Peptic Ulcer Disease

Peptic ulcer disease (PUD) refers to painful open sores (ulcers) that develop on the inner lining of the stomach (gastric ulcers) or the upper part of the small intestine (duodenal ulcers). These ulcers form when the protective mucous layer of the digestive tract is damaged, allowing stomach acid to erode the lining. The two most common causes are infection with Helicobacter pylori bacteria and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and diclofenac. Peptic ulcers are very common in Nigeria, partly due to widespread H. pylori infection, high NSAID use, spicy diet, and significant psychological stress. With appropriate treatment, most ulcers heal completely.

The most common symptom is a burning or gnawing pain in the upper abdomen (epigastric region): • Burning or dull aching pain in the stomach area, often between the navel and breastbone • Pain that may be relieved temporarily by eating (duodenal ulcer) or worsened by eating (gastric ulcer) • Pain that wakes you from sleep, typically between midnight and 3 am • Bloating and belching • Nausea and vomiting • Loss of appetite and unintended weight loss • Feeling of fullness after eating small amounts Some people — especially older adults and those on NSAIDs — have ulcers without any pain ("silent ulcers") and may only present when a complication occurs. Signs of complications (seek emergency care immediately): • Vomiting blood (haematemesis) or material that looks like coffee grounds • Black, tarry, or bloody stools (melaena): sign of bleeding ulcer • Sudden, severe abdominal pain that does not ease (perforation)

The stomach produces acid to aid digestion. A protective mucous layer normally prevents this acid from damaging the stomach or bowel lining. Peptic ulcers occur when something disrupts this protection or increases acid production. Helicobacter pylori (H. pylori): • A spiral-shaped bacterium that infects and weakens the protective mucous lining • Responsible for approximately 70–80% of duodenal ulcers and 60% of gastric ulcers • Very common in Nigeria: estimated to infect over 80% of the population, mainly acquired in childhood through contaminated food, water, or close contact • H. pylori does not always cause ulcers, but in susceptible individuals it does NSAIDs (Non-steroidal anti-inflammatory drugs): • Aspirin, ibuprofen, diclofenac, naproxen, and similar drugs block the production of prostaglandins, which help maintain the protective mucous layer • Risk is higher with long-term or high-dose use, older age, and concurrent H. pylori infection Other contributing factors: • Excessive alcohol consumption • Smoking • Stress (a contributing factor, though not a direct cause) • Rare: Zollinger-Ellison syndrome (a tumour that causes extreme acid overproduction)

• H. pylori infection (very common in Nigeria) • Regular use of NSAIDs (aspirin, ibuprofen, diclofenac): including self-medication for pain, fever, or joint pain • Smoking • Excessive alcohol intake • Previous peptic ulcer • Older age • Family history of peptic ulcer • Blood type O (associated with increased duodenal ulcer risk) • Psychological stress • Corticosteroid use combined with NSAIDs

• Haemorrhage (bleeding): the most common complication; blood loss can be severe and life-threatening • Perforation: the ulcer erodes completely through the stomach or bowel wall, spilling contents into the abdominal cavity and causing peritonitis; a surgical emergency • Gastric outlet obstruction: severe scarring from chronic ulceration narrows the outlet of the stomach, causing persistent vomiting after eating • Penetration: the ulcer burrows into an adjacent organ (usually the pancreas) • Increased risk of stomach cancer: long-standing H. pylori gastritis and chronic gastric ulcers modestly increase gastric cancer risk • Anaemia from chronic blood loss

H. pylori prevention: • Drink clean, treated water • Wash hands thoroughly before eating and after using the toilet • Eat food prepared under hygienic conditions • If H. pylori is detected, complete the full eradication treatment as prescribed (typically a combination of antibiotics and a proton pump inhibitor for 7–14 days) NSAID precautions: • Use NSAIDs only when necessary and at the lowest effective dose for the shortest possible time • Always take NSAIDs with food • Use a stomach-protective medication (proton pump inhibitor) if long-term NSAID use is unavoidable • Paracetamol (acetaminophen) is generally safer for pain relief in those with ulcer history Lifestyle: • Avoid smoking • Limit alcohol intake • Manage stress • Avoid very spicy food if it worsens symptoms