Peptic Ulcer

Heartburn or indigestion is a common problem among adults and is frequently assumed to be a normal part of life. Many people fail to report their symptoms to their healthcare providers².

Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). If it keeps happening, it’s called gastro-oesophageal reflux disease (GORD)³.

OVERVIEW

Peptic ulcers are open sores that develop on the inside lining of your stomach (gastric ulcers), the upper portion of your small intestine (duodenal ulcers)⁴ and the lining of the lower part of the oesophagus, at the junction of the oesophagus and stomach (oesophageal ulcer)⁵. The most common symptom of a peptic ulcer is stomach pain. Another symptom of peptic ulcers can be heartburn⁴. Heartburn (indigestion), occurs as a result of acid reflux, which is caused when stomach acid flows up into your oesophagus. It is a burning pain in your chest, just behind the breastbone, which is often worse after eating, in the evening, or when lying down or bending over⁶. Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers or the regular use of certain pain relievers. Drinking too much alcohol also can contribute to gastritis⁷.

CAUSES AND RISK FACTORS

Peptic ulcers occur when stomach and bile acids, eat away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed⁴. Common causes of peptic ulcers includes⁴:

A bacterium: Helicobacter pylori ( Pylori) bacteria commonly live in the mucous layer that covers and protects tissues lining the stomach and small intestine. Often, the H. Pylori bacterium causes no problems, but it can cause inflammation of the stomach’s inner layer, producing an ulcer.
Regular use of certain pain relievers: Taking aspirin, as well as certain over the counter and prescription pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate, or inflame the lining of your stomach and small intestine.
Other medications: Taking certain other medicines along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, certain selective serotonin reuptake inhibitors (SSRIs), and some medicines that reduce bone loss, can significantly increase the chance of developing ulcers.

Risk factors that weaken the protective mucosal barrier and slow the healing of existing ulcers include: ^4,8,9

Alcohol can irritate and erode the mucus lining of the stomach and increase the amount of acid produced
Untreated stress
Caffeine (e.g., tea, coffee, and colas)
Cigarette smoking
Spicy foods.

Obesity has been shown to have an association with peptic ulcer disease.

SIGNS AND SYMPTOMS

Burning stomach pain
Feeling of fullness, bloating or belching
Intolerance to fatty foods
Heartburn
Nausea

The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night⁴. Many people with peptic ulcers do not even have symptoms^4. Less often, ulcers may cause severe signs or symptoms such as⁴:

Vomiting or vomiting blood — which may appear red or black
Dark blood in stools, or stools that are black or tarry
Trouble breathing
Feeling faint
Nausea or vomiting
Unexplained weight loss
Appetite changes

DIAGNOSIS

See your doctor if you have the severe signs or symptoms listed above. Also, see your doctor if over-the counter antacids and acid blockers relieve your pain but the pain returns⁴.

IMPACT ON QUALITY OF LIFE

If you have been diagnosed with a peptic ulcer or peptic ulcer disease, your healthcare provider will provide medications to reduce stomach acid. Lifestyle is also an important part of your treatment plan. Reducing stress levels, eating healthy, and avoiding alcohol and certain medications, for example, can help to relieve symptoms and help ulcers to heal¹⁰.

TREATMENT

The choice of treatment depends on whether the ulcer is caused by infection with H. Pylori. Regardless of whether the bacteria is the cause, reducing acid in the stomach is an important focus of treatment⁹. The following treatments are recommended for ulcers⁹:

Lifestyle changes: Quit smoking, avoid alcohol, aspirin, and NSAIDs
Acid-blocking medications
Medications that protect the lining of the stomach and duodenum
“Triple-therapy” or “dual-therapy” regimens for ulcers caused by Pylori.

Several types of medications are used to treat ulcers⁹:

Antacids: These non-prescription medications simply neutralize the acid.
Histamine (H2) blockers: These are acid-blocking medications widely used in the treatment of peptic ulcers.
Acid pump inhibitors: These medicines are also known as proton pump inhibitors (PPIs).
Antibiotics: As part of a combination regimen, antibiotics eradicate Pylori, the bacteria that causes ulcers in many people.
Protective agents: These medicines do not affect the amount of acid in the stomach; instead, they protect the mucous lining of the stomach from acid: Sucralfate forms a protective film over the mucosa in ulcerated or inflamed areas of the stomach and protects the gastric mucosa and has the ability to absorb gastric acids and bile acids.

PREVENTION AND LIFESTYLE CHANGES

Preventing infection with H. Pylori is a matter of avoiding contaminated food and water and adhering to strict standards of personal hygiene⁹. If you need the pain relief and anti-inflammatory action of aspirin or an NSAID, you can reduce your risk of ulcers by trying the following⁹:

Try a different NSAID, one that is easier on the stomach
Reduce the dose or the number of times you take the medication
Substitute another medication, such as paracetamol
Talk to your healthcare professional about how you can protect yourself.

