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Ulcer or peptic ulcer is a condition characterised by open sores developing along the lining of the stomach, oesophagus or duodenum (first part of the small intestine) . It occurs when your stomach acids damage the walls of the digestive tract. India ranks 42nd in terms of deaths due to ulcer.
People with ulcers tend to suffer from upper abdominal pain, bloating, etc. In addition, untreated ulcers can lead to other serious health conditions, including gastric ulcers. Therefore, it is important to understand the signs and symptoms, causes and other factors of this disease, to take the best measure possible.
Here’s a quick glance at the symptoms, causes, prevention and treatment of ulcer.
|Symptoms||Weight loss/weight gain, feeling too full after having a meal, nausea and vomiting, belching, bloating, hematemesis, melena, dark red or maroon blood mixed in stools, etc.|
|Complications||Obstruction of the gastric outlet, gastrointestinal bleeding, perforation, stomach cancer, etc.|
|Causes||Helicobacter pylori infection, Non-steroidal Anti-Inflammatory Drugs (NSAIDs), lack of blood supply to the stomach or small intestine, other illnesses related to the stomach, etc.|
|Onset||Sudden onset and the symptoms usually start 2 to 3 hours after a meal or at night.|
|Diagnosis||Blood test, stool test, urea breath test, upper gastrointestinal (GI) endoscopy and biopsy.|
|Prevention||Avoid tobacco, avoid alcohol, avoid excessive use of NSAIDs|
|Medication||Proton pump inhibitors (PPIs), antibiotics, H2-receptor antagonists, antacids and alginates, surgery.|
Here is a comprehensive overview of ulcers – their symptoms, causes, types, diagnosis, treatment and complications. So, continue reading to learn more!
Ulcer symptoms may differ based on your age or the location where it has occurred. Moreover, the timing of the symptoms after meals can say if the ulcer has spread in the stomach or the small intestine.
For instance, the most common symptom of duodenal ulcers is nocturnal pain. You may also experience bloating or fullness.
The most common symptoms of peptic ulcer include :
Some of the more serious and alarming symptoms include :
Bacterial infections such as the Helicobacter pylori (H. pylori) infection and nonsteroidal anti-inflammatory drugs are the two leading causes of peptic ulcers (NSAIDs). However, it can also develop from other, less common causes.
Here is a detailed list of ulcer causes :
The gastric epithelial cells contain the gram-negative bacillus H. pylori. A massive 70% to 90% of stomach ulcers and 90% of duodenal ulcers are caused by this bacterium . Contact with vomit, stool, or saliva from an infected individual may cause the germs to pass from one person to another. The bacteria can cling to and irritate the stomach mucosa because of the broad spectrum of virulence factors that it contains. Because of this, hypo- or achlorhydria develops, which eventually causes stomach ulcers.
After H. pylori infection, the use of non-steroidal anti-inflammatory medicines is the second most frequent cause of the peptic ulcer. NSAIDs include medications like aspirin, ibuprofen, and naproxen. They work to reduce pain, but they can increase the risk of stomach lining damage and ulcers as well. Some varieties are more prone than others to result in ulcers. The chances of ulcer increase due to the following reasons:
Other factors that can cause peptic ulcer include:
Peptic ulcers come in two different types :
Some may develop an ulcer in both the stomach and duodenum.
Treatment for ulcers should start as soon as it is diagnosed. Untreated conditions often cause serious issues like internal bleeding, perforation and even cancer . Therefore, if your diagnosis report shows a positive result, visit a doctor immediately.
Your doctor will plan a treatment plan based on the severity of your condition, age and other factors. Moreover, you must visit your nearest general physician first if you notice any of the symptoms mentioned above.
Ulcer diagnosis can be carried out in different ways. If your healthcare provider suspects this condition, they might take the following steps to confirm it :
Checking your medical and family history will help your doctor to understand the risks and causal factors of the ulcer in a better way. In this step, they will ask you about your symptoms, medical history (if you have had an ulcer before or other bacterial infection, the medications you are under (especially NSAIDs), and if you have a family history of peptic ulcer.
