Peptic ulcer disease : Overview and How is it Treated?

4 min readJan 11, 2023

WHAT IS PEPTIC ULCER DISEASE?

Ulcer formation in the upper GI tract affecting the lining of either the stomach or duodenum, in some rare cases peptic ulcers are also located at the lower end of esophagus. The reason behind the formation of these ulcers relies in the fact that the acid contained in the stomach combined with the pepsin can affect the lining of your stomach. This can happen when the defense mechanism of your stomach against these digestive juices breakdown. So, basically an increase in your stomach acid and decrease in your stomachs defense mechanism make up the perfect environment for stomach ulcer formation.

WHAT ARE THE DIFFERENT LAYERS OF STOMACH?

The inner layer of the stomach which releases the mucus rich in bicarbonate is known as mucosa. The components of this layer protect the lining of stomach from gastric ulcers There are also some special cells contained in this layer known as parietal cells, chief cells and G cells which release hydrochloric acid. pepsinogen and gastrin respectively.
The middle layer of the stomach lining is known as sub-mucosa which mainly contain tissue, nerves and vessels
The outer layer of the stomach which helps in the churning movement of the stomach is known as muscularized externa

HOW ARE PEPTIC ULCERS CAUSED?

To fully understand the process by which the ulcers in stomach are formed, you must understand the compositions of both the defense mechanism and causing of gastric ulcers in the stomach

Components of defense system of stomach lining

Bicarb which protects lining cells
Prostaglandins which regulates stomach profusion and controls release of acid by parietal cells

Components of ulcer causing factors

HCL secreted by parietal cells
Pepsin enzyme

The balance between the defense mechanism and causing factors should be maintained to avoid ulcer development. However, here are some external elements which can disturb this balance:

H Pylori bacterial infection causes the most of the stomach ulcers
Usage of NSAIDs
Zollinger-Ellison syndrome
Smoking cigarettes
And drinking alcohol
Genetics

HOW DOES BACTERIAL INFECTION REALLY CAUSE THE PEPTIC ULCER DISEASE?

The structure of H Pylori helps them to invade the cells of. So, when the bacteria damage the cells of mucosa, histamine is released in the stomach. The role of histamine is to stimulate the parietal cells in order to release the HCL. This causes a cascade of problems leading to stomach ulcer. This type of bacteria is mostly transmitted through contaminated water or food.

SIGNS AND SYMPTOMS OF STOMACH ULCER

The main complains a patient with ulcer will have are as follows:

Indigestion
Epigastric pain

Apart from this peptic ulcer symptoms may vary for stomach and duodenum ulcers:

For stomach

Food making the pain worse
Pain is of the dull and aching type
Weight loss
Vomiting blood

For duodenum

Food usually makes the pain better
Night pain in the abdomen
Pain is of the gnawing type
Tarry dark stool

HOW ARE PEPTIC ULCERS DIAGNOSED?

Some methods for the diagnosis of this disease are as follows:

Endoscopy to observe the lining of GI tract through a camera
Upper GI series
CT Scan
Blood or stool test to confirm the presence of H Pylori
Urea breath test

WHAT COMPLICATIONS A PATIENT OF ULCERS CAN FACE

Gastrointestinal bleeding
Perforation in the stomach lining
Blockage in the bowel movement usually due to duodenal and chronic ulcers
Patients with ulcers, especially due to H Pylori, remain at high risk of developing stomach cancer

WHAT ARE THE STOMACH ULCER TREATMENT OPTIONS?

Nursing interventions

The primary step in the treatment of every patient is

Assessment of vital signs, bowel system, tenderness in the abdomen, stools
Monitoring any complication related to the disease or related to the surgery, if done.
Administration of the medication and education of the patient.

Medication

Antacids: the medications neutralize stomach acid reflux. As these medications interfere with other drugs, they are given alone. Some examples of these medications are; magnesium hydrochloride and calcium carbonate.
Mucosal healing drugs: Sucralfate is one of the common types of these drugs which lines the stomach and adheres to the ulcer site in order to protect it from acids.
Histamine receptor blockers: As the name suggests, these drugs block histamine receptors in order to lower the HCL concentration by not letting histamine stimulate the parietal cells.
Bismuth subsalicylate: You may have heard of Pepto-Bismol as a drug to cover the ulcers and help in killing the bacteria
Proton pump inhibitors: These drugs attach to the proton pump on the parietal cells and blocks the release of hydrogen ions which would have mixed with chloride to make HCL
Antibiotics: Some commonly used drugs are; clarithromycin, tetracycline, amoxicillin etc.

CONCLUSION

It is a modern day triumph to be able to treat a disease like stomach ulcer with medication that previously needed surgery. However, there still are some persistent misconceptions about peptic ulcer disease. A very strong myth is that ulcers are caused by stress, food or too much stomach acid when it is clear now that some external factor disturbs the balance between the defense system and acidic environment of the stomach. Just like Dr. Barry Marshal, who decided to clear all this fuss about peptic ulcers by working dedicatedly towards the people, you need a Dr. Vatsal Mehta upon whom you can trust for dedication and passion for finding the best treatment option for patients.
This kind of professionalism and dedication is guaranteed in order to relieve you from devastating symptoms of ulcer. So to get the best stomach ulcer treatment from the most expert professional, at Alfa Gastro & Liver Care.