Peptic ulcer disease refers to ulcers that develop in the stomach (gastric ulcer) or the upper part of the small intestine (duodenal ulcer). The mechanisms and risk factors for both are similar. It is a common condition among Thais and worldwide. It causes recurring pain, discomfort or burning in the abdomen or epigastric region (pit of the stomach), bloating, indigestion, gastrointestinal bleeding, anemia, stomach perforation, or may even present as a symptom of stomach cancer. Therefore, prevention, accurate diagnosis, ulcer treatment, addressing the underlying causes, and post-treatment follow-up are highly important.

Causes and Risk Factors The two main and most common causes of peptic ulcers are:

• H. pylori Infection: Helicobacter pylori is a type of bacteria that can survive in the highly acidic environment of the stomach lining. Infection causes stomach inflammation, leading to erosions or ulcers (gastric or duodenal ulcers) in the stomach or the upper part of the small intestine, and may eventually lead to stomach cancer.
• Antiplatelet Drugs or NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These medications reduce the production of the protective mucus layer in the stomach. This allows stomach acid to damage the stomach lining more easily, resulting in an increased risk of ulcers.

Other less common but significant causes include stomach cancer, gastric lymphoma, and diseases causing abnormal acid hypersecretion. Co-factors that can increase the risk of complications from existing ulcers include the use of antiplatelets, anticoagulants (blood thinners), high doses or multiple combinations of NSAIDs, corticosteroids, advanced age, alcohol consumption, and smoking.

Symptoms

• Burning pain, discomfort, or tightness in the epigastric region or the left side of the abdomen.
• Indigestion, feeling full quickly, or discomfort after eating.
• Nausea and vomiting.
• Black, tarry stools or bloody stools; vomiting black or red blood.
• Symptoms of anemia, such as dizziness, lightheadedness, fatigue, and weakness.
• Unexplained weight loss and reduced appetite.

Diagnosis Peptic ulcer disease is primarily diagnosed through an upper gastrointestinal endoscopy (EGD). A biopsy can also be performed to confirm that the ulcer is non-cancerous. Additionally, it is essential to test for an H. pylori infection, as it is a major underlying cause of peptic ulcers.

Treatment The primary treatment for this condition is acid-suppressing medication. For gastric ulcers, these are prescribed for at least 8–12 weeks, followed by a mandatory follow-up endoscopy to ensure the ulcer has completely healed. Duodenal ulcers are generally easier to treat, requiring acid-suppressing medication for 4–8 weeks without the need for a follow-up endoscopy unless complications are present.

If an H. pylori infection is present, specific treatment prescribed by a gastroenterologist is required. This typically involves high-dose acid suppressants combined with 2 to 3 types of antibiotics taken continuously. Afterwards, a follow-up test is necessary to confirm the eradication of the bacteria.

If the ulcer is caused by NSAIDs, these medications should be stopped immediately. However, if the use of NSAIDs is unavoidable, they must be taken concurrently with acid-suppressing medications to reduce the risk of ulcer formation and gastrointestinal complications.

Prevention Guidelines

• Avoid using NSAIDs without proper medical indication and always consult a doctor before use.
• Do not use unlabelled pre-packaged drug combinations, herbal medicines, traditional medicinal decoctions, or unverified pain/anti-inflammatory medications.
• If antiplatelet medications are necessary, take them concurrently with acid suppressants and consult a doctor beforehand to assess the necessity and potential complications.
• Eat properly cooked, hygienic food, and use serving spoons when sharing meals.
• Avoid consuming alcohol and smoking.
• Avoid eating highly spicy or heavily seasoned foods.