A peptic ulcer, also known as ulcus pepticum,
PUD or peptic ulcer disease, is an ulcer of an area of the gastrointestinal
tract that is usually acidic and thus extremely painful. As many
as 80% of ulcers are associated with Helicobacter pylori, a spiral-shaped
bacterium that lives in the acidic environment of the stomach.
A major causative factor (60% of gastric and up to 90% of duodenal
ulcers) is chronic inflammation due to Helicobacter pylori that
colonizes the antral mucosa. The immune system is unable to
clear the infection, despite the appearance of antibodies. Thus,
the bacterium can cause a chronic active gastritis (type B gastritis),
resulting in a defect in the regulation of gastrin production
by that part of the stomach.
Another major cause is the use of NSAIDs . The gastric mucosa
protects itself from gastric acid with a layer of mucus, the
secretion of which is stimulated by certain prostaglandins.
Due to increased medical treatment, a greater proportion of
ulcers will be due to increasing NSAID use among individuals
with pain syndromes as well as the growth of aging populations
that develop arthritis.
Tobacco smoking leads to atherosclerosis and vascular spasms,
causing vascular insufficiency and promoting the development
of ulcers through ischemia. Gastrinomas, rare gastrin-secreting
tumors, also cause multiple and difficult to heal ulcers.
There is an association between heavy alcohol use and the development
of peptic ulcer disease.
Abdominal pain, classically epigastric with severity relating
to mealtimes, after around 3 hours of taking a meal (duodenal
ulcers are classically relieved by food, while gastric ulcers
are exacerbated by it).
Bloating and abdominal fullness.
Waterbrash (rush of saliva after an episode of regurgitation
to dilute the acid in esophagus).
Nausea and copious vomiting.
Loss of appetite and weight loss.
Hematemesis (vomiting of blood); this can occur due to bleeding
directly from a gastric ulcer, or from damage to the esophagus
from severe/continuing vomiting.
Melena (tarry, foul-smelling feces due to oxidized iron from
Gastric or duodenal perforation, rarely, an ulcer can lead to
it. This is extremely painful and requires immediate surgery.
A history of heartburn, gastro esophageal reflux disease (GERD)
and use of certain forms of medication can raise the suspicion
for peptic ulcer. Medicines associated with peptic ulcer include
patients with ulcer-like symptoms are often treated with antacids
. Bismuth compounds may actually reduce or even clear organisms,
though it should be noted that the warning labels of some bismuth
subsalicylate products indicate that the product should not
be used by someone with an ulcer.
Patients who are taking nonsteroidal anti-inflammatories (NSAIDs)
may also be prescribed a prostaglandin analogue , in order to
help prevent peptic ulcers, which may be a side-effect of the
When H. pylori infection is present, the most effective treatments
are combinations of 2 antibiotics (e.g. Clarithromycin, Amoxicillin,Tetracycline,
Metronidazole) and 1 proton pump inhibitor (PPI), sometimes
together with a bismuth compound.
Perforated peptic ulcer is a surgical emergency and requires
surgical repair of the perforation. Most bleeding ulcers require
endoscopy urgently to stop bleeding with cautery, injection,