Introduction
Peptic ulcer disease (PUD) is a common gastrointestinal disorder that affects millions of people worldwide. It is characterised by the formation of open sores, or ulcers, in the stomach’s lining or the upper part of the small intestine. These ulcers can be painful and lead to various symptoms, including abdominal pain and diarrhoea. In this essay, we will explore the relationship between abdominal pain and diarrhoea in peptic ulcer disease, and discuss the causes, symptoms, and treatment options for this condition.
Overview of abdominal pain and diarrhoea in peptic ulcer disease
Abdominal pain and diarrhoea are two of the most common symptoms of peptic ulcer disease. The pain is typically described as a burning or gnawing sensation in the upper abdomen, and it can range from mild to severe. The location of the pain may vary depending on the location of the ulcer, but it is most commonly felt in the upper middle or upper left part of the abdomen. Diarrhoea, on the other hand, is characterized by loose, watery stools that occur more frequently than normal. It can be accompanied by other symptoms such as bloating, cramping, and urgency to use the bathroom.
Causes of peptic ulcer disease
H. pylori infection
So, what exactly causes peptic ulcer disease? Several factors can contribute to the development of this condition. The most common cause is a bacterial infection called H. pylori. This bacteria is found in the stomach and small intestine and can cause inflammation and damage to the lining, leading to ulcers. It is estimated that H. pylori is responsible for up to 90% of all peptic ulcers.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Another common cause of peptic ulcer disease is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as aspirin and ibuprofen, can irritate the lining of the stomach and increase the risk of developing ulcers. It is important to note that even over-the-counter NSAIDs can have this effect, so it is important to use them as directed and to talk to your doctor if you experience any stomach discomfort while taking them.
Stress
Stress is another factor that can contribute to the development of peptic ulcer disease. While stress alone does not cause ulcers, it can worsen existing ulcers and delay the healing process. This is because stress can increase the production of stomach acid which can irritate the lining making symptoms worse. Additionally, stress can also weaken the immune system, making it harder for the body to fight off infections like H. pylori.
Alcohol and smoking
Lifestyle choices, such as alcohol consumption and smoking, can also increase the risk of developing peptic ulcer disease. Both alcohol and smoking can irritate the lining of the stomach and increase the production of stomach acid, making it easier for ulcers to form. Additionally, smoking can also slow down the healing process, making it harder for the body to repair any existing ulcers.
It is important to note that while these are the most common risk factors for peptic ulcer disease, there may be other factors at play. Genetics, certain medical conditions, and even age can also increase the risk of developing this condition. If you are experiencing symptoms of peptic ulcer disease, it is important to talk to your doctor to determine the underlying cause and develop a treatment plan.
Symptoms of peptic ulcer disease
Abdominal pain
The most common symptom of peptic ulcer disease is abdominal pain. This pain is typically described as a burning or gnawing sensation located in the upper abdomen. It can also be felt in the chest, back, or lower abdomen. The location and characteristics of the pain may vary depending on the location of the ulcer. For example, if the ulcer is in the stomach, the pain may be felt in the upper abdomen, whereas an ulcer in the small intestine may cause pain in the lower abdomen.
Diarrhoea
In addition to the location and characteristics of the pain, certain triggers can also worsen the symptoms of peptic ulcer disease. These triggers may include spicy or acidic foods, stress, and certain medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Individuals with peptic ulcer disease need to identify their triggers and avoid them to manage their symptoms effectively.
Other symptoms
Another common symptom of peptic ulcer disease is diarrhoea characterised by frequent and loose bowel movements. The consistency of the stool may also vary, ranging from watery to semi-formed. Diarrhoea is caused by the excess production of gastric acid, which can irritate the lining of the intestine and lead to inflammation and increased bowel movements. In some cases, diarrhoea may be the only symptom of peptic ulcer disease.
In addition to abdominal pain and diarrhoea, other symptoms may be associated with peptic ulcer disease. These include nausea and vomiting, which may occur due to the irritation of the stomach lining. Loss of appetite and weight loss may also be present, as the pain and discomfort associated with peptic ulcer disease can make it difficult for individuals to eat and maintain a healthy weight.
