What is peptic ulcer disease?

A peptic ulcer is a break or an open sore in the lining of either the stomach or intestines. Peptic ulcers can be gastric if they are located in the stomach, or duodenal if they are located in the small intestines. Diagnosis of peptic ulcer disease should use an endoscopy to confirm the ulcers.¹

Symptoms and complications of peptic ulcer disease

Peptic ulcer disease mainly presents with pain in the upper abdomen. Other symptoms include indigestion, heartburn, nausea, bloating and reduced appetite.^1,2

Some people may have a peptic ulcer without having any symptoms. On the other hand, if allowed to get worse, the ulcer may lead to complications that require urgent medical attention. Complications of peptic ulcers can arise from severe internal bleeding, perforation of the stomach, or obstruction inside the digestive system.^1,2

Causes and risk factors for peptic ulcer disease

Smoking, alcohol use and stress are suggested to contribute to the development of peptic ulcer disease, particularly in individuals who have had gastric bypass surgery. 

The most common causes of peptic ulcer disease are the use of anti-inflammatory medications and bacterial infection.¹

Anti-inflammatory medication

Aspirin and ibuprofen belong to the same drug family called non-steroidal anti-inflammatory drugs (NSAIDs). These medications can be quite harsh on the stomach. It is advisable to take NSAIDs with or after food, to reduce these side effects.

Bacterial infection

Helicobacter pylori (H. pylori) is a bacterial infection in the stomach that can cause peptic ulcer disease. If a peptic ulcer is found, H. pylori is usually tested for. Peptic ulcers and H. pylori can be treated at the same time.

What is gastro-oesophageal disease (GORD)?

Acid reflux and heartburn

You may have heard the terms acid reflux, heartburn and GORD being used interchangeably. But how do they all relate to each other?

To illustrate this, picture what happens when you eat. 

Food is chewed up in the mouth. 

When we swallow, food travels down the oesophagus. The oesophagus is a long tube inside the chest that connects the mouth to the stomach. 

At the end of the oesophagus is a valve that acts as a gate to the stomach. The valve opens to allow food into the stomach, then closes to prevent the contents of the stomach from moving back upwards.

When the valve does not work properly, it leads to acid reflux. The valve opens at the wrong times and allows the stomach contents to flow the wrong way and escape upwards from the stomach and back into the oesophagus.

Heartburn refers to the unpleasant burning sensation that is felt in the chest when stomach contents rise up the oesophagus. The sensation is similar to burning because the stomach contains digestive acids, enzymes, food and bile. The stomach has a special lining that can withstand the acid but the oesophagus is more sensitive.³

Acid reflux and heartburn are common enough that you may know someone who has experienced it, or have experienced it yourself. It usually happens after eating or lying down. When acid reflux and heartburn become a recurring problem, it can become GORD.

Gastro-oesophageal reflux disease GORD

Gastro-oesophageal reflux disease (GORD) is a long-term condition where acid reflux leads to symptoms of heartburn and has the potential for complications over time.

The Montreal Definition and Classification Global Consensus Group defines GORD as “a condition that develops when the reflux of stomach contents into the oesophagus causes troublesome symptoms and/or complications.³

Symptoms and complications of GORD

The typical symptoms of GORD include 

• Heartburn chest pain
• Cough, hiccups
• Bloating 
• Nausea
• Breath 
• Hoarse voice⁴

In serious cases of GORD, the oesophagus can be afflicted with

• Inflammation
• Ulcers
• Strictures due to excessive exposure to stomach acid 

Other complications can include:

• Aspiration pneumonia
• Barretts oesophagus

Aspiration pneumonia

Pneumonia is a bacterial infection in the lungs. Aspiration pneumonia can happen when the stomach contents are accidentally inhaled into the lungs and cause an infection.⁴

Barrett’s oesophagus

This involves abnormal changes in the cells that line the oesophagus. Barrett’s oesophagus may not always show symptoms but carries a risk of developing into oesophageal cancer.^3,4

The causes and risk factors of GORD

Risk factors have been linked to GORD, including:^3,4

• Being overweight
• Family history of GORD
• Alcohol use and smoking
• Pregnancy

Other triggers for GORD can include:

• Coffee, chocolate and fatty meals may cause symptoms of GORD
• Aspirin, calcium channel blockers and some antidepressants may cause symptoms of GORD as a side effect.

