Peptic ulcers

Removing large chunks of the digestive tract used to be the only way to end the pain of chronic stomach ulcers and avoid the risk of a potentially life-threatening haemorrhage. Now, all most people need is a course of antibiotics.

Symptoms

Although most peptic ulcers are quite small, they can be incredibly painful. This pain tends to be:

• A constant gnawing or burning pain.
• Located in the upper, central abdomen (but may penetrate into the back).
• Worse at night or in the early morning.
• Worse if you miss a meal.
• Relieved by food or 'white medicine' such as antacids or milk.

Other symptoms include:

• Tiredness.
• Nausea and vomiting.
• Indigestion or heartburn, vomiting blood or passing blood in the stools (this may be the only sign of an ulcer).
• Anaemia, caused by blood loss, resulting in paleness and shortness of breath.

However, some people have no symptoms at all.

If left untreated, peptic ulcers may cause rapid internal bleeding, which can be very dangerous, or a perforation or obstruction in the intestines.

Causes and risk factors

Peptic ulcers occur when the membrane lining the digestive system breaks down or erodes. This membrane normally stands up to some fairly tough challenges, containing and churning up food particles while resisting the effects of the stomach's powerful digestive juices.

The discovery that the bacteria Helicobacter pylori (H.pylori) is the main cause of these ulcers has been one of the great success stories of modern medicine.

Several mechanisms protect the digestive membrane, but under certain conditions these fail, allowing acid and digestive enzymes to cause damage. These conditions include:

• Infection with H. pylori - many people carry this bacteria, and while not everyone with H. pylori develops an ulcer, almost everyone with an ulcer has H. pylori.
• Non-steroidal anti-inflammatory drugs (NSAIDs) - these include aspirin, ibuprofen and many painkillers used for conditions such as arthritis. Ulcers and haemorrhage are a common problem with these drugs.
• Smoking.
• Excessive amounts of alcohol.

Other factors that increase the risk of an ulcer include a family history of ulcers and being blood group O.

It used to be thought that high levels of stress could cause ulcers, but many doctors now think emotional stress simply accentuates the pain of an existing ulcer and may interfere with healing.

Events that put mmense physical stress on the body, such as severe burns, major surgery or a major trauma, do seem to be linked to peptic ulcers.

Tests to confirm the diagnosis of an ulcer include:

• Gastroscopy - a thin tube or endoscope is passed into the stomach to look at the digestive membrane.
• Barium studies - a substance called barium is swallowed and then highlights ulcers on an x-ray.

Tests will also look for the presence of H. pylori. These may involve a blood test, breath test or biopsy of the digestive membrane.

Treatment and recovery

If H. pylori is detected, the main treatment is eradication therapy. This usually means taking a combination of two antibiotics and a drug that suppresses stomach acid production for a week. It's commonly known as 'triple therapy'.

It's also important to cut down on factors that can aggravate an ulcer, such as smoking, and stop taking any NSAIDs.

Although medical treatments usually cure the ulcer, an operation is still required in some cases. This may involve cutting the main nerve that controls acid production in the stomach (the vagus nerve) or removing part of the stomach itself.