Ulcers, Digestive Health Article

Complications

Between 10%–20% of peptic ulcer patients develop complications at some time during the course of their illness. All of these are potentially serious conditions. Complications are not always preceded by diagnosis of or treatment for ulcers; as many as 60% of patients with complications have not had prior symptoms.

Bleeding is the most common complication of ulcers. It may result in anemia, vomiting blood, or the passage of bright red blood through the rectum. The mortality rate from ulcer hemorrhage is 6-10%.

About 5% of ulcer patients develop perforations, which are holes through which the stomach contents can leak out into the abdominal cavity. The incidence of perforation is rising because of the increased use of NSAIDs, particularly among the elderly. The signs of an ulcer perforation are severe pain, fever, and tenderness when the doctor touches the abdomen. Most cases of perforation require emergency surgery. The mortality rate is about 5%.

Ulcer penetration is a complication in which the ulcer erodes through the intestinal wall without digestive fluid leaking into the abdomen. Instead, the ulcer penetrates into an adjoining organ, such as the pancreas or liver. The signs of penetration are more severe pain without rhythmicity or periodicity, and the spread of the pain to the lower back.

Obstruction of the stomach outlet occurs in about 2% of ulcer patients. It is caused by swelling or scar tissue formation that narrows the opening between the stomach and the duodenum (the pylorus). Over 90% of patients with obstruction have recurrent vomiting of partly digested or undigested food; 20% are seriously dehydrated.

Physical examination and patient history

The diagnosis of peptic ulcers is rarely made on the basis of a physical examination alone. The only significant finding may be mild soreness in the area over the stomach when the doctor presses (palpates) it. The doctor is more likely to suspect an ulcer if the patient has one or more of the following risk factors:

• member of the male sex
• age over 45
• recent weight loss, bleeding, recurrent vomiting, jaundice, back pain, or anemia
• history of using aspirin or other NSAIDs
• history of heavy smoking
• family history of ulcers or stomach cancer

Endoscopy and imaging studies

An endoscopy is considered the best procedure for diagnosing ulcers and taking tissue samples. An endoscope is a slender tube-shaped instrument used to view the tissues lining the stomach and duodenum. If the ulcer is in the stomach, then a tissue sample will be taken because 3-5% of gastric ulcers are cancerous. Duodenal ulcers are rarely cancerous. Radiological studies are sometimes used instead of endoscopy because they are less expensive, more comfortable for the patient, and are 85% accurate in detecting cancer.

Laboratory tests

Blood tests usually give normal results in ulcer patients without complications. They are useful, however, in evaluating anemia from a bleeding ulcer or a high white cell count from perforation or penetration. Serum gastrin levels can be used to screen for Zollinger-Ellison syndrome.

It is important to test for H. pylori because almost all ulcer patients who are not taking NSAIDs are infected. Noninvasive tests include blood tests for immune response and a breath test. In the breath test, the patient is given an oral dose of radiolabeled urea. If H. pylori is present, it will react with the urea and the patient will exhale radiolabeled carbon dioxide. Invasive tests for H. pylori include tissue biopsies and cultures performed from fluid obtained by endoscopy.

Treatment

Alternative treatments can relieve symptoms and promote healing of ulcers. A primary goal of these treatments is to rebalance the stomach's hydrochloric acid output and to enhance the mucosal lining of the stomach.

Food allergies have been considered a major cause of stomach ulcers. An elimination/challenge diet can help identify the allergenic food(s) and continued elimination of these foods can assist in healing the ulcer.

Ulcer patients should avoid aspirin, stop smoking, avoid antacids, and reduce stress. Dietary changes include avoidance of sugar, caffeine, and alcohol, and reducing milk intake.

Supplements

Dietary supplements that help to control ulcer symptoms include:

• vitamin A
• B-complex vitamins
• vitamin C
• vitamin E
• glutamine
• rice bran oil (gamma oryzanol)
• selenium
• deglycyrrhizinated licorice (DGL)
• zinc picolinate