Peptic Ulcer Disease and Helicobacter pylori

What is a Peptic Ulcer?

A peptic ulcer is a sore or a wound in the lining of our stomach and duodenum. Duodenum is the first part of our small intestine.


What causes peptic ulcer?

  • The natural protective mechanism of our stomach protects us from ulcer. It consists of our strong intestinal lining, our intestine’s acid clearance ability and its acid production rate control. The imbalance of the mechanism may cause a break in the intestinal lining and becomes an ulcer later.
  • Causes of peptic ulcer include:
    • Helicobacter pylori ( pylori) infection
    • Medications – Non-steroidal anti-inflammatory drugs (NSAIDs), a class of pain killers that includes aspirin, ibuprofen, diclofenac and etc.
    • Taking steroids for other medical illness
  • Risk factors of getting peptic ulcer include:
    • Smoking
    • Drinking too much alcohol
    • Patient who had previous peptic ulcer
    • Stressful lifestyle
    • Certain pre-existing illness – MEN syndrome, Zollinger Ellison syndrome, cancer

What other problems can peptic ulcer disease cause?

Peptic ulcer causes many problems including:-

  • bleeding from the ulcer due to a broken blood vessel
  • a hole in the stomach wall or small bowel
  • a blockade that can stop the food from moving from stomach into small bowel

 What are the symptoms of peptic ulcer disease?

The most common symptom of a peptic ulcer is burning pain in the upper abdomen, which can range from mild to severe. In severe cases, the pain may disturb your sleep and wake you up at night.

Other common symptoms include:

  • Loss of appetite
  • Nausea
  • Bloody or black tarry stool
  • Unexplained weight loss
  • Indigestion, feeling bloated or gaseous
  • Vomiting that has coffee ground material or blood
  • Chest pain

How is peptic ulcer diagnosed?

The doctor can make the diagnosis based on medical history, physical examination, laboratory tests, Upper GI Endoscopy and/or other tests.


Upper GI Endoscopy (OGDS)

  • For your comfort, this procedure may be done under adequate sedation while you are lying down on your side
  • The doctor inserts a thin tube with camera down your throat into the stomach and duodenum to examine the area for ulcer.
  • It produces a direct magnified vision of the intestinal lining that allows doctor to perform careful and detail inspection. It also allows the doctor to give treatment and to take tissue biopsy if needed.

The other tests are indirect examination of peptic ulcer, such as Barium meal and Upper GI Series, CT scan, blood tests or Urea Breath Test for H. pylori. These tests are indirect and have their pros and cons.

How is peptic ulcer treated?

  • Your doctor will decide the best treatment based on the cause of the peptic ulcer. The following medications are commonly used, either individually or in combination:-
    • histamine receptor blocker
    • proton pump inhibitor
    • antibiotics to treat pylori infection
  • The duration of treatment depends on the severity and cause of the peptic ulcer.
  • Your doctor may also advise you to reduce or replace certain medications that may have caused the peptic ulcer. Please check with your doctor about which medications may cause peptic ulcer.
  • Drinking alcohol and smoking slows down the healing of peptic ulcer. If you smoke, you should consider quitting. If you drink, you should drink less or consider quitting too.

Can peptic ulcer come back?

Yes, if the risk or causative factors remains, your peptic ulcer is more likely to come back.

How can I prevent peptic ulcer disease?

It can be prevented by avoiding the causative or risk factors mentioned earlier.

Maintaining a healthy lifestyle trough balance diet rich in fruits and vegetables may help to prevent peptic ulcer.


Helicobacter pylori seen under the electron microscope

 What is Helicobacter pylori (H. pylori)?

  • It is a small, spiral, bacteria with tails. It lives or infects the stomach, lives under the mucous layer but above the stomach wall lining. It has the ability to irritate the stomach wall, produces toxin that will weaken the stomach lining and leads to ulcer formation.
  • pylori infection are associated with unclean or contaminated food/water intake.
  • Its presence can be detected with many tests but all have its pro and cons. The commonly used tests are:-
    • Blood test
    • Urea breath test
    • Rapid Urease Test on tissue biopsy during endoscopy
  • pylori infection can be treated with antibiotics and proton pump inhibitor. Re-infection can happen but it can be treated again with medications.
  • To prevent pylori infection, you should:-
    • Wash your hands well after using the bathroom before eating
    • Wash and cook your food properly
    • Drink water from a clean and safe source
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