Living with
Peptic Ulcer Disease (PUD)

What is peptic ulcer disease (PUD)?

When you have peptic ulcer disease (PUD), you have ulcers (open sores) on the lining of the inside your stomach (gastric ulcers) and possibly also on the lining of your duodenum, the upper part of your small intestine, (duodenal ulcers). If you have PUD, you may experience stomach pain when the stomach acid irritates and erodes/eats into the open sores.

 

Infection with the bacterium Helicobacter pylori (H. pylori) and/or long-term, or excessive, use of pain medications, namely aspirin or nonsteroidal anti-inflammatories (NSAIDs), are the most common causes of (PUD).

How do you know if you have peptic ulcer disease?

While almost 75 % of people with PUD may have no symptoms, those with symptoms most commonly report a burning stomach pain. This is caused by the corrosive action of the gastric acid against the ulcers.
Therefore, eating certain foods or taking medications to limit stomach acid production may sometimes help relieve this pain. The pain is also usually worse between meals or at night.

Other symptoms of PUD besides stomach pain may include:

See your doctor if you have any of the above symptoms, and especially if you have any of the severe symptoms below:

  • Vomiting, especially vomiting blood
  • Dark blood in stools (your stools may appear black or tarry)
  • Feeling faint or weak
  • Significant, unexplained weight loss and loss of appetite.

What is the difference between PUD and gastritis?

While PUD is an ulcer or sore in the lining of the stomach or duodenum, gastritis is the widespread inflammation of the stomach lining causing it to become red and swollen.

 

But while PUD and gastritis are separate conditions, they have similar symptoms of a burning stomach pain, nausea and vomiting. Additionally, both conditions have the same two main causes, H. pylori infection and/or regular NSAID use. Therefore, if you have gastritis, you will probably manage your symptoms and get treatment like you would for PUD.
Gastritis, if left untreated, can also cause PUD.

 

What causes PUD?

Normally, a thick layer of mucus protects the stomach lining from the effect of the acidic digestive juices in the stomach. However, certain factors can reduce the protective mucous lining, causing the stomach acid to eat into the linings of the stomach or small intestine, leading to painful open sores or ulcers.

 

The most common causes of PUD are:

  • Helicobacter pylori infection: H. pylori bacteria normally live in the mucous layer lining the upper digestive tract and mostly cause no negative impact to your health. Sometimes though, the bacteria can cause inflammation of the stomach’s inner layer, producing an ulcer.
  • Regular or excessive use of certain pain relievers: If you are taking aspirin or nonsteroidal anti-inflammatories (NSAIDs), like ibuprofen, these medications can irritate the lining of your upper digestive tract and cause severe inflammation.
  • Certain other medications: If you take medications like steroids, anticoagulants, antidepressants like selective serotonin reuptake inhibitors (SSRIs), as well some other less common drugs, then you are at greater risk of developing PUD.

In addition, you may have an increased risk of developing PUD based on whether you:

  • Smoke
  • Drink alcohol: Alcohol can also irritate the lining of your stomach and reduce the mucous layer; moreover, it increases the amount of stomach acid produced.
  • Have a family history of PUD
  • Have certain other medical conditions: These include gastritis, Zollinger-Ellison syndrome (a rare condition that causes your stomach to produce too much acid), Crohn’s disease or cirrhotic liver disease.
  • Are of older age.

Additionally, while spicy foods and experiencing high amounts of unmanaged stress may not cause peptic ulcers, they can make your symptoms worse and much harder to treat.

Living and managing

By making the following lifestyle changes you can help manage your PUD:

  • Eat a healthy diet: Choose a healthy, well-balanced diet, full of foods like fruit, vegetables and whole grains, that are high in vitamins that are needed for your body to heal your ulcer effectively.
    Include probiotics which are good for gut health and are found in dairy products like yogurt. However, consider eliminating milk, as milk can increase gastric production of acid. If in doubt, talk to your doctor about drinking milk. It is a myth that milk relieves stomach pain caused by indigestion, heartburn or GERD.
    See Cooking from the Heart recipes for healthy, delicious and affordable meal options.
  • Avoid excessive use of pain relievers: Consider switching analgesic type if you use pain killers regularly and ask your doctor about alternatives to NSAIDs.
  • Manage stress and get enough sleep: Find ways to relieve stress and make sure you get enough sleep which also counters stress. Try to avoid eating right before bedtime.
  • Stop smoking: Talk to your doctor about ways to quit smoking, as tobacco smoke can make you susceptible to stomach ulcers.
  • Limit your alcohol consumption.

 

What treatment is available for PUD?

Treatment for PUD will depend on the cause; for example, eliminating H. pylori infection, if present, and stopping or reducing NSAID use.
Some medications can also be used to help heal your ulcer.

Medications for the treatment of PUD can include:

  • Antacids: These are available over-the-counter in pharmacies.  Antacids neutralise stomach acid, providing rapid pain relief.
  • Antibiotic medications to kill H. pylori: If significant H. pylori infection is found in your digestive tract, your doctor may recommend a two-week long course of a combination of antibiotics to kill the bacterium. The antibiotics used commonly include amoxicillin, clarithromycin and metronidazole. The antibiotics you will be prescribed will be determined by current antibiotic resistance rates.
  • Proton pump inhibitors (PPIs): These medications reduce stomach acid production and promote healing of the gastric lining. Some of these medications are available over-the-counter, while stronger versions require a prescription from your doctor.
    It is important to note that long-term use of PPIs at high dosages, may increase your risk of hip, wrist and spine fracture. Therefore, ask your doctor whether you could use a calcium supplement to reduce this risk.
  • Histamine (H-2) blockers: These medications also reduce the amount of stomach acid produced and promote healing.
  • Cytoprotective agents: These prescription medications, such as misoprostol, protect the lining of your stomach and small intestine.

