What are peptic ulcers?

A peptic ulcer is a sore on the lining of the stomach (gastric ulcer) or duodenum, the beginning of the small intestine (duodenal ulcer). Less commonly, a peptic ulcer may develop just above the stomach in the oesophagus, the tube that connects the mouth to the stomach (oesophageal ulcer).

Common types of peptic ulcers

The two most common causes of peptic ulcers are an infection by a bacterium called Helicobacter pylori (H. pylori) and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g. aspirin, naproxen, ibuprofen). Rarely, cancerous or non-cancerous tumours in the stomach, duodenum, or pancreas cause ulcers.

Symptoms of peptic ulcers

A common symptom of a peptic ulcer is dull or burning abdominal discomfort (upper abdomen/lower chest). This discomfort usually occurs when the stomach is empty (between meals or during the night) and may be briefly relieved by taking food or antacids. Other symptoms include:

  • Bloating
  • Burping
  • Nausea/vomiting
  • Poor appetite

Some people experience only mild symptoms or none at all. However, some may have the following emergency symptoms and should seek medical help immediately:

  • Sharp, sudden, persistent, and severe stomach pain
  • Bloody or black stools
  • Bloody vomit or vomit that looks like coffee grounds

These symptoms could be signs of a serious problem, such as:

  • Bleeding – when acid or the peptic ulcer breaks a blood vessel
  • Perforation – when the peptic ulcer burrows completely through the stomach or duodenal wall
  • Obstruction – when the peptic ulcer blocks the path of food trying to leave the stomach

Prevalence of bacterial infection

While more than 90 per cent of patients with peptic ulcers used to be infected by H. pylori, the prevalence now ranges from 50 to 75 per cent. It is continuing to decrease in developed countries due in part to widespread anti- H. pylori therapy in both primary practice and the hospital setting, and the improvement of socio-economic and living conditions, says Dr Chuah Sai Wei, Consultant, Department of Gastroenterology & Hepatology, Singapore General Hospital (SGH), a member of the SingHealth group. However, the prevalence of H. pylori infection remains high in the elderly and in less developed countries.

“No one knows for sure how H. pylori is transmitted, although researchers believe that it may be spread through contaminated food or water; or through contact with the stool or vomit of an infected person. H. pylori has also been found in the saliva of some infected people, which means infection could be spread through direct contact with saliva,” adds Dr Chuah.

In the absence of definitive evidence on how H. pylori spreads, prevention is difficult. The usual advice, says Dr Chuah, is to wash your hands with soap and water after using the bathroom and before eating, to eat food that has been washed well and cooked properly, and to only drink water from clean, safe sources.

NSAIDs use and peptic ulcers

Studies have shown that the use of NSAIDs is a major risk factor for non-H. pylori-associated peptic ulcers, especially gastric ulcers. Moreover, NSAIDs increase the risk of peptic ulcer complications three- to five-fold, and are responsible for 15 to 35 per cent of all peptic ulcer complications.

NSAIDs are frequently used for various indications. Many people take them on a regular basis to relieve a throbbing headache, muscle ache or arthritis pain. “Occasional use of NSAIDs for pain relief only poses a low risk but as many as 15 to 25 per cent of chronic NSAID users will develop peptic ulcers. The annual risk of serious complications is 1 to 4 per cent with chronic NSAIDs use,” says Dr Chuah.

NSAIDs use increases with age. The elderly are more likely to develop complications from NSAIDs-induced ulcers and to suffer increased morbidity and mortality from these complications, adds Dr Chuah. According to the US Food and Drug Administration (FDA), a daily dose of 75 to 300 mg of aspirin can double or triple the risk of bleeding ulcers in the stomach and intestine (gastro-intestinal bleeding).

Recommended lifestyle changes for peptic ulcers

What you can do:

  • Stop smoking: Smokers are more likely to get ulcers. In addition, these ulcers prove more difficult to treat and have a higher recurrence rate.
  • Moderate your alcohol intake: In high concentrations, alcohol damages the gastric mucosa and stimulates acid secretion. Alcohol abuse also appears to interfere with ulcer healing.

Ref. T12