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Peptic ulcer 

Alternative names: Stomach ulcers

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Overview of Peptic Ulcer

Peptic ulcer disease (PUD) refers to painful sores or ulcers in the mucosal lining of the stomach or the first part of the small intestine, the duodenum, secondary to pepsin and gastric acid secretion. The predominant causes of PUD are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs).1

Endoscopy is the widely preferred diagnostic procedure for peptic ulcer disease , as it can identify superficial lesions, ulcer scars, as well as active ulcers. Serious complications include bleeding, perforation or gastric outlet obstruction.

Peptic ulcer treatment has evolved from simple dietary modifications and use of antacids to gastric acid suppression with H2-receptor antagonists and proton pump inhibitors to eradication of H. pylori infection. Surgery is indicated for patients who are resistant to medical therapy or at high-risk for complications.

Pathogenesis of pepti ulcer (How peptic ulcer develops)

Normally, there is a physiologic balance between peptic acid secretion and gastroduodenal mucosal defense. Mucosal injury and subsequent peptic ulcer occur when the balance between the aggressive factors and the defensive mechanisms is disrupted.

The pathogenesis of peptic ulcer disease differs between duodenal and gastric ulcers. Duodenal ulcer, essentially an H. pylori-related disease, is caused mainly by an increase in the acid and pepsin load. In gastric ulcer, NSAID ingestion plays a major role in the ulcer development although H. pylori infection might also be present. Chronic, superficial and atrophic gastritis predominate in patients with gastric ulcers. Nevertheless, both ulcers are associated with an imbalance between protective and aggressive factors, with inflammation being a leading cause of the imbalance.

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Symptoms of Peptic Ulcer

Many signs and symptoms of peptic ulcer disease are obscure. People may complain only of indigestion or other vague dyspeptic symptoms commonly found in other conditions.

Classic presentations of peptic ulcer disease include

  • Fat intolerance and

Chronic duodenal ulcer frequently presents with epigastric pain. The pain varies markedly in nature and intensity, characteristically, occurring from 90 min to 3 h after eating and frequently awakens the person at night. The pain is usually relieved in a few minutes by food or antacid. Although symptoms tend to be recurrent and episodic, duodenal ulcers often recur in the absence of pain. Periods of remission usually last from weeks to years and are almost always longer than the episodes of pain.

 

Management of Peptic Ulcer

The goals of management are to control any active bleeding, to heal the ulcer and prevent its recurrence. Initial management strategies are guided by the patient’s clinical condition and endoscopic findings.

Thus, treatment may consist of

     1. Medical therapy

     2. Endoscopic

     3. And at times, surgery.2

Medical therapy: In order to facilitate healing and to decrease the risk for recurrence of peptic ulcer disease (PUD), H. pylori should be eradicated. Patients should receive antisecretory therapy, preferably with a proton pump inhibitor (PPI) for 4 weeks.

Endoscopy: Endoscopy should be performed in patients with persistent symptoms.

Surgery: Surgery is recommended in the presence of complications or when the ulcer is refractory to pharmacotherapy. The most common indication for surgery is bleeding. Rarely, complications such as perforation and gastric outlet obstruction may occur.

Patients negative for H. pylori infection should receive an empiric trial of acid suppression for 4–8 weeks and if beneficial it can be continued. Along with medications, lifestyle modifications are an important subset of management. Elimination or modification of peptic ulcer disease risk factors reduces the risk of ulcer recurrence.

Home remedies for acidity

Written by: Healthplus24 team
Date last updated: June 22, 2013