Peptic ulcer is a common defect in the gastric or duodenal mucosa which may be caused by a variety of factors.
In uncomplicated cases of peptic ulcer disease, the clinical findings are few and non-specific with the following often recorded:
In patients with perforated peptic ulcer disease, onset of severe, sharp, abdominal pain is a common presentation . In some other patients, generalised pain is described while epigastric pain is seen in rare cases. Since slight movement can bring about worsening of pains, a common presentation among peptic ulcer patients is the assumption of fetal position most of the time.
Abdominal examination also shows general tenderness, rigidity, rebound tenderness and guarding.
In diagnosis of ulcers, patients are subjected to diagnostic tests such as:
Treatment for peptic ulcers is dependent on the cause of the condition. Antibiotic medications taken over a period of two weeks can eradicate Helicobacter pylori . Antibiotics are often used with additional medications to reduce stomach acid.
In the case of excessive acid production, protein pump inhibitors that block the production and promote healing can be used. Other treatment agents are histamine blockers, and antacids. Antacids are used to provide relief but they do not heal ulcers .
As long as the underlying cause is addressed, prognosis is positive. Majority of patients are successfully treated with eradication of Helicobacter pylori, adequate use of antisecretory therapy and the avoidance of drugs that are etiologic factors . When Helicobacter pylori is eradicated, the natural history of the disease is altered and this leads to reduction of the recurrence rate from 60-90% to around 10-20%.
Mortality rate for peptic ulcer disease has decreased a great deal over the last three decades to approximately 1 death for every 100,000 cases.
Ulcers are caused by a variety of factors but in most cases, they arise as a result of Helicobacter pylori infection . Other main causes of ulcer are drug use, unfavourable life style choices, severe physiologic stress, hypersecretory states and genetics.
Other lesser etiologic factors include:
Peptic ulcer affects around 4.5 million people each year in the US. In other countries, the figures are variable and incidence is determined majorly on association with the major causes of peptic ulcer .
In the past, peptic ulcer was seen more in males than in females but now it occurs similarly in both males and females. Age statistics show that ulcer occurrence is declining in younger men especially for duodenal ulcer, while rates continue to increase in older women.
Peptic ulcers signify a defect in the gastric or duodenal mucosa which extends through the muscularis mucosa . In a healthy individual, there is a physiologic balance between gastric acid secretion and gastroduodenal mucosal defense.
Mucosal injury and peptic ulcer set in when the balance between the aggressive factors and defensive mechanisms of the stomach become disrupted. Aggressive factors like Helicobacter pylori infection, alcohol pepsin and bile salts can alter the mucosal defense by allowing hydrogen ion diffusion and ensuing injury to the epithelial cell. Again, Helicobacter pylori colonisation often results in inflammation.
To reduce the risk of peptic ulcer, the following is advised :
Peptic ulcer refers to the condition that arises when there is a clear breach in the mucosal lining of the stomach or the first part of the small intestine . The former is known as gastric ulcer while the latter is known as duodenal ulcer. Peptic ulcers arise following the caustic effects of acid and pepsin in the lumen.
Peptic ulcer is defined histologically as a necrosis of the mucosa that leads to the production of lesions that are equal to or greater than 0.5 cm. It is also the most common ulcer of the gastrointestinal tract. The very painful nature of the condition is a result of the acidic nature of the gastrointestinal tract. Ulcers are often worsened by drugs like aspirin or ibuprofen.
Peptic ulcers occur four times more in the duodenum than in the stomach. 4% of gastric ulcers are as a result of a malignant tumor . This is why biopsies are used in most cases to exclude the possibility of cancer. Duodenal ulcers are benign generally.
Ulcers that occur inside the stomach are known as gastric ulcers while those that occur in the throat and in the upper part of the small intestine are known as esophageal and duodenal ulcers respectively.
Treatment of ulcers in most cases is with the aid of antibiotics and medication to help reduce the pain and other symptoms that arise from it. Contrary to common opinion, eating spicy meals or working a stressful shift does not cause ulcer.