Bruce Springsteen announced on Wednesday that his remaining September tour dates will be postponed for medical reasons. The exact health issue: peptic ulcer disease.
But what exactly is peptic ulcer disease and why would treatment require the Boss to miss his upcoming shows? We asked gastroenterologists to explain what the condition entails, as well as its potential causes, treatments and other important things to know.
What is peptic ulcer disease?
“Peptic ulcer disease is a break in the lining of the stomach or intestine caused by increased acid,” Dr. Judith Kim, a gastroenterologist at NYU Langone Health, told HuffPost via email. “It affects about 5-10% of the population.”
Basically, peptic ulcer disease is a fancy medical way of saying that someone has stomach ulcers or duodenal ulcers, which are defects in the first part of the small intestine (known as the duodenum).
“It almost looks like a little crater in the lining,” said Dr. Aaron Martin, a gastroenterologist at Jefferson Health in Philadelphia. “The symptoms can vary, and sometimes people can be asymptomatic. But the most common would be pain in the epigastric area, right at the top of your belly in the centre, just below where your sternum is.”
In addition to abdominal pain, common symptoms of peptic ulcer disease include nausea, blood in the stool and poor appetite or feeling full quickly after eating.
What causes it?
“The most common cause of peptic ulcer disease worldwide is the bacteria H. pylori,” said Dr. Harmony Allison, a gastroenterologist at Tufts Medical Center in Boston. “The second most common cause is nonsteroidal anti-inflammatory medications like ibuprofen, naproxen and aspirin.”
When H. pylori infects your stomach, the bacteria can damage the protective lining and weaken it. As a result, your stomach acid can cause ulcers in the lining. Although there’s still some uncertainty around how H. pylori infection is spread, health experts believe the germs can be passed from one person to another through contact with saliva (like kissing), vomit or stool (as with faecal contamination).
Nonsteroidal anti-inflammatory drugs, commonly known as NSAIDs, include Advil, Aleve and Motrin but not, as some mistakenly believe, Tylenol. Another common misconception around the cause of peptic ulcer disease is that it stems from certain foods or stress.
“I still frequently hear people say things like, ‘My job is so stressful, I’m going to give myself an ulcer,’” Martin said. “Although we do think of stress as contributing to the development of ulcers, that doesn’t typically refer to the stress of daily life. It’s more the stress of someone who is very sick and has been in the hospital in critical care for a long period of time.”
There are additional risk factors and less common causes as well.
“The incidence of peptic ulcer disease increases with age,” Kim said. “There is similar prevalence in men and women, though stomach ulcers tend to be more common in women and ulcers in the intestine more common in men. Smoking and alcohol use are risk factors for ulcers. Other medications like steroids or blood thinners have been associated with ulcers as well.”
How is it diagnosed and treated?
“We can make a presumptive diagnosis based on somebody’s symptoms and history, so if someone says they have pain in that area and they’ve been taking a lot of ibuprofen, sometimes we can make a presumptive diagnosis that that’s what they have,” Martin said.
A breath or stool test can also help identify peptic ulcer disease caused by H. pylori.
“But to make an official ulcer diagnosis, we perform an endoscopy ― look in their stomach with a camera while someone is asleep,” Martin said.
An upper endoscopy allows doctors to directly visualise the patient’s digestive tract.
“If the ulcer is actively bleeding at the time of endoscopy, there are techniques and tools we can use to stop the bleeding,” said Dr. Kevin Cronley, a gastroenterologist with Gastro Health in Cincinnati.
In rare cases, peptic ulcer disease might require surgical treatment, but most of the time there are less invasive options.
“Ulcers are typically treated with proton pump inhibitors which decrease the acid produced by the stomach,” Kim said. “Usually we expect healing within 4-8 weeks of treatment. If there is a H. pylori infection, people are treated with a course of antibiotics as well. In addition, avoiding NSAIDs or other irritants like tobacco and alcohol help recovery.”
Most people with peptic ulcer disease can be treated as an outpatient and recover by taking medications like Prilosec and Nexium to suppress acid production. But if there are complications, you might require hospitalisation.
How can you prevent ulcers? What should you do if you think you might be developing one?
“Some ulcers can be prevented by avoiding NSAIDs or by treating H. pylori infection early before ulcers develop,” Kim said. “Avoiding smoking and alcohol can also help to prevent ulcer disease.”
It’s important to take action if you suspect you might be developing an ulcer. Your primary care provider can help guide you through the initial evaluation and steps and refer you to a gastroenterologist.
“If you have persistent pain ― most days of the week for more than one week ― or nausea, a bloating sensation or other discomfort, it is reasonable to discuss with your primary care provider,” Allison said. “If you notice black stools or blood in your stools, you may want to seek more immediate attention.”Those with known risk factors or the above symptoms should not delay evaluation.
“Peptic ulcer left untreated can result is significant complications including GI haemorrhage and perforation of the bowel,” Cronley said. “It is very important to seek urgent evaluation by a gastroenterologist if peptic ulcer disease is suspected. If caught early, it can very easily be treated and prevent significant complications.”