Peptic Ulcer

     Peptic Ulcer is a sore on the lining of the stomach or the first part of the small intestine (duodenum). Common symptoms can range from epigastric pain or pain under the left rib cage, nausea, vomiting, to black or bloody stools.

How to Know if You Have a Peptic Ulcer

Common symptoms of peptic ulcers can be observed in 4 main cases:

1. Uncomplicated Peptic Ulcer

          Patients may experience pain in the epigastrium or under the left rib cage, which is often related to meals, along with nausea and vomiting.

2. Bleeding Peptic Ulcer

Occurs when the ulcer is deep enough to reach a blood vessel, causing bleeding with symptoms such as:

• Vomiting blood or black coffee-ground-like fluid
• Bloody or black (tarry) stools
• Chronic anemia

3. Gastric Outlet Obstruction from Chronic Large Ulcers

Such ulcers can block the digestive path, leading to severe abdominal pain, excessive vomiting, and bloating shortly after eating.

4.  Perforated Peptic Ulcer

• Sudden acute epigastric pain accompanied by fever.
  
   

Why do Peptic Ulcers occur?

Although the stomach normally has defense mechanisms to prevent ulcers, repair damage, and resist acid well, several factors can cause issues:

• H. pylori Bacteria: May be contracted through contaminated food or water.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Mostly used for chronic conditions like joint pain, muscle aches, menstrual pain, and headaches, including aspirin for stroke and coronary artery disease prevention.
• Comorbidities: Such as heart disease, diabetes, and cirrhosis.
• Smoking and Alcohol Consumption

What to do if you suspect a Peptic Ulcer?

     If you have any of these symptoms, such as abdominal pain, nausea, or chronic vomiting, it is recommended to see a doctor for an examination. The most common method is an Upper GI Endoscopy (Gastroscopy).

Who should undergo a Gastroscopy?

Since the stomach is located beneath the epigastrium, any pain or discomfort in this area often makes stomach disease the first thing a doctor suspects. Generally, endoscopy results show normal findings in up to 70% of cases, with less than 1% chance of finding cancer. However, doctors still choose endoscopy for diagnosis if they suspect gastrointestinal lesions or concerning symptoms:

• Chronic abdominal pain that does not improve after treatment.
• History of black stools (tar-like) or vomiting blood.
• Iron deficiency anemia or unexplained weight loss.
• Palpable mass in the epigastric area suspicious of a stomach or duodenal tumor.
• Difficulty swallowing or painful swallowing.

Treatment of Peptic Ulcers

• Medication: Mostly consists of acid reducers, as acid makes ulcers more severe or harder to heal. These include:
  • PPIs (Proton Pump Inhibitors) or PCABs
  • Mucosal protective agents such as Rebamipide
  • Antacids like Alum milk or Alginates
• Endoscopic Treatment: Performed in cases of bleeding ulcers to stop the bleed and identify the cause.
• Surgery: Used in cases of digestive tract obstruction or ulcer perforation.