THE WARNING SIGNS OF A PEPTIC ULCER – AND HOW TO TREAT THEM
At the age of 73, Bruce Springsteen has long been renowned for his extraordinary stamina as a performer. In 2016, he performed a 34-song set which clocked in at more than four hours.
But the rock legend, who has earned the nickname The Boss, has been undone by a peptic ulcer, a sore in the stomach lining or small intestine.
Having already cancelled two concerts in August, Springsteen has now postponed his tour dates for all of September as he undergoes treatment with the aim of being well enough to continue performing in Canada in November.
He tweeted early on Thursday:
According to Dr Ahmed Albusoda, a gastroenterologist at the Princess Grace Hospital in London, Springsteen falls in the at-risk category for peptic ulcers, being over the age of 70.
He said: “People are more vulnerable with age. The lining of your stomach becomes different. Your regeneration, your physiology becomes weaker, you become more fragile.”
What is a peptic ulcer?
According to the US National Institutes of Health, peptic ulcer disease affects at least four million people worldwide every year, and every one of us has about a five to 10 per cent chance of getting one in our lifetime.
Dr Albusoda explained that we are vulnerable to this because our stomach is continuously changing its lining throughout our lives.
“Every couple of weeks you get a new stomach lining and that is basically to withstand the acidic environment,” he said.
When this lining breaks down for various reasons, it leads to the formation of an ulcer. There are two main types: gastric ulcers, which occur on the inside of the stomach, and duodenal ulcers, which form on the inside of the upper segment of the small intestine.
One contributory factor to Springsteen’s ulcer could potentially be the stress of touring. According to Dr Albusoda: “Stress can sometimes prevent this renewal of the lining of the stomach. An unhealthy lifestyle – for example, skipping breakfast – can also cause problems with the renewal of the lining of the stomach.”
Smokers are more vulnerable to peptic ulcers, as are people with chronic illnesses such as arthritis who are taking long-term nonsteroidal anti-inflammatory drugs (NSAIDs) – such as the painkillers aspirin, ibuprofen and diclofenac – to manage their condition.
“We reasonably commonly see people who have been taking lots of pain relief because of arthritis, then presenting with peptic ulcer disease,” said Guy Blackshaw, a consultant upper gastrointestinal surgeon at Spire Healthcare.
What causes peptic ulcers?
We might traditionally think of peptic ulcers as being because of overindulgence. But in reality, science has shown that the most common cause of them is an infection with the bacterium Helicobacter pylori (H.pylori), which lives in the stomach.
This infection is acquired very early in life and will make certain people much more vulnerable to developing an ulcer.
“There are different H.pylori bacteria depending on the region the person comes from, and some are more aggressive than others,” said Dr Albusoda.
“Once your stomach lining is a bit weaker and you’re a bit more stressed, it gets the opportunity to actually cause more ulcers.”
Peptic ulcer disease symptoms
While not everyone presents with symptoms, the most common sign of a peptic ulcer is crippling, burning stomach pain, accompanied by bloating, belching, heartburn, nausea and intolerance to fatty foods.
In severe cases, people can even end up vomiting blood or pass stools containing dark blood – both signs of complications.
Blackshaw said: “There are two main complications you can get from a peptic ulcer. They can bleed. Duodenal ulcers can bleed quite significantly, and that can be life-threatening.
“Then there’s perforation, which is where the ulcer becomes so deep, it actually perforates. That would then cause peritonitis, which is inflammation of the peritoneum, the membrane lining the abdominal cavity, and this requires emergency surgery.”
How are you diagnosed with a peptic ulcer?
The first stage of peptic ulcer treatment involves testing for H.pylori, which can either be done through a breath test, a blood test or testing a stool sample.
In some cases, doctors might want to conduct an endoscopy to collect a biopsy from the stomach or upper small intestine.
“They put that biopsy sample in a pot, and if the patient has H.pylori, there’s a colour change from yellow to red,” says Blackshaw. “And you can eradicate that with two different types of antibiotics.”
The typical diagnostic procedure involves something called an upper gastrointestinal tract endoscopy.
“This is essentially a camera examination that goes through the oesophagus to the stomach, and then you exit the stomach and go into the duodenum,” said Blackshaw. “It’s the best diagnostic test for somebody who’s got a peptic ulcer.”
According to Dr Albusoda, doctors are often keen to look inside the stomach because in rare cases, what might seem like symptoms of an ulcer can be small tumours which represent the beginnings of gastric cancer.
Peptic ulcer treatment
Antibiotics most commonly used to treat H.pylori are the drugs amoxicillin, clarithromycin and metronidazole.
If someone is H.pylori negative, the main alternative treatment is a class of drugs known as proton pump inhibitors or PPIs.
“They suppress the amount of acid that the stomach produces, and that’s a successful treatment,” said Blackshaw. “Springsteen is most likely on a PPI as we speak.”
If the person is taking a particular NSAID to manage a chronic condition, their GP will typically try to shift them to a different drug which causes less inflammation in the stomach.
How can you prevent peptic ulcers?
While they cannot always be helped, Dr Albusoda says that there are different things you can do to reduce your risk of developing an ulcer.
For example, if family members have developed ulcers, you could ask your GP whether they will give you an H.pylori test.
“If positive, then that can be treated to eradicate the bacteria, even if you don’t have an ulcer and that will reduce your risk,” he said. “But things like healthy eating habits, stopping smoking and stress reduction can also all help.”
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