Bruce Springsteen, 73, was diagnosed with peptic ulcer disease (PUD).
PUD is commonly caused by Helicobacter pylori (H. pylori) infection or NSAID use, although other causes exist.
Symptoms include abdominal pain (with bloating or without), pain after eating, feeling very full, pale skin, and shortness of breath. PUD can be treated, and most patients make a full recovery.
Bruce Springsteen’s E Street Band put eight shows on hold after the 73-year-old rockstar was diagnosed with peptic ulcer disease (PUD), according to news reports.
Rudolph Bedford, MD, gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA tells MDLinx patients should be on the lookout for a few key symptoms, including abdominal pain (which may or may not be accompanied bybloating), pain that comes and goes after eating (pain from a duodenal ulcer may occur two or three hours after eating), feeling overly full, pale skin, and shortness of breath.
On the other hand, sometimes patients can be asymptomatic, adds Judith Kim, a gastroenterologist at NYU Langone Health. In fact, two-thirds of patients may not experience symptoms at all, according to the American Journal of Medicine.
While making a diagnosis, MDs should be aware of conditions that may mimic PUD, such as gastritis, gastroesophageal reflux disease, gastric cancer, pancreatitis, biliary colic, and cholecystitis. Myocardial infarction, mesenteric ischemia, and mesenteric vasculitis may also have similar presentations. PUD is often caused by a Helicobacter pylori (H. pylori) infection as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs). PUD can also—more rarely—stem from other health conditions, including (but not limited to) cancer, Zollinger-Ellison syndrome, viral infections, Crohn’s disease, and vascular insufficiency.
H. pylorus is a bacteria found in the gastric epithelial cells—responsible for 90% of duodenal ulcers and 70-90% of gastric ulcers. It’s often acquired during childhood, although it can remain dormant for years.
The National Library of Medicine says H. Pylori has a few key virulence factors:
“Urease: The secretion of urease breaks down urea into ammonia and protects the organism by neutralizing the acidic gastric environment.
Toxins: CagA/VacA is associated with stomach mucosal inflammation and host tissue damage.
Flagella: Provides motility and allows movement toward the gastric epithelium.”
NSAID-associated PUD stems from the medication blocking prostaglandin synthesis by inhibiting the COX-1 enzyme. This leads to reduced gastric mucus and bicarbonate production as well as a decrease in mucosal blood flow. Patients who use NSAIDs for a long time, use NSAIDS while having H. Pylori, use multiple NSAIDSs, or who take high doses of NSAIDS may be at risk of PUD.
“Other medications like steroids or blood thinners have been associated with ulcers as well,” Dr. Kim says. “People often talk about their stress causing ulcers, but this is not really true. However, we do see stress ulcers in patients who have been in critical care units for prolonged periods. Smoking and alcohol use are also risk factors for ulcers.”
Dr. Kim says that the incidence of peptic ulcer disease does increase with age. “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,” Dr. Kim clarifies.
Some patients may be genetically predisposed to ulcers, especially in people with type O blood. For patients who want to prevent PUD, a reduction in NSAIDs is key. Otherwise, you’ll want to treat their H. pylori infection before ulcers even develop. Patients should be told to avoid smoking and drinking alcohol. Recurrence does occur commonly.
In a study of 456,327 individuals from the UK, researchers found eight genetic variations associated with increased PUD risk—several of them making people more prone to H. pylori infection.
Dr. Kim says patients with possible PUD may need an upper endoscopy for diagnostic purposes and for urgent treatment if the ulcer is severe and bleeding. StatPearls notes all patients with suspected PUD should be tested for H. Pylori.
Dr. Kim adds that acid-decreasing proton pump inhibitors are commonly used and that surgery is rare. That said, “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,” Dr. Kim stresses.
MDs can tell their patients to expect healing within four to eight weeks of treatment, she notes. Patients generally recover fully and “I certainly expect the same for Mr. Springsteen,” Dr. Bedford says.