Diagnosis
Medical history and physical examination
The first step in diagnosing PUD is to obtain a thorough medical history and perform a physical examination. This involves asking the patient about their symptoms, medical history, and any risk factors that may contribute to the development of PUD. The physical examination may include checking for signs of anaemia, tenderness in the abdomen, and any other abnormalities that may indicate the presence of an ulcer. According to a study published in the American Journal of Gastroenterology, a detailed medical history and physical examination can accurately diagnose PUD in up to 80% of cases.1
Diagnostic tests
Endoscopy
Once the initial assessment is completed, the next step is to perform diagnostic tests to confirm the diagnosis of PUD. The most commonly used test for diagnosing PUD is endoscopy, which involves inserting a thin, flexible tube with a camera into the mouth and down the oesophagus to examine the stomach and duodenum. This allows the doctor to visualize any ulcers or inflammation in the lining of these organs. According to a study published in the World Journal of Gastroenterology, endoscopy has a sensitivity of 95% and a specificity of 100% in diagnosing PUD.2
Helicobacter pylori testing
In addition to endoscopy, H. pylori testing is also an essential part of the diagnostic process for PUD. This bacteria is responsible for causing more than 90% of duodenal ulcers and up to 80% of gastric ulcers.3 There are various methods for testing for H. pylori, including blood tests, breath tests, and stool tests. These tests detect the presence of antibodies, bacterial products, or the bacteria itself in the body. According to a study published in the Journal of Clinical Microbiology, stool tests have a sensitivity of 97% and a specificity of 100% in detecting H. pylori infection.4
Stool tests & Imaging tests
Stool tests are also used to detect the presence of blood in the stool, which can be a sign of bleeding ulcers. This test, known as a faecal occult blood test (FOBT), is a non-invasive and cost-effective method for diagnosing PUD. In some cases, imaging tests such as X-rays, CT scans, or MRI scans may also be used to detect ulcers or any complications of PUD, such as perforation or obstruction. These tests can provide a more detailed view of the digestive organs and help the doctor determine the severity of the condition.
Treatment
Medications
One of the main treatment approaches for PUD is the use of medications. Proton pump inhibitors (PPIs) are commonly prescribed to reduce the production of stomach acid, which can help to heal ulcers and relieve symptoms. Examples of PPIs include omeprazole, lansoprazole, and esomeprazole. These medications are highly effective and have been shown to promote ulcer healing in up to 90% of patients.5 However, it is important to note that PPIs may have side effects such as headache, nausea, and diarrhoea, and long-term use may increase the risk of certain infections and nutrient deficiencies.6 Therefore, it is important to use PPIs under the guidance of a healthcare professional.
In addition to PPIs, antibiotics may also be prescribed to treat PUD. This is because a type of bacteria called Helicobacter pylori (H. pylori) has been identified as a major cause of PUD. Antibiotics such as amoxicillin, clarithromycin, and metronidazole are used to eradicate H. pylori and prevent the recurrence of ulcers.7 It is important to complete the course of antibiotics as prescribed to eliminate bacteria. In some cases, a combination of PPIs and antibiotics may be used for more effective treatment.
Antacids, which are available over-the-counter, can also be used to provide temporary relief from symptoms of PUD. These medications work by neutralizing stomach acid and can provide quick relief from pain and discomfort. However, they do not heal the ulcers or prevent their recurrence, so they are often used in combination with other medications.8
Lifestyle changes
Aside from medications, lifestyle changes can also play a crucial role in managing PUD. Dietary modifications, such as avoiding spicy and acidic foods, can help to reduce irritation to the stomach lining and prevent symptoms from worsening.9 Stress management techniques, such as yoga and meditation, can also be beneficial as stress has been linked to increased acid production and worsening of PUD symptoms.10 Additionally, avoiding irritants such as alcohol and smoking can also help to improve symptoms and promote healing.
Surgery
In severe cases of PUD, surgery may be necessary. This is usually reserved for cases where there are complications such as bleeding or perforation of the ulcer. Surgery may involve removing the affected portion of the stomach or small intestine or repairing any damage to the lining.11 However, with the availability of effective medications and lifestyle modifications, surgery is rarely needed for PUD treatment.
