Peptic ulcer

Peptic ulcer – what is a peptic ulcer

Peptic ulcer (peptic ulcer disease) represents open sores in the mucous membrane of the lower esophagus, stomach or duodenum mainly as a result of bacterial infection caused by Helicobacter pylori. The most common symptom is severe stomach pain that extends from the navel to the sternum. If left untreated over time, sores get worse and can cause serious complications.

Symptoms

Symptoms of peptic ulcer depend on the location of the ulcer and the age of the patient, as many patients, especially the older ones, have few or no symptoms at all.

Pain is the most common symptom of a peptic ulcer, often localized in the epigastrium. It has the character of burning or biting, and can also spread to the back or to the right rib arch, which is usually a sign of complication. Sudden sharp and very severe pain indicates a perforation.

Pain in the duodenal ulcer occurs on an empty stomach and 2 to 3 hours after a meal. It also often occurs during the night. After taking a small amount of food or antacid, the pain stops.

In a gastric ulcer, the pain occurs within one hour of ingestion, and eating out of the desire for relief may further exacerbate the pain.

Difficult discharge of the gastroduodenum may be due to the localization of an acute ulcer or fibro-stenotic anatomical changes after previous ulcers. In these cases, inappetence (lack of appetite), nausea and vomiting may occur. These symptoms result in weight loss.

Heartburn is common in patients with duodenal ulcer. The appearance of melena (stool as black as tar) or hematemesis (vomiting of fresh, red or only minimal liquid mixed with blood or clotting blood, or vomiting of dark blood) indicates a bleeding ulcer.

peptic ulcer

Causes and risk factors

It was once believed that peptic ulcers were caused by spicy foods or a stressful life. Today, the most common causes of stomach ulcers are:

Heliobacter pylori (H. pylori) infection

Although it is not entirely clear how Heliobacter pylori spread, most scientists believe it is most commonly transmitted directly from infected to healthy individuals. It can also enter into the human organism through food and water. This bacterium has several strains and most commonly lives on the gastric mucosa. In most cases, it does not cause problems, but it can cause acute inflammation (gastritis), which then becomes chronic and can cause an ulcer. Studies show that about 15 to 20% of people infected with H. pylori will develop a gastric or duodenal ulcer, and less than 1% will have cancer or gastric lymphoma.

Regular use of certain painkillers

Certain painkillers from the group of NSAIDs make the stomach or duodenal mucosa more susceptible to injury. These are medicines like ketoprofen, ibuprofen, diclofenac, indomethacin and others. Approximately 30% of adults who regularly use these drug groups experience side effects on the digestive system.

Risk factors for gastric ulcer are:

Smoking and alcohol consumption – Both bad habits stimulate the stomach to produce more acid than usual. If a person also has an H. pylori infection, the risk of developing a peptic ulcer is even greater,

Cocaine and methamphetamine intake – These narcotics restrict blood flow to the gastric mucosa, preventing its normal functioning,

Viral diseases – Viruses, such as cytomegalovirus and herpes, especially in the elderly and those whose immunity is already compromised can increase the risk of peptic ulcer development

Emotional stress

Treatment

The type of therapy will certainly depend on the cause of the ulcer. Some of the options are:

Antibiotics

If a peptic ulcer is caused by H. pylori infection, therapy will consist of a combination of two antibiotics and some type of acid-blocking drugs, such as a proton pump inhibitor.

Proton pump inhibitors

Unless a bacterial infection is present, these medicines will regulate the amount of gastric acid and help cure the ulcer.

Recommendations

Reduce the use of non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen. These drugs are used by people of all ages, as they are often prescribed to treat a wide variety of conditions such as fever and pain – and some abuse and rely on these drugs alone to relieve chronic pain (such as headache, arthritis (joint pain). PMS cramps, etc.). This group of drugs has a great impact on the digestive system by reducing the production of mucus, which plays a very important role in the defense of the gastric and intestinal mucous membranes against strong gastric acid and other digestive enzymes. Try to stop using these medicines or at least reduce them. Talk to your doctor about other possible ways to control your pain.

Control stress situations. Although the theory that stress alone can be the cause of peptic ulcer is no longer supported, it is still considered somewhat “psychosomatic”. When one experiences chronic stress, the risk of developing an ulcer goes up a lot because there is a strong connection between the brain and the digestive process.