Following the treatment recommendations of your healthcare professional can help prevent the recurrence of ulcers. This includes taking all medications as prescribed, especially if you have an H. Pylori infection.

SUCRALFATE

Sucralfate forms a protective film over the mucosa in ulcerated or inflamed areas of the stomach and protects the gastric mucosa. Sucralfate is used to treat and prevent the return of duodenal ulcers (ulcers located in first part of the small intestine). Treatment with other medications, such as antibiotics, may also be necessary to treat and prevent the return of ulcers caused by a certain type of bacteria (H. pylori). Sucralfate is in a class of medications called protectants. It sticks to damaged ulcer tissue and protects against acid and enzymes so healing can occur¹. ULSANIC is indicated for gastric and duodenal ulcers, chronic gastritis, and reflux oesophagitis. ULSANIC produces relief of subjective symptoms of peptic ulceration e.g., epigastric pain, hyperchlorhydria, vomiting and is also indicated for maintenance treatment after a successful endoscopically proven, recently healed duodenal ulcer. ULSANIC is available in 3 dosage forms:

ULSANIC Effervescent Tablets
ULSANIC 1 g Tablets
ULSANIC Suspension

Medical References

AHFS Patient Medication Information [Internet]. Bethesda (MD): American Society of Health-System Pharmacists, Inc.; c2019. Drugs, Herbs and Supplements: Sucralfate. [Updated: 15 April 2017; cited 21 December 2022]. Available from: https://medlineplus.gov/druginfo/meds/a681049.html#:~:text=Sucralfate%20is%20used%20to%20treat,certain%20ty pe%20of%20bacteria%20(H.
Feldman M. Symptoms of Oesophageal Disease, in Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 2021. Available from: https://www.sciencedirect.com/topics/medicine-and-dentistry/heartburn. Accessed on: 20 August 2022.
[Internet]. Health A to Z: Heartburn and Acid Reflux. [last reviewed: 9 September 2020]. Available from: https://www.nhs.uk/conditions/heartburn-and-acid-reflux/. Accessed on 18 October 2022.
Mayo Clinic. [Internet]. Patient Care & Health Information: Diseases & Conditions: Peptic ulcer. [updated, 11 June 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223. Accessed on: 20 August 2022.
[Internet]. Esophageal Ulcer. [Updated on 17 April 2020]. Available from: https://www.healthline.com/health/esophageal-ulcer. Accessed on 18 October 2022.
Mayo Clinic. [Internet]. Patient Care & Health Information: Diseases & Conditions: Heartburn. [updated 13 May 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/heartburn/symptoms-causes/syc-20373223. Accessed on: 20 August 2022.
Mayo Clinic. [Internet]. Patient Care & Health Information: Diseases & Conditions: Gastritis. [updated 15 March 2022]. Available from: https://www.mayoclinic.org/diseases-conditions/gastritis/symptoms-causes/syc-20355807. Accessed on 18 October 2022
[Internet]. Peptic Ulcer Disease Patient Education. [updated 26 April 2021]. Available from: https://emedicine.medscape.com/article/181753-overview#a9. Accessed on 18 August 2022.
Cunha J.P. eMedicineHealth. [Internet]. Digestive Disorders Centre. Peptic Ulcers.[reviewed on 17 August 2022]. Available from: https://www.emedicinehealth.com/peptic_ulcers/article_em.htm. Accessed on 18 August 2022.
Gillson S. verywellhealth. [Internet]. Digestive Health. Coping with Peptic Ulcer Disease. Lifestyle tips on how to manage the condition. [updated 16 May 2022]. Available from: https://www.verywellhealth.com/living-with-pepticulcers-1742816. Accessed on 21 December 2022.

S0 ULSANIC Suspension. Reg. No.: V/11.4.3/315. Each 5 ml suspension contains 1 g sucralfate. S0 ULSANIC Effervescent Tablets. Reg. No.: 31/11.4.3/0119. Each effervescent tablet contains 1 g sucralfate. S0 ULSANIC 1 g Tablets. Reg. No.: Q/11.4.3/147. Each tablet contains 1 g sucralfate. Trademarks are owned by or licensed to the Aspen Group of companies.© 2023 Aspen Group of companies or its licensor. All rights reserved. Marketed by Pharmacare Limited t/a Aspen Pharmacare.Co. Reg. No.: 1898/000252/06. Healthcare Park, Woodlands Drive, Woodmead, 2191. ZAR-SUC-08-22-00002 08/2023

Medical References

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