Peptic ulcer is an injury to the internal mucous membrane of the stomach or duodenum, the first part of the small intestine. It is the most common form of ulcer, the presence of which is often linked to Helicobacter pylori, a germ responsible for inflammation in the stomach.

Professor Silvio Danese, gastroenterologist, coordinator of Humanitas Immunology Center, Head of the Centre for Chronic Inflammatory Intestinal Diseases of Humanitas and lecturer at Humanitas University, spoke about peptic ulcers in an interview with Corriere della Sera.

“Peptic ulcer is the most common form of ulcer,” explains Professor Danese. “Duodenal ulcers can affect people of less advanced age, while gastric ulcers can affect older people.


What are the causes of a peptic ulcer?

The discovery of Helicobacter pylori in the 1980s was fundamental in getting to know this disease in greater depth. It is precisely this germ that is most responsible for peptic ulcers; its presence is also linked to gastritis and stomach cancer. It should be noted that 70% of gastric ulcers are related to the presence of this bacteria and more than 90% of duodenal ulcers are attributable to the infection caused by it.

On the other hand, 5% of duodenal ulcers and 15-20% of gastric ulcers are due to regular intake of non-steroidal anti-inflammatory drugs.

Among the causes, even if these cases are more rare, is Zollinger-Ellison syndrome, characterized by an excessive production of gastric acids.


What are your symptoms?

Pain and burning sensation between the breastbone and navel are the main symptoms of peptic ulcer. In the case of a duodenal ulcer, the symptoms may be felt even on an empty stomach, whereas in the case of a gastric ulcer, the symptoms are usually felt after eating. The duration of the symptomatology can vary from a few minutes to several hours and the disorder can also be present during the night.

“The pain can be accompanied by other symptoms, those typical of dyspepsia, namely a certain difficulty in digesting, nausea and premature satiety; less frequent symptoms include vomiting, loss of appetite, slimming, anemia due to untreated internal bleeding, and the presence of occult blood in the feces,” emphasizes professor Danese.


The diagnosis of an ulcer

In order to diagnose an ulcer, it must be ensured that it is infected. To check whether or not the bacterium is present, the patient is subjected to a serological or breath test, or a feces test. Gastroscopy, on the other hand, is only useful in certain special cases.

“Endoscopy, with the analysis of fragments of the mucosa of the stomach or intestine, is considered the best tool for the diagnosis of ulcers,” explains Prof. Danese.


Drug Therapy

Antibiotic therapy is required to eliminate Helicobacter pylori. Other drugs that may be useful include gastric acid secretion inhibitors, proton pump inhibitors, and gastric mucosa protectors.

“Drugs that block acid production reduce acid release in the digestive tract by promoting ulcer healing, while antacids such as proton pump inhibitors can relieve symptoms by reducing stomach pain,” the specialist emphasizes.


The role of food and lifestyle

During the therapy it is advisable to have a healthy diet, rich in fruit and vegetables (such as apples, carrots, green leafy vegetables), legumes, fish, white meat and whole grains; yoghurt with probiotics and mature cheeses should be preferred over milk, which increases the secretion of acids. Beware of dishes that are too savory, seasoned or spicy, and dishes that are spicy or rich in fat; these can make the pain more intense and slow down the digestive process.

“It is good to quit smoking, limit coffee consumption and avoid alcohol. Smokers run a higher risk of developing a peptic ulcer or relapse. It is also important not to eat before bedtime and to try to contain, as much as possible, the impact of the most stressful activities on your life after diagnosis. There is no evidence that anxiety and stress are a cause for this disorder, but stress can worsen the symptoms,” concluded professor Danese.