Peptic ulcer disease

 When peptic ulcers occur, they can be found in either the lining of the stomach, the lining of the duodenum, or in both. Peptic ulcers that occur in the stomach are named gastric ulcers whereas ulcers found in the duodenum are referred to as duodenal ulcers. Peptic ulcers can be minor (they only go through the first or the second layers of the stomach), or can be considered a medical emergency (they go through every layer of the stomach or duodenum lining causing major internal bleeding). Small ulcers may not be noticeable, whereas large ulcers are considered medical emergencies. Abdominal pain is a common symptom seen with multiple types of ulcers.

Causes

Normally, the lining of the stomach and small intestines can protect itself against strong stomach acids. However, if the lining breaks down, the result may be swollen and inflamed tissue, called (gastritis) or an ulcer formation. Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency. The most common cause of ulcers is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their digestive tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer. The following factors raise your risk for peptic ulcers:

·        Drinking too much alcohol

·    Regular use of aspirin, ibuprofen, naproxen, or other non-steroidal anti-inflammatory drugs (NSAIDs). These drugs weaken the stomach or duodenal lining. Taking aspirin or NSAIDs once in a while is safe for most people.

·        Smoking cigarettes or chewing tobacco

·        Being very ill, such as being on a breathing machine

·        Having radiation treatments

·        Some suggested risk factors such as diet, and spice consumption, were hypothesised as ulcerogens (helping cause ulcers)

·        A rare condition called Zollinger-Ellison Syndrome causes stomach and duodenal ulcers. Many people believe that stress causes ulcers. It is not clear if this is true for normal stress.

Symptoms

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain located at the upper most part of the abdomen near the chest is a common symptom. The pain can differ from person to person, and some people, however, have no pain. Other symptoms include:

    Feeling of fullness and problems drinking as much fluid as usual

    Hunger and an empty feeling in the stomach, often 1 – 3 hours after a meal

    Mild nausea that may go away with vomiting

    Pain or discomfort in the upper abdomen

    Pain in the upper abdomen that wakes you up at night

    Water brash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus

 

Other possible symptoms include:

    Bloody or dark tarry stools

    Chest pain

    Fatigue

    Vomiting, possibly bloody

    Weight loss

A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. In patients over 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid production is increased as food enters the stomach. Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes to concentrate the stomach contents; therefore acid is not reaching the duodenum. Duodenal ulcer pain would manifest mostly 2 to 3 hours after the meal, when the stomach begins to release digested food and acid into the duodenum. Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient’s age. Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane or disappear. Usually, children and the elderly do not develop any symptoms unless complications have arisen. Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers. This pain can be misinterpreted as hunger, indigestion or heartburn. Pain is usually caused by the ulcer but it may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the sternum, it may last from few minutes to several hours and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication. 

However, peptic ulcer disease symptoms may be different for every sufferer.

 

Outlook (prognosis)

Peptic ulcers tend to come back if untreated. There is a good chance that the H. pylori infection will be cured if you take your medicines and follow your doctor’s treatment advice. You will be much less likely to get another ulcer.

Possible complications

    Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood vessels

    Perforation (a hole in the wall of the gastrointestinal tract) often leads to catastrophic consequences if left untreated. Erosion of the gastrointestinal wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity. Perforation and penetration are when the ulcer continues into adjacent organs such as the liver and pancreas.

    Gastric outlet obstruction is the narrowing of pyloric canal by scarring and swelling of gastric antrum and duodenum due to peptic ulcers. Patient often presents with severe vomiting

    Cancer is included with Helicobacter pylori as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer

 

When to contact a medical professional

Get medical help right away if you:

    Develop sudden, sharp abdominal pain

    Have a rigid, hard abdomen that is tender to touch

    Have symptoms of shock, such as fainting, excessive sweating, or confusion

    Vomit blood or have blood in your stool (especially if it’s maroon or dark, tarry black) 

 

Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead but never abuse it. If you must take such medicines, talk to your doctor first. Do not smoke or chew tobacco and alcohol.

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