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Peptic Ulcer Disease - Peptic Ulcer Disease symptom, treatment, causes

Peptic Ulcer Disease is a condition in which ulceration of the lining of the intestine caused by the action of the hydrochloric acid and pepsin (digestive enzyme) secreted by the stomach. Peptic ulcers may develop in the stomach, duodenum (first part of the small intestine), in the lower oesophagus (gullet) as a complication of GASTRO-OESOPHAGEAL REFLUX, and on rare occasions in other parts of the small intestine. Peptic ulcer disease is common. In Australia it is estimated that 40 000 people per year are affected by uncomplicated peptic ulcer disease, and that 7000 are admitted to hospital per year because of complications.

A peptic ulcer is an ulcer of one of those areas of the gastrointestinal tract that are usually acidic. The causes of PUD have gradually become clear. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. An ulcer occurs when the lining of these organs is corroded by the acidic digestive juices which are secreted by the stomach cells. Peptic ulcers are common One in 10 Americans develops an ulcer at some time in his or her life. One cause of peptic ulcer is bacterial infection, but some ulcers are caused by long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and ibuprofen. In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. Peptic ulcers are not caused by stress or eating spicy food, but these can make ulcers worse.

A peptic ulcer is a sore on the lining of the stomach or duodenum, which is the beginning of the small intestine. If peptic ulcers are found in the stomach, they're called gastric ulcers. They affect more than 4 million people each year in the United States. Peptic ulcers usually occur in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer), which is the upper region of the small intestine. The stomach and duodenal lining have a number of mechanisms that protect it from digesting itself. The most common symptom of petic ulcer is abdominal pain that is dull, comes and goes over a period of time, may occur a few hours after eating or during the night, and is relieved by food and/or antacids. The laboratory diagnosis of peptic ulcers caused by H. pylori can be performed using a variety of different methods and specimen types. The most common laboratory test for diagnosing peptic ulcers is a blood test for the presence of antibodies to H. pylori . The presence of H. pylori antibodies means you have been infected at some time with this organism. A stool sample may be collected to look for the H. pylori antigen ; however, this test is not appropriate for individuals who have blood in their stool. These include an upper GI series that involves taking x-rays of the GI tract and endoscopy, in which a tiny camera on the end of a thin tube is fed through the mouth, down the esophagus, to the duodenum. Treatment usually involves a combination of antibiotics to kill the bacteria and drugs to reduce the amount of stomach acid produced.

Cause of Peptic Ulcer Disease

The disease was once thought to be due to oversecretion of acid by the stomach, but the cause is now known to be more complex. Everyone secretes acid (it is essential for proper digestion), but only I in 10 people ever develops peptic ulcer disease. It is believed that peptic ulcers result from' disturbed balance betweeq productiori of' acid and the thick mucus that protects the intestinal lining. There are many adverse influences on this balance.

• Severe injuries or emotional stress can increase' acid secretion and cause superficial erosion of the stomach lining.
• Abnormal contractions of muscles in the wall of the gut may push acid or bile into parts of the gut where they should not be, to damage and ulcerate the lining membrane.
• The bacterium Helicobacterpylori, often found in the upper bowel in association with peptic ulcer disease, can cause chronic inflammation of stomach and duodenal linings, making them more susceptible to ulceration. It was previously thought that there was an inherited tendency to the disease, but it now seems more likely that it
  is H.pylori infection that family members share.
• Certain drugs (especially aspirin. NON-STEROIDALANTI-INFLAMMATORY DRUGS and possibly CORTICOSTEROID DRUGS) damage the protective mucus layer in the stomach and interfere with the action of other protective sub-stances such as PROSTAGLANDINS.
• Rare disorders such as ZOLLINGER-ELLISON SYNDROME cause increased acid secretion.

• Mucus production and other protective factors become less effective with age (most stomach and duodenal ulcers occur in people over the age of 401.

Symptom of Peptic Ulcer Disease

Burning or gnawing upper abdominal pain is the most common symptom. The pain is steady in intensity and its position, and is generally relieved by food or antacids. Some patients have no symptoms, and the ulcer is discovered when complications develop. Some common Symptoms of Peptic Ulcer Disease :

• Nausea.
• Weight loss.
• Fatigue.
• Chest pain.
• Vomiting blood .
• Abdominal pain..
• Loss of appetite and weight loss.
• Hematemesis (vomiting of blood).

Complication of Peptic Ulcer Disease

The most common complication is bleeding from the ulcer. Acute bleeding causes vomiting of blood and makes dark, tarry blood appear in the faeces. This is an emergency needing blood transfusion and surgery to control the bleeding. Chronic bleeding leads to anaemia.

A less common complication is perforation of the gut at the site of the ulcer, leading to leakage of stomach acid and other gut contents into the abdominal cavity, which results in PERITONITIS (inflammation of the abdominal lining). Perforation generally causes very severe pain and sHOCK, and is an emergency. If the ulcer is at tche back of the stomach or duodenum, penetration into the pan-creas or liver causes intense pain that may be referred to .the right shoulder 0f back. Scarring in ulcers may lead to narrowing or obstruction of the intestine.

Diagnosis of Peptic Ulcer Disease

Traditionally, barium meal X-ray has been used--for peptic ulcer diagnosis,but gas-troscopy (internal examination of the stomach via a viewing instrument) is more reliable and is now the preferred method

Treament of Peptic Ulcer Disease

Antacid drugs neutralise acid and temporarily relieve symptoms. Effective drugs are available to heal ulcers by reducing acid secretion, improving mucus production, and sealing the ulcer under a protective layer. If H. pylori is detected, the patient is treated by means of antibiotics to eradicate the bacteria, plus bismuth subcitrate and drugs that reduce acid secretion to speed healing and prevent recurrence. Contributing factors such as smoking and alcoholism are best stopped.

• Try simple antacid mixtures or tablets to neutralise the acid. These will usually only ease the symptoms, although very high doses may eradicate an ulcer. NB high doses should not be used without due consultation with a doctor.
• Eat small meals regularly.
• Your doctor may prescribe a tablet which reduces the production of acid in the stomach. This is likely to cure an active ulcer.
• Avoid any foods which seem to bring on pain.
• If you smoke stop.
• If you drink heavily, stop or cut down.
• If you have Helicobacter pylori or your doctor has good grounds to think that you may have it, they may well prescribe a course of antibiotics (possibly two types) along with acid reducing tablets. This treatment is aimed at eradication of the bacteria, and as such is likely to cure the current ulcer and make it much less likely that further problems will occur.