with your course until you finish them all. This will help heal your ulcer quickly. You will avoid having to take medicines long term.