Peptic ulcer

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Peptic ulcer is an open sore in the lining of a person’s esophagus, stomach, and the upper portion of one’s small intestine. The word ulcer means a sore or a wound.

Between 5% and 10% of adults around the world are estimated to have experienced peptic ulcers at least once in their lifetimes.

Contents

Types

  1. Gastric ulcer – A type of peptic ulcer that takes place on the inside of the stomach.
  2. Esophageal ulcer – A type of peptic ulcer that takes place inside the hollow tube (esophagus) where food travels from one’s throat to the stomach.
  3. Duodenal ulcer – A type of peptic ulcer that occurs on the inside of the upper portion of one’s small intestine (duodenum).

Signs and symptoms

Burning pain is the most common symptom associated with peptic ulcer. The pain is caused by the open sore which worsens due to stomach acid that comes in contact with the ulcerated area. The pain could be described in the following manner:

  • The pain is concentrated in the area between one’s navel up to the breastbone.
  • The pain is aggravated when the stomach is empty.
  • The pain flares at night.
  • There is temporarily relief when one eats certain foods that buffer the stomach acid.
  • There is temporarily relief when one takes acid-reducing medication.
  • The pain disappears but returns after several days or weeks.

Other signs and symptoms are:

  • Loss of appetite.
  • Unexplained weight loss.

Severe symptoms (considered medical emergencies) are:

  • Nausea or vomiting.
  • Vomiting of blood (color may be red or black)
  • Dark blood manifested in stools or stools that appear black, tarry, or sticky.

Causes and risk factors

  • Bacterium – A common cause of ulcers is associated to the corkscrew-shaped bacterium Helicobacter pylori. This bacterium usually thrives within the mucous layer responsible for covering and protecting tissues that line the stomach and small intestine. The bacterium can cause a problem if it disrupts the mucous layer and inflames the lining of one’s stomach or duodenum. If this occurs, an ulcer is produced.
  • Frequent use of pain relievers. - Regular use of pain relievers (over-the-counter and prescription) can irritate the lining of the stomach and small intestine. Such medications include aspirin, ibuprofen, naproxen, ketoprofen, and others. It is best to take such medications on a full stomach to avoid stomach irritation.
  • Other medications. – Medications that treat osteoporosis (bisphosphonates) may cause peptic ulcers.
  • Genetics – There is a possibility of genetic factors behind ulcers. Some patients have been observed to have close relatives with the same condition.
  • Smoking – Regular smokers tobacco are more likely to develop peptic ulcers as compared to non-smokers.
  • Alcohol consumption – Regular heavy drinkers have greater risks of developing peptic ulcers.
  • Stress – Some cases of stress, particularly mental stress, have been associated with peptic ulcers.

Diagnosis and tests

Confirming peptic ulcer may require a diagnostic imaging test. Common diagnostic imaging tests performed are the following:

  • Upper GI series (UGI) – This is a special x-ray. The patient drinks a chalky form of liquid containing barium to make features easier to see.
  • Endoscopy (EGD) – This procedure makes use of an endoscope to see the lining of the stomach to diagnose a peptic ulcer. Tiny samples of the tissue will be examined under a microscope.

If an ulcer is revealed through the diagnostic imaging test, the next step is to determine presence of H pylori bacteria through any of the following procedures:

  • Blood testsH pylori bacteria is detected by measuring antibodies to the bacteria.
  • Breath tests - H pylori bacteria is detected by measuring carbon dioxide in the patient’s breath after drinking a special fluid.
  • Tissue tests – These tests are recommended if an endoscopic biopsy has already been done. The sample of tissue from the stomach is vital in detecting the bacteria.

Treatment

  • Antibiotics developed to kill H pylori can be prescribed by the doctor.
  • Acid-blocking medications can be taken to reduce the amount of acid released into one’s digestive tract. This shall help relieve ulcer pain and promote healing.
  • Medications that protect the lining of the stomach and duodenum can be taken.
  • Triple-therapy or dual-therapy regimens are recommended for ulcers caused by H pylori.

Treatment for bleeding ulcers include:

  • IV fluids
  • Bed rest and taking clear fluids without food for a few days.
  • Placement of a nasogastric tube through the nose and down into the stomach. This procedure will relieve pressure in the stomach.
  • Urgent endoscopy or surgery may be required in some cases.

Possible complications

Peptic ulcer can lead to the following complications if left untreated:

  • Internal bleeding – Bleeding can take place as slow blood loss results to anemia. Severe blood loss may require blood transfusion.
  • Infection – It is possible for peptic ulcers to eat a hole through the wall of the small or small intestine. When this happens, the body can develop serious infection.
  • Scar tissue – Peptic ulcers can result to scar tissue that can block the entry of food through the digestive tract. Development of scar tissue can make a person vomit easily and lose weight.

Prevention and control

  • Peptic ulcer can be prevented by avoiding substances that trigger the break down of the stomach's protective barrier. These include alcohol, tobacco, caffeine, aspirin and non-steroidal anti-inflammatory drugs.
  • A healthy diet of fruits, vegetables and whole grains can help the body heal ulcer.
  • The patient should not be stressed out to avoid worsening of ulcer symptoms.
  • H pylori infection can be prevented by avoiding contaminated food and water. It is important to practice strict standards of personal hygiene such as washing the hands with warm water and soap before and after preparing food and after using the bathroom.

References