The physical examination includes checking for abdominal swelling, listening to abdominal sounds with the help of a stethoscope, checking for pain or tenderness in the abdominal region, etc. This can help the doctor to find out any complications related to the disease.
Blood tests fall under clinical tests that check if the condition is triggered by an H. pylori infection. In this test, a small sample of your blood will be taken to check for the presence of antibodies to fight the bacterial infection.
The stool test has rapidly replaced the blood test to check for the H. pylori bacteria. Here, a sample of your stool is tested to look for bacterial presence.
A urea breath test is another effective way to confirm a bacterial infection. Here, you will be given a liquid or a capsule that contains urea. If there is a presence of the H. pylori bacteria, it will break down the urea into carbon dioxide. This can be confirmed after a few minutes by testing your breath (exhaling carbon dioxide).
An upper GI Endoscopy can be used to confirm the diagnosis as well as the cause of the peptic ulcer. In this test, an endoscope is used to view the walls or linings of the upper gastrointestinal tract, stomach, oesophagus, and duodenum. During an upper GI endoscopy, your healthcare professional may also take biopsies by inserting a tool through the endoscope and scraping tissue from your stomach lining. These tissues are then tested for the H. pylori bacteria.
Peptic ulcer has a very good prognosis when the underlying cause is effectively treated. Moreover, repetition or recurrence may also be avoided if you practise proper hygiene and avoid the use of NSAIDs, alcohol, and cigarettes.
Unfortunately, the recurrence of ulcer is found to be very common with a rate of over 60% in most cases. In addition, gastric perforation is found at a rate of 0.3% each year in each patient . It is majorly led by NSAID usage. However, the mortality rate caused by peptic ulcer is found to have dropped significantly compared to earlier cases.
Ulcer treatment depends on its cause. It can be cured if treatment is carried out effectively for a few months.
For instance, if you have an ulcer triggered by the H. pylori bacteria, your doctor will most likely prescribe you antibiotics and a proton pump inhibitor (PPI). On the other hand, an NSAID-induced ulcer may need a course of PPIs or H2-receptor antagonists.
Here are the medications you may be prescribed as a part of ulcer treatment :
These are prescribed when you have an ulcer caused by the H. pylori bacterial infection. Usually, it is taken for a one-week course with two antibiotics twice a day.
Common antibiotics include:
After you complete the course, your doctor will recommend a second test to check for any remaining bacteria or infection in the affected area. In case there is, you will have to continue the medicinal course with another antibiotic.
You may experience some common side effects with antibiotics, including:
PPIs are used in order to decrease the level of acid in your stomach, as a treatment for stomach ulcers. As a high level of acid can damage the stomach walls further, PPI helps to prevent it. Generally, PPI is prescribed for 4 to 8 weeks depending on your condition.
Here is a list of PPIs that are commonly used for gastric ulcers:
These medications also may induce side effects such as:
However, once you finish the treatment course, these side effects fade away as well.
These are often used as alternative medications to PPIs. Consequently, they help to reduce the acid amount in your stomach to stop further damage to its linings.
The most commonly used H2-receptor antagonist is ranitidine.
Side effects of this treatment are rare. However, you may experience:
Your healthcare provider may prescribe you some antacids to reduce your symptoms for the short term by neutralising your stomach acids. The antacids may also consist of alginates, a medicine that offers a protective layer to the stomach linings. However, you must choose the one that helps your condition.
You can take antacids after a meal or at bedtime if you are experiencing symptoms or anticipating them. In addition, the best time to take alginates is after meals.
