Stomach pain that spells peptic ulcer

Most of us suffer an occasional pain in the abdomen between the breastbone and the navel and in the majority of cases, the cause is indigestion or wind. But when the pain coincides with intermittent periods of marked abdominal discomfort that persists several weeks, induces a burning sensation and bloating, and becomes more intense when the stomach is empty, partly improving after eating a meal or taking anti-acid medication, it might be a peptic ulcer.
A common condition that affects one adult in 10 in their lifetime, the peptic ulcer is an erosive lesion of the inner coating of the stomach or the duodenum, the initial part of the small intestine connected to the stomach. During digestion, the stomach releases acid to break down the food. In normal conditions, the inner mucosa of the stomach is protected from the corrosive effects of that acid. When either too much acid is produced or when the protective factors of the lining are insufficient, an ulcer occurs.
Without treatment, an ulcer may trigger serious complications, among them bleeding, a perforation leading to an intra-abdominal infection or obstruction of the alimentary transit.
In 1982, the diagnosis and treatment of peptic ulcer was revolutionised following the discovery by two Australian scientists that a bacteria specific to humans – Helicobacter pylori – living within the stomach mucosa was responsible for 70 to 90 per cent of peptic ulcers. Fifty per cent of the world population is infected by the bacterium ranging from 20 to 30 per cent in developed countries to 80 per cent in emerging nations.
H pylori infection occurs during childhood through person to person contacts or contaminated food or water. Often the infection does not induce any abnormality but it might cause a chronic inflammation of the stomach mucosa leading to an ulcer and, in rare cases, to stomach cancer or some blood diseases. The second most frequent cause of ulcer is the long-term use of some medicines, especially anti-inflammatory agents such as aspirin and ibuprofen as well as bisphophonates prescribed for osteoporosis. Alcohol consumption (due to its irritant effect) and smoking (which increases acid production) are also risk factors.
When experiencing any lasting pain in the upper centre of the abdomen, it is wise to seek a medical opinion because of the potential complications that may suddenly arise.
The symptoms are usually suggestive of a peptic ulcer but because stomach cancer could also be the cause, the diagnosis is often confirmed by a visualisation exam known as an endoscopy. The investigation is carried out by a gastroenterologist who uses a flexible tube introduced from the throat to the stomach equipped at the end with a camera and biopsy instrument.
A small portion of the ulcer site is taken for analysis of the cells to rule out a cancerous lesion. The search for H pylori infection is made from the biopsy fragment or through other methods such as breath test, blood sample or stool analysis.
The treatment aims to control the pain, speed up the healing process and prevent relapses and complications. When the infection is found, the eradication of H pylori is systematically proposed through two antibiotics and a medication controlling the acid production. The antibiotics are usually given for 14 days and the anti-acid medicine for 3 to 6 weeks. The regimen is effective in 80 per cent of the cases and recurrence is low.
When the cause is a medicine, the offending medication is switched to something less harmful to the stomach. Due to the risk of stomach cancer, complete healing of an ulcer must be confirmed through bacterium eradication testing and renewed biopsies.

Dr Gerard Lalande is Managing Director of CEO-HEALTH, which |provides medical referrals for expatriates and customised |executive medical check-ups in Thailand. He can be contacted |at [email protected].