Gastric Mucosal Integrity: Demystifying Peptic Ulcer Disease

 

By Stephanie Nwakaegho, Gentechnews Health Columnist

What Exactly Is a Peptic Ulcer?

Peptic ulcers are openings or sores in the lining of the stomach or the upper small intestine. These openings reach deep enough to break through the protective surface and expose the sensitive layer underneath. Although many people still assume ulcers are caused by stress or the wrong foods, modern evidence points to very specific triggers. According to long standing clinical guidance from the American College of Gastroenterology, the most common causes are a stomach infection called Helicobacter pylori and frequent use of certain pain relievers. When these causes are identified and addressed, most ulcers heal completely.

Why the Stomach Needs Strong Protection

To understand how ulcers form, it helps to look at how much the stomach must protect itself. The stomach produces hydrochloric acid, a fluid with a strength similar to that used for industrial cleaning. Even a brief exposure of unprotected tissue to this acid can create a burn. Along with this acid is pepsin, an enzyme that breaks down proteins and becomes active only in very acidic conditions. Acid release is guided by chemical messengers like acetylcholine, gastrin, and histamine. These messengers activate tiny bumps on stomach cells known as proton pumps, which act as acid release valves. According to research summarized in The Lancet, this system is essential for digestion, but it must be kept in balance or it can damage the stomach wall.

Protection comes from a thick layer of mucus mixed with bicarbonate. This layer acts as both a physical shield and a chemical buffer. Bicarbonate raises the pH at the stomach surface so the lining itself never touches raw acid. The epithelial cells under this barrier are tightly connected and replace themselves rapidly, which keeps small injuries from turning into deeper ones. Prostaglandins, which are natural chemical protectors, support this process by increasing mucus production and improving blood flow. Multiple studies, including reviews highlighted in Gastroenterology, show that when prostaglandins decrease, the stomach becomes much more vulnerable. This explains why medications that interfere with prostaglandins can lead to ulcers.

Causes of Ulcer

One major cause is Helicobacter pylori, often called H. pylori. It is a spiral shaped bacterium that settles into the stomach. According to the Maastricht V/Florence Consensus Report, this bacterium survives by producing urease, Urease is an enzyme that creates a protective covering of less acidic fluid around the bacteria so it can live in a place that would normally kill it.

Over time, H. pylori embeds into the stomach lining and releases toxins that interfere with cell protection and repair leading to long lasting irritation and inflammation. This inflammation weakens the stomach’s defenses over time, eventually allowing acid to reach deeper layers and create an ulcer.   The good news is that once H. pylori is found and treated with antibiotics, the ulcer usually heals and rarely comes back. Which is why identifying the infection is a major part of care.

How Common Pain Medications Lead to Ulcers

Many everyday pain relievers such as ibuprofen, naproxen, and aspirin can injure the stomach if taken often. These medicines are called NSAIDs. According to clinical research, NSAIDs block COX 1, an enzyme the body needs to make prostaglandins. Without enough prostaglandins, the mucus layer becomes thinner and blood flow to the stomach lining decreases, and the stomach becomes more exposed to acid.

According to large clinical reviews, NSAIDs can also slip into the cells lining the stomach and cause direct irritation. This combination makes frequent NSAID use one of the most important risk factors for ulcer complications in adults.

Common Symptoms of Peptic Ulcer Disease

PUD Symptoms may vary, but many people describe a burning or gnawing pain in the upper abdomen. The timing of the pain can offer clues. Pain from a duodenal ulcer often appears a few hours after eating and may improve with food, while pain from a stomach ulcer tends to worsen shortly after eating. People may also feel full quickly, feel bloated, or experience nausea. Because these symptoms overlap with many other conditions, relying on symptoms alone can lead to missed diagnoses. According to guidance published in the American Journal of Gastroenterology, accurate diagnosis requires testing.

How To Diagnose And Confirm PUD

For a clear diagnosis, doctors often use an upper Endoscopy which is the most reliable test. A thin flexible tube with a camera is passed through the mouth, allowing a clear view of the stomach and duodenum. This procedure helps confirm whether an ulcer is present, measure its size, and check for bleeding. Tissue samples may be taken to test for H. pylori or to rule out other conditions such as stomach cancer.

 Other alternatives include, noninvasive tests like the urea breath test or stool antigen test that can identify active H. pylori infection with high accuracy. According to the ACG, blood antibody tests are no longer recommended because they cannot distinguish between past exposure and ongoing infection.

Treatment of Peptic Ulcer Disease

Treatment of PUD depends on the cause. The main goal is to reduce acid long enough for the tissue to heal.

Proton pump inhibitors are the first choice for reducing acid because they turn off the proton pump, the final step in acid release. This allows the ulcer to heal in a less acidic environment.

When H. pylori is the cause, antibiotics are added. According to current guidelines, treatment usually includes a PPI plus two or more antibiotics for 10 to 14 days. This combination is needed because the bacteria can be difficult to eliminate. A follow up breath or stool test is recommended at least four weeks after treatment to confirm the infection is gone.

If NSAIDs are the cause, stopping the medication is the most effective step. If someone must continue NSAIDs for medical reasons, long term PPI use or switching to a safer type of pain reliever may be necessary.

Complications of PUD

If ulcers are not treated, they can lead to complications.

According to studies published in The Lancet:

• Bleeding is the most common serious problem. Signs include vomiting blood, passing black stools, dizziness, or weakness.
• Perforation happens when the ulcer burns all the way through the stomach wall, causing sudden severe abdominal pain. This is a medical emergency.
• Stomach outlet blockage can occur when swelling or scar tissue narrows the passage where food leaves the stomach. This leads to vomiting and difficulty eating.

Note that these complications are preventable with timely care.

Influence of Lifestyle choices on PUD

Lifestyle choices can influence healing.          Smoking slows recovery by reducing blood flow to the stomach. Alcohol can irritate the stomach surface, especially when consumed in large amounts. Eating at regular times often helps regulate acid levels. There is no universal ulcer diet, but avoiding personal trigger foods is reasonable. While stress is not a direct cause, it can intensify discomfort in some people, which is why stress reduction may improve quality of life during recovery.

Nurses Insight

Peptic ulcer disease is a manageable condition with a high rate of full recovery. When the underlying trigger is identified and addressed, most ulcers heal without long term consequences. The combination of accurate testing, appropriate medication, and patient centered education is the foundation of effective care. With proper guidance, most individuals regain comfort, prevent recurrence, and return to normal daily living.

Stephanie Nwakaegho, Gentechnews Health Columnist can be reached via thestephanienwakaegho@gmail.com