Complications of peptic ulcer disease
Bleeding
One of the most common complications of PUD is bleeding. When the ulcers in the stomach or small intestine become deep enough, they can erode the blood vessels, leading to internal bleeding. This can result in symptoms such as abdominal pain, dark or tarry stools, and weakness. In severe cases, it can even lead to anaemia, a condition in which the body lacks enough healthy red blood cells to carry oxygen to the tissues. According to a study published in the Journal of Clinical Gastroenterology, about 15-20% of patients with PUD will experience bleeding as a complication.12
Perforation
Another potential complication of PUD is perforation, which occurs when the ulcer penetrates through the entire thickness of the stomach or small intestine. This can cause the contents of the stomach or small intestine to leak into the abdominal cavity, leading to a serious infection known as peritonitis. Perforation is a medical emergency that requires immediate treatment, as it can be life-threatening. According to a review published in the World Journal of Gastrointestinal Surgery, perforation occurs in about 5% of patients with PUD.13
Obstruction
Obstruction is another complication of PUD that can cause abdominal pain and diarrhoea. When the ulcers become large enough, they can block the passage of food through the digestive tract, leading to symptoms such as bloating, nausea, and vomiting. This can also result in weight loss and malnutrition if left untreated. A study published in the Journal of Gastroenterology and Hepatology found that obstruction occurs in about 2-5% of patients with PUD.14
Gastric cancer
Lastly, PUD has been linked to an increased risk of gastric cancer. While the exact mechanism is not fully understood, it is believed that chronic inflammation caused by PUD can lead to changes in the cells of the stomach, increasing the risk of cancer development. According to a study published in the American Journal of Gastroenterology, patients with PUD have a 2-3 times higher risk of developing gastric cancer compared to the general population.15
Prevention
Avoiding risk factors
One of the most important ways to prevent peptic ulcer disease is by avoiding risk factors. This includes limiting or avoiding the use of NSAIDs, as these medications can irritate the lining of the stomach and increase the risk of developing ulcers. If you must take NSAIDs for a medical condition, it is important to discuss with your doctor about the potential risks and ways to minimize them. Additionally, quitting smoking and limiting alcohol consumption can also help reduce the risk of developing peptic ulcers.
Taking medications as prescribed
In addition to avoiding risk factors, taking medications as prescribed is crucial in preventing peptic ulcer disease. This includes following the recommended dosage and duration of treatment for any medications prescribed by your doctor. For example, if you are taking NSAIDs for a chronic condition, your doctor may recommend taking a proton pump inhibitor (PPI) to help protect the lining of your stomach. It is important to take these medications as directed to ensure their effectiveness in preventing ulcers.
Regular check-ups and screenings
Regular check-ups and screenings are also important in preventing peptic ulcer disease. This allows your doctor to monitor your overall health and identify any potential risk factors or early signs of ulcers. If you are at a higher risk for developing peptic ulcers, your doctor may recommend more frequent screenings to catch any issues early on. Additionally, if you are experiencing symptoms such as abdominal pain and diarrhoea, it is important to seek medical attention and get screened for peptic ulcer disease.
Conclusion
In conclusion, peptic ulcer disease is a common gastrointestinal disorder that is characterised by the formation of open sores in the lining of the stomach or small intestine. The main symptoms of this condition are abdominal pain and diarrhoea, which can be caused by factors such as H. pylori infection, the use of NSAIDs, stress, and lifestyle choices like smoking and alcohol consumption. It is important for individuals experiencing these symptoms to consult with their doctor to determine the underlying cause and develop a treatment plan. By avoiding triggers and following a prescribed treatment plan, individuals with peptic ulcer disease can effectively manage their symptoms and improve their overall quality of life.
References
- Laine L, Hopkins RJ, Girardi LS. Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta-analysis of rigorously designed trials. Am J Gastroenterol. 1998;93(9):1409-1415.
- Laine L, Cohen H, Sloane R, Marin-Sorensen M, Weinstein WM. Interobserver agreement and predictive value of endoscopic findings for H. pylori and gastritis in normal volunteers. Gastrointest Endosc. 1995;42(5):420-423.
- Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report. Gut. 2017;66(1):6-30.
- Vaira D, Malfertheiner P, Megraud F, et al. Diagnosis of Helicobacter pylori infection with a new non-invasive antigen-based assay. Lancet. 1999;354(9172):30-33.
- Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613-624.
- Moayyedi P, Leontiadis GI. The risks of PPI therapy. Nat Rev Gastroenterol Hepatol. 2012;9(3):132-139.
- Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017;112(2):212-239.
- Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107(3):345-360. doi:10.1038/ajg.2011.480
- Møller MH, Adamsen S, Thomsen RW, Møller AM. Perforated peptic ulcer: how to improve outcome? Scand J Gastroenterol. 2009;44(1):15-22. doi:10.1080/00365520802396739
- Ladas SD, Karamanolis G, Ben-Soussan E. Colonic obstruction and perforation due to peptic ulcer disease. J Gastroenterol Hepatol. 2007;22(3):418-420. doi:10.1111/j.1440-1746.2006.04503.x
- Sonnenberg A, Genta RM. Helicobacter pylori is a risk factor for colonic neoplasms. Am J Gastroenterol. 2013;108(2):208-215. doi:10.1038/ajg.2012.395