While much of our digestive
tract is alkaline, the stomach
is an exception, containing
hydrochloric acid which is
important for initial digestion
and killing of many bacteria.
When the stomach and small
intestine lining (mucosa) is
damaged, this acid may cause
injury resulting in a peptic ulcer.
The word ‘peptic’ describes
the acidic component of the
digestive tract, while ‘ulcer’
refers to an eroded area in the
Peptic ulcers may be gastric ulcers or
duodenal ulcers. If the ulcer occurs in
the stomach, it is called a gastric ulcer.
If it occurs just after the stomach, in
the first part of the small intestine
(duodenum), it is called a duodenal
In the majority of cases, a bacteria
called helicobacter pylori (HP)
infects the mucosal lining, causing
inflammation which weakens the
lining and leads to ulceration.
Another cause is the class of painkillers
called NSAIDs (non-steroidal antiinflammatory
drugs) which affects
the action of prostaglandins, a
protective substance produced by the
mucosa. Many painkillers (apart from
paracetamol, codeine and tramadol)
belong to this group. Examples include
diclofenac, naproxen, ketoprofen,
indomethacin and celecoxib. Check
with your doctor if your painkillers are
NSAIDS. Aspirin used for heart and
stroke patients is also in this group.
Doctors often prescribe an antiulcer
drug when prescribing these
medications. With the exception of
aspirin, NSAIDs should not be taken
If these persist, one may have an ulcer, or a milder form of injury – which is an gastritis or duodenitis inflammation of the gut lining.
PUD is proven by undergoing endoscopy of the stomach, called oesophago-gastro-duodenoscopy (OGD), where a fibre-optic tube with a camera attachment is passed, after a local anaesthetic spray, via the mouth through the oesophagus to the stomach and into the duodenum. This enables the viewing and photography of abnormal portions and the taking of biopsies - tiny mucosal samples of tissue, which are tested for helicobacter pylori (HP)and to exclude more sinister diagnoses like cancer.
Although OGD takes less than five minutes, patients can choose to be sedated with a short-acting intravenous drug so that they can be asleep during the procedure.
Is there any other way to diagnose peptic ulcer?
Barium meal, where a drink containing barium salt is used to outline the stomach lining before taking x-rays of the stomach and duodenum. It is done when OGD is not performed for various reasons.
NSAIDs must be discontinued. If HP has been identified, a three antibiotic regimen lasting two weeks is often necessary to eradicate the bacteria. To demonstrate that HP has been eliminated, a repeat OGD and biopsy or a breath test may be done. A blood test and stool test is also available.
Powerful drugs that reduce acid secretion either belong to the class ‘proton pump inhibitors’ like omeprazole or esomeprazole or ‘H2 blockers’ like ranitidine or famotidine. Maintenance with these drugs is required for six to eight weeks.
Over-the-counter alkaline salts called
antacids (chewable or liquid) can
provide quick relief of symptoms. They
may contain magnesium trisilicate,
calcium carbonate or sodium
bicarbonate. On their own they cannot
Complications of Peptic Ulcers
Bleeding can occur from ulcers
causing black stool (the appearance of
blood after undergoing digestion) or
even vomiting of blood. Perforation,
is where the ulcer deepens and
penetrates a hole right through the
muscular wall of the stomach or
duodenum, with spillage of stomach
contents into the abdominal cavity
causing infection. This requires
emergency surgery. Sometimes the
ulcer can heal with a scar causing
deformity of the stomach outflow
called gastric outlet obstruction. This
also requires surgery.
Fortunately, with prompt and effective
treatment, these consequences are
quite rare today.
Can my upper abdominal pain be
caused by other possibilities?
Not all upper abdominal pain is
due to peptic ulcer, gastritis or
duodenitis. Your doctor can help
Avoidance of prolonged NSAIDs is
important. Alcohol, smoking, stressful
situations, delayed and irregular
meals are often linked to gastritis and
ulcers. By themselves these do not
generally cause ulcers, but may affect
promptness of recovery. Therefore, it is
prudent to avoid these factors.
Please consult your Family Doctor if you have any concerns
about your health.
Specialist services available at the following SingHealth
Singapore General HospitalTel: 6321 4377
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