A peptic ulcer is a break in the inner lining of either the upper part of the intestine or stomach, resulting in what are essentially gastrointestinal sores. It is a condition that can cause serious discomfort or pain at its very worst. There is also the danger of perforation occurring when it gets bad.
There are many medications that can be used to treat peptic ulcer disease, but they may not help entirely in some patients. In more severe instances, surgical treatment can be considered. However, it is understandable that some people may want to avoid this, especially with the risk of recurrence. Fortunately, animal studies have shown that using stomach stem cells can accelerate the healing of such ulcers.
This article will discuss peptic ulcers in some detail. It will also discuss the usual treatment options for this condition, as well as its treatment using stem cells.
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What is peptic ulcer disease?
Peptic ulcer disease is a medical condition characterized by ulcers, commonly known as sores, that develop in the internal lining of the stomach and upper segment of the small intestine.
Under normal circumstances, ulcers do not develop because there’s a protective layer of mucus lining the inside of the stomach. However, any condition that depletes this layer increases the risk of damage by stomach acid. This, in turn, leads to ulcers developing.
Types of peptic ulcers
Depending on the location of the ulcer in the gastrointestinal tract, peptic ulcers can be divided into two types:
- Gastric ulcer: the ulcer occurs in the stomach.
- Duodenal ulcer: the ulcer occurs in the upper section of the small intestine (the duodenum).
Due to the difference in location, these ulcers tend to have distinct symptoms. These can be used by a physician to determine the position of the ulcer before any further investigations are carried out.
Symptoms of the disease
Depending on the age of the patient and the location of the ulcer, some symptoms that patients experience may differ. Both types of peptic ulcers share some common symptoms, however. The following symptoms are found:
- Abdominal pain: In peptic ulcer disease, this is specifically epigastric pain, due to it being felt in the uppermost central region of the abdomen. It is a meal-related symptom, and it differs in the time of manifestation for gastric and duodenal ulcers. During a meal, the epigastric pain with gastric ulcers becomes so pronounced due to the production of acid as food enters the stomach. This acid irritates the ulcer, resulting in pain. In a duodenal ulcer, a meal seems to alleviate the pain since the pyloric sphincter (the ‘exit’ of the stomach) closes to concentrate the stomach contents, so the acid does not reach the duodenum. However, some hours after the meal, when the food has been digested, and the stomach releases the digested food and acid into the duodenum; the pain becomes pronounced.
- Distended stomach and feeling of stomach fullness.
- Weight loss, usually accompanied by loss of appetite.
- Vomiting of blood is also known as haematemesis. The blood vomited usually comes from the gastric ulcer and damaged esophagus.
- The patient’s feces are usually dark-green or blackish, with an offensive smell due to the presence of oxidized iron from metabolized hemoglobin.
- In rare cases, a peptic ulcer results in gastric or duodenal perforation. This causes acute peritonitis and requires immediate surgical intervention.
Causes of peptic ulcer disease
There are different factors and elements which can contribute to the development of a peptic ulcer. They include the following:
- Helicobacter pylori, a bacterium, has been implicated in both types of peptic ulcers. It causes more than 50% of recurrence in both types of ulcers. Despite the presence of H. pylori antibodies in serum, the immune system is unable to fight and resolve infections due to H. pylori, which colonizes the anterior part of the stomach mucosa. This leads to chronic inflammation that often results in gastritis. Gastritis then predisposes to the development of ulcers.
- Drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) are a major factor leading to peptic ulcers. NSAIDs such as ibuprofen and aspirin function by blocking the enzyme responsible for secreting prostaglandins, which help protect the gastric mucosa by stimulating it to produce a layer of mucus. When this happens, the gastric mucosa becomes unprotected from gastric acid, and this will eventually result in ulceration.
- There are some more unusual causes of peptic ulcers that should be considered. These include:
- constant tobacco use
- Zollinger-Ellison syndrome
- liver cirrhosis
- stress arising from severe illness
- Behcet disease
- Crohn disease.
Diagnosis of peptic ulcer disease
Peptic ulcers can traditionally be diagnosed clinically. That is, with the symptoms that the patient presents with. Usually, doctors give empirical treatment based on these present signs and symptoms.
Laboratory tests and other diagnostic procedures are undertaken when the disease fails to resolve.
- Test for H. pylori antibodies in the serum or plasma. This is not confirmatory as this test does not differentiate between current and past infection. A blood test can also show the false-negative result when the patient is on certain medications, like some antibiotics and proton-pump inhibitors.
- Confirmatory tests: using endoscopies or barium contrast x-rays.
- Direct detection: H. pylori can be detected using a urea breath test. It can also be isolated from the direct culture of the esophagogastroduodenoscopy (EGD) biopsy specimen. The urease activity performed by H. pylori can be checked using the urease test.
- Other tests include stool antigen test and histological procedures involving staining and examination of EGD biopsy.
The prognosis for the disease
The prognosis for patients with peptic ulcer disease is very good in most cases. However, this is when the cause of the condition is treated as it should be. This allows for proper healing and a low risk of recurrence. However, many patients do not observe the proper precautions, which makes recurrence common.
The risk of recurrence can be kept low when patients avoid doing the following:
- drinking alcohol
- smoking tobacco
- using NSAIDs
Fortunately, the risk of perforation caused by NSAIDs is relatively low, and with that, mortality rates are kept equally low.
