It could be a stomach ulcer

A stomach ulcer, also called peptic ulcer disease, is one of the most common conditions affecting the gastrointestinal tract. It represents damage to the lining of the stomach or duodenum (upper portion of the small intestine). In the past, stomach ulcers affected predominantly men, but in the United States, in the last two decades, there has been a shift to an equal presentation in both sexes.

Two major causes

Normally, the stomach maintains a balance between protective factors and aggressive factors. Stomach ulcers develop when the aggressive factors (acid secretion and stomach enzymes) exceed the protective action of mucus and bicarbonate.

The balance is altered by two major causes - helicobacter pylori bacteria and the intake of non-steroidal anti-inflammatory drugs (NSAID). The helicobacter bacteria is responsible for about 70 per cent of stomach and duodenal ulcers. People infected with helicobacter are more likely to have bleeding ulcers.

The use of NSAIDs for pain relief, especially among the elderly, is responsible for 26 per cent of stomach ulcers. These drugs cause erosions and small bleeds in the stomach lining. The greatest risk of developing an ulcer occurs in the first three months of NSAID use but persists throughout the use of these medications.

Signs of an ulcer

Most affected people say that they frequently miss meals. People with gastric ulcers may complain of pain in the epigastrium (the soft spot below the breast bone) shortly after eating. Sometimes the pain is located to the right or left upper quadrant of the abdomen.

Affected people may also say that antacids do not ease the pain. People with a duodenal ulcer often complain of pain which occurs hours after eating or at night. These people find relief in eating meals or taking antacids. Bleeding stomach ulcers may manifest as episodes of fainting, vomiting blood or passing dark blood in the stool. These occurrences should prompt an urgent visit to a medical doctor.

Confirming an ulcer

The presence of a stomach ulcer may be confirmed by upper gastrointestinal radiography called a double contrast barium study. These days endoscopy of the upper gastrointestinal tract is easily arranged and allows direct visualisation of the oesophagus (food pipe), stomach and duodenum. This also allows immediate biopsy of suspicious ulcers and testing for helicobacter pylori.

Ulcer treatment

Treatment involves the restoration of the balance between acid secretion and mucosal protection. People who are infected with helicobacter pylori must be treated with antibiotic therapy and receive medication to suppress acid secretion.

Beware of stomach cancer

Stomach cancers may also present as ulcers, so it is important for people who present with symptoms of ulcers not to treat themselves or continue with prolonged use of medications. Each case must be carefully investigated to rule out the possibility of a malignant cause.

Dr Pauline Williams-Green is a family physician and president of the Caribbean College of Family Physicians; email: yourhealth@gleanerjm.com.