Patients Care

PEPTIC ULCER

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.

Causes

  • 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.

Signs and symptoms

  • 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 hemoglobin).
  • 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 NSAID.

Management

MEDICAL TREATMENT:

  • Younger 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 NSAIDs.
  • 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.

SURGICAL TREATMENT:

  • 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, or clipping.