Typical treatment of peptic ulcers
Under traditional circumstances, peptic ulcers are treated empirically. This means that a physician uses the patient’s clinical history to prescribe appropriate medication without needing specialized investigations.
The following are the common treatment modalities used for peptic ulcer disease:
- Antacids or H2 antagonists: These can be seen used in children who present with ulcer-related symptoms.
- Prostaglandin analogs together with NSAIDs to help circumvent peptic ulcers.
- Prescribing medication that decreases acid production, e.g., H2 antagonists and proton-pump inhibitors.
- Treating H. pylori infection: This is treated with the ‘triple regimen’: a combination of two antibiotics and a proton-pump inhibitor.
- Surgical intervention is used for recurrent peptic ulcers that do not respond to any form of treatment, or for emergency treatment of perforated peptic ulcers.
With the research done so far on the use of gastric stem cells for the treatment of stomach ulcers, there is hope that peptic ulcer disease will be easier to treat.
How can stem cell therapy help patients with painful stomach ulcers?
Some researchers have found that the risk of developing stomach ulcers increases with age and some factors, such as reduced ability to heal injuries, also play an important role. The cells healing the lining are stomach stem cells. Ensuring that these are healthy and capable of performing their roles can improve the outcome.
Gastric stem cells isolated from young mice have been experimentally transplanted into older mice with a stomach ulcer. The transplanted cells which replaced cells at the site of injury were observed and found to speed up the healing process. A study in pigs also showed the same benefit for ulcer healing. Transplanted stem cells reduced local inflammation and enhanced re-epithelization, which led to healing.
From this, we can gather that stem cells, harvested and cultivated to the required number, can be used to improve the rate of healing in patients with gastric or duodenal ulcers.
Benefits of stem cell therapy for peptic ulcer
An animal study had gastric perforations in rats sutured and injected with mesenchymal stem cells. It was found that this injection caused significant improvement in the rate at which these perforations healed. This healing was shown to have little wound adhesion and the lowest rate of wound breakdown compared to other treatment methods used in the study.
In addition, examination on a cellular scale showed that groups who received stem cells in the stomach showed less inflammation and more re-epithelization.
Another animal study indicated that the antioxidant activity of mesenchymal stem cells might be another contributing factor to the beneficial behavior of these stem cells in the stomach.
Despite these benefits, it’s important for patients to understand that improvement is not 100% guaranteed with stem cell therapy. All patients are different and while many will see positive changes with stem cells healing the stomach, it should always be kept in mind that the extent of these improvements may vary.
How safe is stem cell therapy for peptic ulcer?
Although there is not an abundance of studies focusing on the replacement of gastric stem cells with other stem cells to promote healing in the stomach, animal studies have shown a degree of safety, with minimal adverse effects.
One systematic review from 2018 made the conclusion that treating peptic ulcers with adipose-derived stem cells is safe, while still remaining beneficial. This was based on the findings from a total of 23 trials.
To have the best understanding of how suitable stem cell therapy is for treating your peptic ulcer disease, it is best to talk to healthcare professionals who are experts in this regard. Reach out to us for a free online consultation. You can have your pressing questions and concerns answered, and learn more about stem cell treatment.
Get a free online consultation to learn about the expected results of the treatment, its cost and duration, and what the treatment involves.
List of References
Sachdeva, A. K., Zaren, H. A., & Sigel, B. (1991). Surgical treatment of peptic ulcer disease. The Medical clinics of North America, 75(4), 999–1012.
Kusters, J. G., van Vliet, A. H., & Kuipers, E. J. (2006). Pathogenesis of Helicobacter pylori infection. Clinical microbiology reviews, 19(3), 449–490.
David Y. Graham, Muhammad Miftahussurur (2018). Helicobacter pylori urease for diagnosis of Helicobacter pylori infection: A mini review. Journal of Advanced Research, 2018, volume 13, pages 51-57, ISSN 2090-1232.
Malik, T. F., Gnanapandithan, K., Singh, K., (2021). Peptic Ulcer Disease. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
Bjarnason I, Hayllar J, MacPherson AJ, Russell AS (1993). Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine in humans. Gastroenterology. 1993 Jun;104(6):1832-47.
Xia, X., Chan, K. F., Wong, G., Wang, P., Liu, L., Yeung, B., Ng, E., Lau, J., & Chiu, P. (2019). Mesenchymal stem cells promote healing of nonsteroidal anti-inflammatory drug-related peptic ulcer through paracrine actions in pigs. Science translational medicine, 11(516).
Liu, L., Chiu, P. W., Lam, P. K., Poon, C. C., Lam, C. C., Ng, E. K., & Lai, P. B. (2015). Effect of local injection of mesenchymal stem cells on healing of sutured gastric perforation in an experimental model. The British journal of surgery, 102(2), e158–e168.
Alazzouni, A. S., Fathalla, A. S., Gabri, M. S., Dkhil, M. A., & Hassan, B. N. (2020). Role of bone marrow derived-mesenchymal stem cells against gastric ulceration: Histological, immunohistochemical and ultrastructural study. Saudi journal of biological sciences, 27(12), 3456–3464.
Holm, J. S., Toyserkani, N. M., & Sorensen, J. A. (2018). Adipose-derived stem cells for treatment of chronic ulcers: current status. Stem cell research & therapy, 9(1), 142.
Medical Advisor, Swiss Medica doctor