What are the complications associated with PUD?

If left untreated, peptic ulcers can result in serious complications like:

  • Internal bleeding: Slow bleeding may cause anaemia, while acute, severe blood loss that may require emergency hospital care and/or a blood transfusion.
  • Infection: Sometimes, a peptic ulcer can perforate through the entire wall of your stomach or small intestine, putting you at risk of developing a serious infection of your abdominal cavity (peritonitis) from leaked digestive fluids.
  • Obstruction: The scar tissue from peptic ulcers can also block the passage of food, causing you to vomit or to become easily full and lose weight.
Sources

National Institutes of Health. (2014) Symptoms and Causes of Peptic Ulcers (Stomach Ulcers).National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), US Dept. of Health and Human Services. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes

 

InformedHealth.org. (2015) Gastritis: Peptic ulcers. Institute for Quality and Efficiency in Health Care, Cologne, Germany. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310262/

 

Cleveland Clinic Staff. (2020) Peptic Ulcer Disease. The Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease#:~:text=Peptic%20ulcer%20disease%20is%20a,effect%20of%20its%20digestive%20juices.

 

Cleveland Clinic Staff. (2020) Peptic Ulcer Disease: Management and Treatment. The Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease/management-and-treatment

 

Digestive Disease Consultants. (n.d.) Peptic Ulcer Disease and Gastritis. Available from: https://www.mygidocs.com/diseases-conditions/peptic-ulcer-disease-gastritis/

 

Gastritis or Ulcer, No Antibiotic Treatment. The StayWell Company, USA. Available from: https://www.fairview.org/patienteducation/116655EN#:~:text=Gastritis%20is%20irritation%20and%20inflammation,the%20lining%20of%20the%20stomach.

 

Judith E. Tintinalli, J. Stephan Stapczynski, O. John Ma, Donald M. Yealy, Garth D. Meckler, David M. Cline. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Chapter 78: Peptic ulcer disease and gastritis. Access Medicine. Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109430430

 

Vakil N. (2020) Introduction to Gastritis and Peptic Ulcer Disease. MSD Manual, Merck & Co. Available from: https://www.msdmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/introduction-to-gastritis-and-peptic-ulcer-disease

 

Torrance Memorial Physician Network. (n.d.) Ulcer and Gastritis. Available from: https://www.tmphysiciannetwork.org/specialties/primary-care/ulcers-gastritis/

 

Rogers G. (2020) Peptic Ulcer. Healthline. Available from: https://www.healthline.com/health/peptic-ulcer

 

Murrell D. (2019) Gastritis. Healthline. Available from: https://www.healthline.com/health/gastritis

 

Mayo Clinic staff. (n.d.) Diseases & Condition: Peptic ulcer. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223

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Sources

National Institutes of Health. (2014) Symptoms and Causes of Peptic Ulcers (Stomach Ulcers).National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), US Dept. of Health and Human Services. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes

 

InformedHealth.org. (2015) Gastritis: Peptic ulcers. Institute for Quality and Efficiency in Health Care, Cologne, Germany. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310262/

 

Cleveland Clinic Staff. (2020) Peptic Ulcer Disease. The Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease#:~:text=Peptic%20ulcer%20disease%20is%20a,effect%20of%20its%20digestive%20juices.

 

Cleveland Clinic Staff. (2020) Peptic Ulcer Disease: Management and Treatment. The Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease/management-and-treatment

 

Digestive Disease Consultants. (n.d.) Peptic Ulcer Disease and Gastritis. Available from: https://www.mygidocs.com/diseases-conditions/peptic-ulcer-disease-gastritis/

 

Gastritis or Ulcer, No Antibiotic Treatment. The StayWell Company, USA. Available from: https://www.fairview.org/patienteducation/116655EN#:~:text=Gastritis%20is%20irritation%20and%20inflammation,the%20lining%20of%20the%20stomach.

 

Judith E. Tintinalli, J. Stephan Stapczynski, O. John Ma, Donald M. Yealy, Garth D. Meckler, David M. Cline. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Chapter 78: Peptic ulcer disease and gastritis. Access Medicine. Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=1658&sectionid=109430430

 

Vakil N. (2020) Introduction to Gastritis and Peptic Ulcer Disease. MSD Manual, Merck & Co. Available from: https://www.msdmanuals.com/home/digestive-disorders/gastritis-and-peptic-ulcer-disease/introduction-to-gastritis-and-peptic-ulcer-disease

 

Torrance Memorial Physician Network. (n.d.) Ulcer and Gastritis. Available from: https://www.tmphysiciannetwork.org/specialties/primary-care/ulcers-gastritis/

 

Rogers G. (2020) Peptic Ulcer. Healthline. Available from: https://www.healthline.com/health/peptic-ulcer

 

Murrell D. (2019) Gastritis. Healthline. Available from: https://www.healthline.com/health/gastritis

 

Mayo Clinic staff. (n.d.) Diseases & Condition: Peptic ulcer. Mayo Clinic. Available from: https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223