Balance your diet. Although talking about eating frequently throughout the day is not the best option in this case. Try to skip meals and reduce meals to 3 times a day, but large amounts of food can aggravate the symptoms of an ulcer in the digestive tract, so be careful. Also, avoiding breakfast, in this case, is not the best idea. If you are able, it would be best to seek help with a diet plan with your doctor or fitness trainer.

Crohn‘s disease

Crohn‘s disease

Crohn’s disease is an inflammatory disease of the gastrointestinal tract that can affect any part of the digestive system, from the oral cavity to the end of the colon, and is often difficult to distinguish from ulcerous colitis (inflammation of the colon with ulcerations).

Most commonly, the affected part of the gastrointestinal tract in Crohn’s disease is the terminal part of the small intestine (ileum) and large intestine (colon), although changes can occur on any part of the digestive organ. An intestinal wall can bleed and even lead to perforation of the intestinal wall with leakage of intestinal contents into the abdominal cavity causing numerous complications.

Causes

Various clinical studies have shown that the genetic factor plays a very important role in the onset of this disease. There is a high degree of concordance in the disease of monozygotic twins.

Numerous infective, bacterial and viral agents have been suggested as the cause, but without definitive evidence. M. paratuberculosis causes, in ruminants, Johne’s disease, a chronic inflammatory disease of the ileum, similar to Crohn’s disease.

The predisposing factors of Crohn’s disease include diets containing a lot of refined sugars and the use of contraceptives. Smoking is also one of the possible synergistic triggers for this disease.

Signs and symptoms

Periods of exacerbation and improvement change, besides the ileocecum, the descending colon and other segments can be affected also, so the symptoms mainly depend on the localization. However, three are dominant: diarrhea, abdominal pain, weight loss.

The acute phase goes with fever, loss of appetite, nausea; often the clinical picture is nonspecific and atypical. Palpable mass can be found in the ileocecum, the involvement of the entire small intestine is prognostically unfavorable. Colonic involvement is mainly manifested by diarrhea, rarely by hematochezia, and extra-intestinal symptoms are more common than in the small intestine.

intestines

Perianal involvement is manifested by fissures, ulcerated hemorrhoids, and ulcers. Abscesses, rarely, anovaginal fistulas and strictures are also seen, either as an underlying disease or a complication.

Extra-intestinal complications are, in fact, systemic disease outbreaks, which include: osteoporosis, arthritis, ankylosing spondylitis, erythema nodosum, changes in the eyes – episcleritis, uveitis, aphthous stomatitis, fatty liver, cholangitis, renal calculus, nutritional deficits, and anemia are frequent due to malabsorption defects, loss of appetite and chronic diseases.

Diagnosis

Diagnosis should be considered in all diarrhea patients, with or without blood, and abdominal pain. Atypical manifestations, fever of unexplained origin without intestinal symptoms, or extra-intestinal manifestations, such as arthritis or liver disease, are possible.

As Crohn’s disease can also affect the small intestine, it should be considered in all forms of malabsorption syndromes, intermittent intestinal obstruction, and abdominal fistulas.

Blood tests are nonspecific. They may show moderate anemia (normochromic, normocytic or hypochromic), increased sedimentation, leukocytosis and thrombocytosis, hypoproteinemia. Diarrhea can lead to electrolyte disruption and malabsorption in Crohn’s disease to steatorrhea.

The prevalence of the disease is determined by an X-ray examination of the small intestine with barium and lower gastrointestinal series. These may show changes in mucosal appearance, deep ulceration, and a pathognomonic “ribbon or wire sign.” Changes often affect the ileum and colon continuously. In chronic cases, strictures may occur. Intestinal lesions are usually discontinuous.

Treatment

For the treatment of mild to moderate cases of the disease, anti-inflammatory drugs are mostly used. Corticosteroids (budesonide and prednisone) are used briefly to relieve the symptoms of Crohn’s disease since they suppress the immune system and cause various other side effects.

Immunomodulators such as ciclosporin A and azathioprine help to maintain remission and can also help treat fistulas. Antibiotics are most commonly used when it is necessary to treat abscesses or other bacterial infections that occur as a result of Crohn’s disease.

Surgical methods of treatment for patients are mostly suggested in the case of the need to remove damaged bowel sections to avoid more serious complications, blockages or ruptures. Surgical methods are also resorted to in case the medicines do not show good results.

Crohn's disease

Surgery can bring remarkable improvement, and there is a possibility that the next attack will not occur for many years. However, absorption of vitamins, fats, and other important micronutrients may be reduced after the removal of a portion of the intestine.