Common side effects that can occur for both medicines include:
A refractory peptic ulcer is usually over 5mm in diameter and has not healed despite PPI therapy for at least 8-12 weeks. Sustained H. pylori infection or continuous use of NSAIDs or other serious co-existing health conditions that resist the healing process, or other afflictions such as gastrinoma or gastric cancer all are considered a trigger for peptic ulcer . Doctors in general opt for surgical treatment if the medical response remains inactive or resistant or if there remains a possibility of further complications. Vagotomy or partial gastrectomy remain the two options for surgical treatment depending on the medical situation of the patient.
Here are some tips you can follow in order to reduce chances of peptic ulcer:
Untimely diagnosis and treatment of peptic ulcer might lead to massive complications. Although they don’t happen often, their complications can be very serious. The following issues could arise with ulcers :
This is a very common complication, especially related to stomach ulcers. There are two possible causes of bleeding:
However, if your anaemia symptoms are persistent, you should see a gastroenterologist.
The passage of food through your digestive tract may sometimes be blocked by an inflamed (swollen) or damaged stomach ulcer. This is called gastric outlet obstruction.
It also includes symptoms such as:
Perforation is an uncommon complication of peptic ulcer that involves the stomach lining bursting open. It can be quite dangerous as it allows stomach bacteria to escape and attack the walls of your abdomen (peritoneum). It is also referred to as peritonitis.
This infection has the potential to quickly enter the bloodstream causing sepsis and then moving on to other organs. If left untreated, this has the potential to cause multi-organ failure and be lethal. Hospital admission is necessary in such a case.
The cost of ulcer treatment in India may range approximately between Rs.10,000 to Rs.40,000. However, this amount may vary depending on the type of treatment your case requires. The charges include diagnostic test costs, medications and surgery in case you need one. For instance, the average cost of a biopsy in India is about Rs.4000 to Rs.10,000.
On the other hand, the cost of surgery ranges between Rs.70,000 and Rs.4,45,000. However, the costs may be significantly lower if you opt for treatment at a government facility.
Ulcer is painful and could also lead to complications if left untreated. However, with proper and effective treatment, ulcers can be cured completely. In most cases, taking regular prescribed medication can treat the condition. However, in severe cases, you may need to undergo surgery.
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A peptic ulcer is not generally a contagious disease, therefore, does not easily spread from one person to another. However, if your ulcer is caused by the H. pylori infection, then it can spread in various ways. The bacteria generally enter the body from the mouth and move to the gastrointestinal tract to attack it. Therefore, it can be passed on through food, drinking water, kissing or oral sex, or faecal contamination.
Ulcers caused by the H. pylori bacteria can be highly contagious. Therefore, as a preventive measure, you must ensure high personal hygiene to reduce the risk of contamination. This may include washing hands frequently, especially after eating, cooking or using the bathroom. You should also avoid eating leftover food from someone else and ensure to have clean hygienic meals and drinking water. In addition, if your partner or family member is infected with the H. pylori bacteria, ensure that they complete their treatment effectively as per their prescription, to reduce the chances of contamination.
Yes, recent studies have shown that there is a link between gastric ulcers and stomach cancer. The most common cause of ulcers is a bacterial infection caused by H. pylori, which is also related to carcinoma. When ulcer produces an open sore in the stomach lining, it can cause a DNA mutation and damage the stomach wall cells. Consequently, when there is prolonged inflammation due to lack of treatment, it can lead to stomach cancer.
Yes, peptic ulcers can be fatal if conditions worsen to perforation and peritonitis. This can be treated with surgery, but in case of a late or false diagnosis, it can lead to mortality. Moreover, an ulcer can cause severe internal bleeding, which can also cause death if not controlled effectively.
In most cases, peptic ulcers heal within 8 to 12 weeks; if medications are taken as prescribed by the doctor. However, the medications must not be stopped abruptly even if the symptoms go away quickly. However, in the case of refractory ulcers, standard medications may not cure the condition. Therefore, their treatment may be continued for another 6 to 8 weeks. In rare cases, surgery may be required if other treatments fail.
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