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Peptic Ulcer Disease
Peptic ulcer which is also called peptic ulcer disease (PUD) is an ulcer or mucosal erosion occurring in the gastrointestinal tract leading to severe pain experiences. The ulcer may be around 0.5 centimeters in diameter or larger. Pain may last anywhere from a few days to several weeks depending on severity and treatment approach. The problem also tends to intensify if the affected individual’s stomach is empty but is usually relieved if full.
There are several causes and risk factors associated with the development of the condition and it can get worse if left unattended. About 1 out of every 10 people in the United States develops an ulcer at a certain point in time. It is a very common problem with Helicobacter pylori bacteria being one of the main culprits. Drugs can also lead to development or worsen peptic ulcer. Some people may manifest symptoms differently. It is possible for one to acquire the infection and only show the signs after several years. Knowing more about the progress will help in successful treatment.
The most common symptom of peptic ulcer disease would be burning and gnawing pain in the upper abdomen. Pain usually occurs around 3 hours after eating as the food leaves the stomach with acid production relatively high. Duodenal ulcer can be relieved with the ingestion of food but gastric ulcer gets worse by it. Severe burning pain can also occur at night which causes the patient to wake up. Extreme hunger pangs and abdominal bloating and fullness are other symptoms that may be relieved with milk or antacids temporarily. An ulcer is a wound which can bleed so black stools with or without pain is indicative of that. Bleeding is considered as a serious complication.
Waterbrash is a symptom described as having a saliva rush after regurgitating in order to dilute the acid in the esophagus. Adults may feel nauseous and vomit a lot, lose appetite then weight, experience hematemesis or vomit blood from esophagus damage or ulcer bleeding or melena which is passing black tarry foul-smelling stool from oxidized iron from hemoglobin. Complications may also result such as perforation, penetration of the ulcer to blood vessels and adjacent organs and pyloric stenosis.
Children can also develop peptic ulcer and present symptoms such as burning pain in the abdominal area located between the belly button and breastbone, nausea, vomiting, loss of appetite, frequent burping or hiccups, loss of weight, chest pain described as dull, difficult feeding and dark red or black vomit or stool which indicates bleeding.
PUD may be classified according to the specific location of the sore. Gastric ulcer is defined as having an ulcer in the stomach. Duodenal ulcer is having an ulcer in the first of three parts of the small intestine called the duodenum. Esophageal ulcer is having an ulcer in the lower region of the esophagus which is also highly associated with chronic GERD or gastrointestinal reflux disease. Peptic ulcer may also present as a Meckel’s diverticulum.
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Helicobacter pylori bacteria are the most common cause of the condition comprising about 80% of all cases. The pathogen has a spiral shape and infects the mucous lining of the stomach. People usually come in contact with the bacteria by taking contaminated food or drinks or touching contaminated objects. People can also acquire the bacteria from other people through kissing or sexual contact. The bacteria initially cause inflammation or gastritis and causes peptic ulcer after injuring the mucous layer.
In some cases, the person produces high amounts of acid which causes the ulcers which is referred to as Zollinger-Ellison syndrome. There are other substances and risk factors associated with developing the problem. Caffeine and alcohol are known to stimulate stomach acid secretion and should be taken in very small amounts or completely avoided during the acute phase of peptic ulcer. Cigarette smoking causes nicotine to delay ulcer healing. Stress was highly regarded in the past as the leading cause of PUD but at present, it was discovered to rarely be a predisposing factor.
Aspirin and arthritis medications are like Advil, Lodine, Feldene, Voltaren and Indocin are also known to damage the mucous lining allowing stomach acid to cause the sore. Antacids may also aggravate the condition and symptoms except for bismuth. Pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs) can inflame and damage stomach and small intestine lining. These should be taken together with meals to prevent digestive problems.
Treatment approach for PUD greatly depends on the cause and location. For ulcer caused by Helicobacter pylori, the main goal would be to eliminate bacterial presence. This can be achieved by taking antibiotics such as omeprazole, pantoprazole, metronidazole, rabeprazole, amoxicillin and clarithromycin if patient is allergic to penicillin. Medicines may be combined depending on the needs of the patient. It would take around 2 weeks to get rid of the bacteria.
For peptic ulcer caused by NSAIDs, the patient should first stop taking these medications. Only in special cases are individuals allowed to continue taking them if doctors deem it necessary. If complications occur, these medications should be stopped altogether. With the presence of bacteria, antibiotics will be provided. Without bacteria, a histamine H2 antagonist or proton pump inhibitor may be provided. Blood test, gastroscopy and breath test are diagnostic tests done after treatment to confirm presence or absence of bacteria.
Perforated and bleeding ulcers are an emergency case which may require surgery and blood transfusion. Nearby organs and blood vessels should be protected by injecting helpful substances into the mucous lining. During surgery, blood vessels and the ulcer are closed and sewed together to stop bleeding. On the average, vagotomy, partial gastrectomy or a combination of the two may be done depending on the ulcer location. Duodenum scarring is treated through surgical means to facilitate gastric emptying. For chronic ulcer, treatment approaches may be directed towards alleviation of symptoms.
The best ways to prevent PUD development would be to steer clear of the risk factors. Stop smoking, drink moderate or small amounts of alcohol and caffeine. Minimize or avoid intake of NSAIDs and always have stress-relieving activities. If you’re taking maintenance medicines for other conditions, ask for safer alternatives that do not predispose to peptic ulcer. Wash hands regularly and be cautious about possibly infected food, drinks, items and individuals. Go to a physician and get a thorough checkup at least once every year to assess for possible presence of Helicobacter pylori.
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- Ulcers are "sores" that frequently affect the stomach and the first part of the small intestine (duodenum).
- Bacterial infection is the most common cause of duodenal ulcers.
- Stomach ulcers are often a side effect of pain killers and anti-inflammatory drugs used primarily to treat arthritis.
- Alcohol ingestion, cigarette smoking, and emotional stress may also influence the development of an ulcer or interfere with its healing.
- Upper abdominal pain is the most common symptom of ulcers, but many ulcers cause no symptoms at all.
- Ulcers may hemorrhage (bleeding) into the gastrointestinal tract; this results in the passage of black ("tarry") stool. Very serious ulcer disease may also cause a blockage between the stomach and small intestine and this complication results in persistent vomiting. Severe pain results from the most urgent complication of ulcers - peritonitis caused by a tear through the wall of the stomach or duodenum.
- Almost all ulcers can be treated successfully, usually without surgery. Many ulcers can be prevented.
- Ulcer treatments include antibiotics, agents that neutralize gastric acid or reduce its secretion, and drugs that strengthen the resistance of the stomach and duodenum.
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Latest page update: made by dr.rufusrajadurai
, Nov 8 2008, 3:38 PM EST
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