Bruce Springsteen made an announcement on Wednesday that his upcoming tour dates in September will be postponed due to medical reasons. The specific health issue that he is facing is peptic ulcer disease. But what exactly is peptic ulcer disease and why would it require him to miss his shows? We spoke to gastroenterologists to get more information about the condition, its causes, treatments, and other important details.
What is peptic ulcer disease?
“Peptic ulcer disease is a condition in which there is a break in the lining of the stomach or intestine caused by increased acid,” explained Dr. Judith Kim, a gastroenterologist at NYU Langone Health. “It affects approximately 5-10% of the population.”
In simpler terms, peptic ulcer disease refers to stomach ulcers or duodenal ulcers, which are defects in the first part of the small intestine known as the duodenum. “It appears like a small crater in the lining,” said Dr. Aaron Martin, a gastroenterologist at Jefferson Health. “The symptoms can vary, and sometimes people may not experience any symptoms. However, the most common symptom is pain in the epigastric area, which is located at the top center of the belly, just below the sternum.”
In addition to abdominal pain, other common symptoms include nausea, blood in the stool, and poor appetite or feeling full quickly after eating.
What causes peptic ulcer disease?
“The most common cause of peptic ulcer disease worldwide is the bacteria H. pylori,” stated Dr. Harmony Allison, a gastroenterologist at Tufts Medical Center. “The second most common cause is the use of nonsteroidal anti-inflammatory medications like ibuprofen, naproxen, and aspirin.”
When H. pylori infects the stomach, it can damage the protective lining and weaken it, leading to ulcers. While there is still uncertainty about how H. pylori infection spreads, health experts believe that it can be transmitted through contact with saliva, vomit, or stool. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil, Aleve, and Motrin (excluding Tylenol) are another common cause of peptic ulcer disease. It is important to note that contrary to popular belief, peptic ulcer disease is not caused by certain foods or stress. Stress is only considered a contributing factor in cases of severe illness and prolonged hospitalization.
There are additional risk factors and less common causes of peptic ulcer disease as well. “The incidence of peptic ulcer disease increases with age,” explained Dr. Kim. “It is equally prevalent in men and women, though stomach ulcers tend to be more common in women and intestinal ulcers are more common in men. Smoking and alcohol use are also risk factors, as well as other medications like steroids or blood thinners.”
How is peptic ulcer disease diagnosed and treated?
“A preliminary diagnosis can be made based on the symptoms and history,” said Dr. Martin. “For example, if someone has pain in the epigastric area and has been using a lot of ibuprofen, we may make a presumptive diagnosis of peptic ulcer disease.” Tests such as breath or stool tests can also help identify if H. pylori is causing the ulcers.
To make an official diagnosis, an endoscopy is performed. “During an endoscopy, we use a camera to look inside the patient’s stomach while they are under anesthesia,” explained Dr. Martin. This procedure allows doctors to directly visualize the patient’s digestive tract. If an ulcer is actively bleeding, there are techniques and tools available to stop the bleeding. In rare cases, surgical treatment may be necessary, but most of the time less invasive options are sufficient.
“Ulcers are typically treated with proton pump inhibitors, which reduce stomach acid production,” Dr. Kim stated. “Healing is usually expected within 4-8 weeks of treatment. If there is an H. pylori infection, antibiotics are also prescribed. Additionally, avoiding NSAIDs or other irritants like tobacco and alcohol can aid in recovery.” Most people with peptic ulcer disease can be treated as outpatients and recover by taking medications such as Prilosec and Nexium to decrease acid production. However, in cases of complications, hospitalization may be required.
How can peptic ulcers be prevented?
“Some ulcers can be prevented by avoiding NSAIDs or by early treatment of H. pylori infection before ulcers develop,” advised Dr. Kim. “Avoiding smoking and alcohol can also help prevent ulcer disease.” It is crucial to take action if you suspect you might be developing an ulcer. Your primary care provider can guide you through the initial evaluation and steps and refer you to a gastroenterologist if needed.
“If you experience persistent pain, nausea, bloating, or other discomfort most days of the week for more than one week, it is reasonable to discuss with your primary care provider,” said Dr. Allison. “If you notice black stools or blood in your stools, it is advisable to seek immediate medical attention.” It is also important not to delay evaluation if you have known risk factors or experience the aforementioned symptoms.
“Untreated peptic ulcer disease can lead to significant complications such as gastrointestinal hemorrhage and bowel perforation,” warned Dr. Cronley, a gastroenterologist with Gastro Health. “It is vital to seek urgent evaluation by a gastroenterologist if peptic ulcer disease is suspected. If caught early, it can be easily treated and prevent serious complications.”
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