When conventional treatments do not work, biological drugs can also be used, but only if the doctor has approved this type of therapy. During the onset of the disease, it is necessary to rest. In order to alleviate the symptoms, it is necessary to follow all the instructions given by your doctor.

Dietary supplements that you can use include supplements of vitamins A, C, E, B12, K, folic acid, minerals – calcium, magnesium, zinc and selenium, amino acid glutamine, essential fatty acids, and probiotics.

Disease activation is often associated with emotional or physical stress, but in some cases, it is not entirely clear why the disease has returned.

Helicobacter pylori

Helicobacter pylori is a bacterium that is only found in humans in the lower part of the stomach and according to the World Health Organization, half of humanity is infected with this bacterium. If left untreated, helicoid bacteria can cause more serious medical conditions.

Helicobacter causes local inflammation of the gastric mucosa, that is, gastritis, and some people infected with this type of bacterium may develop ulcers on the duodenum and stomach. The bacterium thrives in the acidic environment of the stomach because it secretes the enzyme urease that breaks down urea and thus releases ammonia, which neutralizes gastric acid with its basic properties.


How is helicobacter transmitted?


Helicobacter is transmitted through dirty hands, which is why it is most prevalent in those parts of the world where there are unhygienic living conditions and are socially and economically underdeveloped. In these countries, it is estimated that up to 80% of the population is infected with this bacterium, while the percentage of infected persons in developed parts of the world is smaller and ranges between 20% and 50%. In addition, the channels through which this bacterium can be transmitted are contaminated food, ie unwashed fruits and vegetables, defective water. And it can also be transmitted by the mouth-to-mouth method from a person infected to a healthy person.

Helicobacter symptoms


Symptoms in some people who are infected with the bacterium are almost not manifested, so the bacterium can stay in the body for decades, even throughout life. In some people, certain symptoms may develop over time. However, this also depends on the immune properties of the organism. The most common symptoms are bloating, stomach pain, nausea, and indigestion, bad breath, and heartburn. Persons suffering from chronic gastritis do not feel anxious, but this changes if a stomach ulcer occurs. Appetite is reduced, which causes weight loss, and in some cases, blood in the stool may occur.


Chronic fatigue, insomnia, anxiety, depression can all be indirect indications that helicobacter has formed in the body. In some people, gastric disorders are much more pronounced, while in some people the intensity of indirect problems is higher.

Pain caused by Helicobacter

Proper nutrition

One of the basic things for eliminating helicobacter from the body is proper and reduced diet and changing lifestyle. It is necessary to have breakfast, lunch, and dinner at about the same time. The interval between meals should not be less than 3 hours and ideally around 4 hours. Avoid carbonated beverages, alcohol, especially white wine, coffee, sweets and sugars, refined foods (eg white flour products…), cooked, roasted and heavily spicy food. Consume green or black tea instead of coffee.

Against the increased secretion of acid, drink at least half an hour before breakfast unsweetened chamomile tea, flax seeds, thyme, sage, nettle, flacon (not hot at all). Strictly avoid tobacco smoke as it stimulates the secretion of gastric acid. Consume integral colostrum, oats and barley. Avoid fresh, white, wheat, cornbread.

Integral or red rice is recommended for lunch until 3 pm in combination with grilled vegetables or low-fat fish. Do not season soups or stews and cooked meals with strong spices that contain additives and flavor enhancers. Do not waste food. From dairy products, sour milk, young cheese and sometimes butter are recommended. Cow’s milk is prohibited. Legumes (beans, peas) should be consumed as a puree, but in principle be careful and limited bring them in.

Recommended vegetables are cabbage, broccoli, spinach, artichokes, kale, currant, arugula, beets, cauliflower. Tomatoes and tomato products, onions, cucumbers, green peppers, mushrooms should be avoided, or at least restricted, as they enhance the secretion of gastric acid. Consumption of fruits rich in raspberry, pear and plum fiber is advised. Cranberries and apples contain flavonoids – chemicals that can stop the growth of helicobacter. Cranberry juice is also rich in flavonoids. Consume fruits between 4 pm and 6 pm, every third or fourth day. Meat (veal, beef, chicken, rabbit…) or fish (sea or river) should be cooked or grilled. Avoid greasy and stronger types of meat or fish. The use of fresh and fried eggs is prohibited. Soft boiled eggs are recommended. Meals should be moderately warm and beverages moderately cold. Eat slowly and cook well.