In the digestive system, ulcer comprises the area where the tissue has been destroyed by gastric juices and stomach acid. Peptic ulcer disease is a general term used for ulcers that occur in the stomach or duodenum (upper part of the small intestine) or esophagus. A peptic ulcer is a sore formed due to injury in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum - a duodenal ulcer; and of the esophagus - an esophageal ulcer.

An ulcer occurs when the body's acidic digestive juices, which are secreted by the stomach cells, erode the lining of these organs. Thus, the mucous membrane lining of the digestive tract is damaged causing gradual breakdown of tissue.

What are the causes of the peptic ulcer?

The main causes of peptic ulcer are -

1.Peptic ulcer is mainly caused due to an infection by a bacteria called Helicobacter pylori - also referred to as H. pylori. It is considered the primary cause of ulcers. This bacterium is found in the stomach, and along with acidic secretions can damage the tissue of the stomach and duodenal, causing inflammation and ulcers.

2.Acid and pepsin -

When one eats, the food is partially digested in the stomach and the rest gets carried forward to the duodenum. Our body's defense mechanisms are such that the stomach can protect itself from the digestive juices in various ways like production of mucus by stomach, which protects stomach tissues, and also the blood circulating in the lining of the stomach protects it. But, when the hydrochloric acid and pepsin enzymes overcome this defense mechanism of the gastrointestinal tract, it causes erosion of the mucosal wall resulting in peptic ulcer.

3.NSAIDs – Non Steroidal Anti-Inflammatory Drugs -

The most common NSAIDs which cause ulcers are aspirin, ibuprofen. Others medicines used to treat several arthritic conditions also lead to the same. They can fail the stomach's defense mechanisms, making it vulnerable to harmful effects of acid and pepsin by reducing the stomach's ability to produce mucus and bicarbonates, and also reducing the blood flow and cell repair in the stomach lining.

4.Smoking –

Researches show that cigarette smoking increases chances of developing an ulcer. Smoking also reduces the healing rate of existing ulcers and contributes to ulcer recurrence.

5.Caffeine –

Caffeine rich beverages and foods stimulate acid secretion in the stomach. Also it can aggravate an existing ulcer.

6.Alcohol –

While no direct causal relationship has been established which goes on to prove that alcohol causes peptic ulcer, but high co-relationship has been found which indicates that people who consume large amount of alcohol are more prone to peptic ulcer.

7.Physical stress –

Physical stress can increase the risk of developing ulcers, especially in the stomach. Examples of physical stress that can lead to ulcers are injuries such as severe burns and any major surgery.

What are symptoms of peptic ulcer?

Many a times, symptoms of peptic ulcer are late to show up. The common symptoms of ulcer disease are several and mostly include -

1.Abdominal pain –The pain is usually in the upper middle part of the abdomen, above the navel and below the breastbone. The pain often occurs several hours after a meal, which becomes worse at night and early morning, when the stomach is relatively empty. Temporary relief from pain is possible if some amount of food, if antacids are taken.

2.Burning pain in the gut

3.Nausea, vomiting, loss of appetite and unexplained loss of weight are some of the associated symptoms.

4.Bleeding – In very severe ulcers cases, bleeding in the stomach or duodenum may also occur. Bleeding can be either in the form of vomiting of blood or blood in the stool.

5.Chest pain

6.A slowly bleeding ulcer can also cause anaemia, where there are not enough red blood cells to transport oxygen around the body.

How is peptic ulcer diagnosed?

Peptic ulcer is mainly diagnosed after analyzing the symptoms, lifestyle and diet of the person. Some tests that help diagnose ulcer include a blood test, endoscopy and an upper gastrointestinal test with barium.

What increases a person's risk of getting peptic ulcer?

A person is more likely to develop a peptic ulcer if he:

•has an H. pylori infection

•uses NSAIDs quite often

•smokes cigarettes, eats tobacco

•chronic alcoholic

•have relatives with peptic ulcers

•are older than 50 years.

How is it treated ?

A customized treatment is required based on age, condition and the extent of the ulcer, and the person's compatibility with drugs. Generally, doctors prescribe some antacids, or inhibitors of the proton pump. If H. Pylori causes the ulcer, the patient will be prescribed some antibiotic drugs too.

Apart from drugs, few lifestyle changes are also recommended.

Smoking and drinking alcohol and coffee must be totally abandoned. Avoid taking foods that causes pain and burning in the gut. The person should lose excess weight, if overweight. In case medicinal treatment is not effective, then surgery is the ultimate solution.

How to prevent peptic ulcer?

One can prevent peptic ulcers by avoiding alcohol, smoking, taking aspirin and non-steroidal anti-inflammatory drugs, which trigger break down of the stomach's protective barrier and increases stomach acid secretion.

To prevent infection from H pylori, one should avoid contaminated food and water and observe complete personal hygiene.