Treatment of peptic ulcer disease and GORD 

Treatment of both conditions employs approaches that manage symptoms of abdominal discomfort, including heartburn and indigestion. In peptic ulcer disease, there is additional focus on the healing of ulcers and treatment of H. pylori infection, if present. There is no cure for GORD, but the condition can be managed with medication.

Non-drug treatment

People with peptic ulcer disease or GORD may be given advice to help reduce the severity of their symptoms, including:^2,4

• Eating smaller meals on a more frequent basis
• Losing weight and reducing smoking or alcohol use
• Finding relaxing activities to enjoy, to prevent stress from exacerbating their condition
• Raising the head of the bed when sleeping at night, to alleviate pressure on the stomach
• Avoid eating meals up to three to four hours before bed, to allow the stomach to settle before laying down
• Avoid consuming trigger foods and drinks
• Avoid wearing clothes that are tight around the waist

Drug treatment

There are a range of medications that alleviate the symptoms of peptic ulcer disease and GORD, including antacids, alginates and acid reducers.

These medications can affect the absorption of other medications when taken at the same time. These medications may also contain large amounts of sodium-based salts, making them unsuitable for people with heart problems requiring a low-sodium diet. It is always important to check whether a medication is suitable for the individual to take.

Antacids

Antacids are salts that neutralise stomach acid and are suitable for relieving mild symptoms of indigestion and heartburn. The effects are short, lasting up to a few hours. Examples of antacids include salts of calcium carbonate, sodium bicarbonate, aluminium and magnesium.²

Alginates

Alginates are a type of medication that is more helpful for GORD. Alginates work by forming a barrier over the stomach contents, providing short-term relief from acid reflux. They are best taken with or after meals, when it is most likely for heartburn to occur.²

Acid reducers 

This is a group of drugs that includesproton-pump inhibitors (for example, omeprazole and lansoprazole), and H₂-receptor antagonists (for example, famotidine and ranitidine).^1,2

Both proton-pump inhibitors and H₂-receptor antagonists are normally prescribed for short courses, but people who are at high risk of complications may need to take them for longer.

Antibiotics

Peptic ulcer disease is highly associated with H. pylori infection. It is common to test for H. pylori when a patient is diagnosed with peptic ulcer disease, particularly in older people. If tested to be positive with H. pylori, antibiotics will be required to treat the infection. Treatment involves a prescribed course that includes a combination of two antibiotics and a proton pump inhibitor.¹

Antibiotics will not be required in GORD unless an infection is detected.

Optimising medications

Some people may be taking medication that can worsen peptic ulcers or exacerbate symptoms of GORD. Examples of such medication include NSAIDs, bisphosphonates, corticosteroids and certain antidepressants.^2,4

To avoid worsening the peptic ulcer or GORD, their medication may be stopped, switched to a different medication, or the dose may be reduced. If appropriate, the individual may continue taking their usual medication alongside a proton-pump inhibitor or a H₂-receptor antagonist to protect the stomach.

Summary 

Both peptic ulcer disease and GORD are conditions that affect the stomach and digestive system. Although both can cause similar symptoms of burning upper abdominal pain and nausea, they have physically different causes.

In peptic ulcer disease, abdominal pain and discomfort is due to the presence of open sores within the lining of the stomach. On the other hand, GORD is the unpleasant burning sensation of acid reflux due to a faulty valve between the oesophagus and the stomach.

A range of medications are available to manage symptoms in both conditions. It is important to consider whether a medicine is suitable for the individual, and whether medications currently taken by the individual can affect their condition.