The Margin

Bruce Springsteen’s peptic ulcer disease should be a gut-check for millions born in the USA 

More than 4 million Americans suffer from peptic ulcer disease in the U.S. every year, costing an estimated $10 billion in direct and indirect healthcare costs

Bruce Springsteen has postponed his September shows while he treats peptic ulcer disease symptoms. Here’s what you need to know about the common digestive disorder.

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The Boss isn’t the only one suffering from peptic ulcer disease. 

Turns out, up to 10% of the global population — including more than 4 million Americans a year — suffer from the often painful digestive disorder. And it runs up an estimated $10 billion annual tab for both direct and indirect healthcare costs, according to the American Academy of Family Physicians. In fact, the global peptic ulcer drugs market was valued at $4.25 billion in 2019, according to Fortune Business Insights, and it is projected to reach $5.13 billion by 2027.

So after Bruce Springsteen revealed he’s following his medical advisers’ orders, and postponing all of his September tour dates with the E Street Band to treat symptoms of peptic ulcer disease, it’s not too surprising that Google searches digging into the condition and its warning signs quickly spiked this week. 

So what is peptic ulcer disease, and what do you need to know to treat it — or, better yet, prevent it? MarketWatch spoke with Dr. Judith Kim, a gastroenterologist at NYU Langone Health, to clear things up. 

What is peptic ulcer disease? 

Peptic ulcer disease is a condition when there’s too much acid in the stomach, which creates open sores that break down the lining in the stomach or the intestines. It affects about 10% of the global population. If left untreated, it can cause internal bleeding, the Mayo Clinic notes. Peptic ulcers can also block food from passing through your digestive track, which is also serious.

And the worst-case scenario is if the peptic ulcer disease perforates the stomach, or creates a hole in it, which puts you at serious risk of infection in your abdominal cavity. “That’s obviously severe and can require surgery,” Kim says. “But luckily, surgery is becoming a lot less common in peptic ulcer disease than in the past, because we know more about what causes it and how to prevent, and we have medications that treat ulcers very effectively.” 

What causes peptic ulcer disease? 

The most common causes of these ulcers are: a bacterial infection called H. pylori, as well as using nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. Other medications like steroids or blood thinners have also been associated with ulcers as well, Kim says.

“People often talk about their stress causing ulcers, but this is not really true,” she adds. “We do see stress ulcers in patients who have been in critical-care units for prolonged periods … but that’s a different type of physiological stress than day-to-day stress.”   

What are the symptoms of peptic ulcer disease? 

While the most common symptom of peptic ulcer disease is stomach or abdominal pain, including burning pain, it’s important to know that this type of ulcer can present in a number of different ways. Symptoms can also include: often feeling full, bloated or belching; heartburn; nausea; vomiting; poor appetite; unexplained weight loss; trouble breathing and feeling faint. And untreated ulcers that lead to internal bleeding can cause more severe symptoms, such as dark blood in stools, or stools that are black, as well as vomiting blood — which can appear red or black. 

Kim notes that sometimes people can be asymptomatic, as well; they just may find that their appetite has changed, and they’re not as hungry or eating as much as they used to eat. “It’s important to get to your doctor a little early” if anything seems off, she says. “Prevention is better than having to treat something, so being mindful and seeing your doctor early is key.”  

Who is most at risk for peptic ulcer disease? 

Peptic ulcer disease becomes more common the older you get, with the peak incidence occurring between 55 and 65 years old. “It’s mostly likely because, as people get older, they are more likely to be on medications that can cause ulcers,” Kim says. 

She also notes that there is similar peptic ulcer prevalence in men and women, although stomach ulcers tend to be more common in women, and ulcers in the intestine more common in men. 

Smoking and alcohol use are also risk factors for ulcers. 

How is peptic ulcer disease treated? 

Kim says it’s usually diagnosed by an upper endoscopy — a procedure in which a doctor uses a flexible tube with a camera, aka an endoscope, to see the lining of your upper gastrointestinal tract. This allows for urgent treatment if the ulcer is severe and bleeding. 

Rarely, surgery is needed for ulcers in extreme cases, such as finding a hole in the stomach lining. 

Ulcers are usually treated with proton pump inhibitors — aka PPIs, which are probably more familiar to you as over-the-counter medications such as lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (AcipHex) and esomeprazole (Nexium). PPIs decrease the acid produced by the stomach. And if there is a H. pylori bacterial infection, then people are also treated with a course of antibiotics.

Kim says that peptic ulcers usually heal within four to eight weeks of treatment.  In addition, avoiding NSAIDs (like ibuprofen and aspirin) or other irritants like tobacco and alcohol can help recovery. 

What are some common misconceptions about peptic ulcer disease?

“I would say blaming stress is probably the biggest misconception: ‘It was a stressful time in my life, and so I developed an ulcer,’” says Kim, noting, again, that peptic ulcer disease is most often caused by a bacterial infection, as well as using nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen.

“Another common misconception is people think it’s something that they eat. They are worried they ate something too spicy or too salty, and that caused an ulcer,” she adds. While these foods could potentially worsen acid production, Kim says “it hasn’t been well-proven.” 

How can peptic ulcer disease be prevented? 

Kim says that some ulcers can be prevented by avoiding NSAIDs (or, taking them with an antacid) or by treating an H. pylori  bacterial infection early, before ulcers develop. Avoiding smoking and alcohol can also help to prevent ulcer disease.

And again, prevention is better than having to treat something. “Be mindful and see your doctor early” if you suspect you may be developing an ulcer, or something doesn’t feel right, Kim says.