Acid Disorders and Peptic Ulcer Disease
What is Acid Disorders and Peptic Ulcer Disease?
Dyspepsia is another word for indigestion and refers to the symptom of pain or discomfort, bloating or a feeling of fullness in the upper abdomen. Peptic ulcer disease specifically refers to a break in the lining of the gastric or duodenal mucosa. Both dyspepsia and peptic ulcer disease are often thought to be due to an overproduction of acid, but in reality, both dyspepsia and peptic ulcer disease are often due to multiple factors involving but not exclusive to the production of acid, colonization of the stomach by Helicobacter pylori, medications consumed by the patient.
Both dyspepsia and peptic ulcer disease can cause symptoms such as abdominal pain, bloating and abdominal fullness, nausea and loss of appetite. In addition, peptic ulcer disease can present with hematemesis (vomiting of blood) and melena (black tarry stool, caused by the oxidation of digested blood). In extreme cases, acute peritonitis can occur due to gastric or duodenal perforation. Symptoms include extreme pain, fever, and even shock.
You can try over-the-counter medication such as antacids for mild symptoms. But if you continue to feel unwell with persistent symptoms, you should see your GP for a full assessment and thorough examination. If there are alarming symptoms, such as vomiting or blood present in the vomit, it is vital to seek immediate medical attention.
There are many causes of peptic ulcers, such as:
- Helicobacter Pylori
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Antiplatelet agents e.g clopidogrel, ticlopidine
- Gastrinoma (Zollinger–Ellison syndrome), rare gastrin-secreting tumours can also lead to increased acid production and ulcers.
- Other causes of peptic ulcer disease include the following: gastric ischemia, drugs, metabolic disturbances, infections such as cytomegalovirus (CMV), radiotherapy, Crohn’s disease, and vasculitis
Risk factors for Acid Disorders and Peptic Ulcer Disease include stress, diet and lifestyle factors.
Stress due to extreme illness such as septic shock requiring intensive care management is well described as a cause of peptic ulcers, which are also known as stress ulcers. Diet has been thought to be a contributing factor to dyspepsia and peptic ulcer disease.
However, there is no conclusive evidence to prove the aforementioned statement except for excessive alcohol intake, which in association with Helicobacter pylori has been shown to increase the risk of peptic ulcer disease. Smoking and the toxins in cigarette smoke predispose to both ulcers and gastric cancers.
The assessment and management of non-ulcer dyspepsia and peptic ulcer disease generally rely on taking a good history and physical examination of the patient and identifying potential causes such as previous medications. It is also important to note that the patient does not have any red flag symptoms that warrant immediate medical attention.
Making a firm diagnosis lies with determining what is going on in the stomach and duodenum (the peptic area). This could involve investigations such as a Barium meal or gastroscopy (do watch our video on how a gastroscopy is performed), the latter would also allow for biopsies to be taken.
Most patients will receive a short trial of over-the-counter medication such as antacids for symptom relief. The core principle is the use of acid suppressants such as Proton Pump Inhibitors (PPIs) or acid blockers to reduce gastric acidity so that ulcers do not erode further and can heal. This approach is also used for the treatment of non-ulcer dyspepsia and gastritis. But the key is treating any underlying pathology. For example, if H Pylori is found, then antibiotics will be administered for bacterial eradication.