What is a Peptic Ulcer Disease?

Peptic Ulcer is defined as disruption of the mucosal integrity of our stomach or Duodenum which leads to a local defect or excavation due to active inflammation and due to stomach acids.

There are two types of Peptic Ulcer Disease:

• Gastric Ulcer- which affects stomach lining.
• Duodenal Ulcer- which affects mostly the first part of Duodenum. These ulcers are more commonly found.

How common is Ulcer Disease in Kashmir?

As per the research done by renowned Gastroenterologists of Kashmir in randomly selected groups of people aged 15 years and above. The point prevalence of peptic ulcer was 4.72% and lifetime prevalence was 11.22%. The prevalence increases with age, with peak prevalence in the 5th decade of life (>50years). The data suggests that the disease is quite common which is hugely affected by our lifestyle habits and self medications.

Two major causes of PUD are:

Helicobacter Pylori(H.Pylori)- This is one the major cause of Peptic Ulcers, usually our digestive tract have a proper mucosal defense lining,  which protects our Gastric Mucosal lining from Acidic Environment,  and the main mechanism by which this bacteria induces Ulcers, is by disrupting this protective mucosal barrier by various mechanisms. These bacteria produces various virulence factors (like Cytotoxin-associated gene A, Vacuolating Toxin A, PAMPs, Gamma Glutamyl transpeptidase etc.) and produces Proteases and Phospholipases. These virulence factors and enzymes by various mechanisms disrupt the mucosal integrity resulting in Peptic ulcers.

NSAID(Analgesics, Pain Killers)-Induced PUD-  These are the most commonly used medications in the world and also one of the most commonly used in our region as well, mostly by self medications. The mechanism of NSAID induced ulcer disease also targets to disrupt the Protective mucosal layer by inhibiting and blocking the formation of Prostaglandins. Prostaglandins play a critical role in maintaining gastroduodenal mucosal integrity and repair. These Drugs therefore induce interruption of Prostaglandin synthesis which impairs the mucosal defense and repair system, thus resulting in mucosal injury/Ulcers by various mechanisms.

Other common causes we should take notice of- Smoking, Stress and Anxiety, Spicy Food etc.

What are the common symptoms of Peptic Ulcer Disease

Epigastric Burning Pain or discomfort , Nocturnal pain in stomach, Bloated Feeling, Nausea , Vomiting,  Burping, Loss of Appetite or weight loss, Heartburn, Dark or Black Stool(due to bleeding). Usually small ulcers are asymptomatic, but we should be aware of all these symptoms and not delay our visit to a Doctor, and try to avoid self medications.

How we can diagnose Peptic Ulcer Disease

• Most common method to diagnose upper gastric problems is Endoscopy.
• Nowadays Tests for H.Pylori are widely used to detect the bacteria.
• Breath test is the easiest way to discover it, also Rapid Urease Test (RUD) is commonly done to detect the presence of H.Pylori.
• Stool tests can also be done to check blood in stools.
• X Rays and CT Scans are less frequently done.

How can we prevent the prevalence of PUD?

• Quit Smoking
• Consume vegetables, fruits, and grains.
• Limit intake of spicy,fatty,fried foods which may exacerbate PUD.
• Avoid Self medications and unnecessary and increased use of PainKillers.
• Stay hydrated and limit caffeine intake.
• Avoid Psychological stress and Anxiety.
• Intake of Foods Rich in probiotics like Yogurts, Kefir etc.

How Peptic Ulcers are treated

We should never delay the treatment for PUDs, it's better to consult Doctor at the earliest. Treatment depends upon the cause of PUD. H.Pylori induced PUD is properly treated by Antibiotic Therapy, Proton Pump Inhibitors are used, Mucosal Protective Medications can be used, NSAID Induced Ulcers are properly treated based on the Patient's medical condition.

The best way to treat the Ulcer Disease is to consult a Doctor and follow all the recommendations besides improving lifestyle habits. No self medications and no Pharmacists can help us to treat The Peptic Ulcer Disease. We should never delay or compromise with our health. It's far better to be treated at early stages than to be at Severe stages .

Keep Spreading Knowledge, Stay Healthy...!

(Author is 5th Year Medical Student. Email- fizahameed12@gmail.com)