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Peptic ulcer

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Peptic ulcer also known as ulcus pepticum, PUD or peptic ulcer disease is ulceration or the break on the lining of the stomach where it joins the small intestine (duodenum). The stomach secretes various juices and acids that help in digestion of food. Many a times the stomach produces the excess juices & acids which can disturb the stomach lining leading to break in its surface.

 

The stomach is naturally protected from these acids by a mucous layer that covers it.

 

A peptic ulcer may arise at various locations

Stomach (gastric ulcer)
Duodenum (duodenal ulcer)
Esophagus (esophageal ulcer)
Meckel's Diverticulum (Meckel's Diverticulum ulcer)

 

 

Major causes of peptic ulcer

  • Drugs called NSAIDs like Brufen, Diclofenac, and Aspirin etc which are advised to reduce pain may also cause stomach ulcers
  • These medications reduce the production of prostaglandin to reduce pain. But in doing so, they also impair the natural protection of the stomach against the acids
  • Infections: Bacterium called HP (Helicobacter pylori bacteria) which can add to more cases of stomach ulcers. This bacterium is also responsible for causing other conditions like stomach inflammation and cancer
  • Zollinger-Ellison syndrome (ZES): In this condition, the pancreas produces excessive amounts of the hormone called gastrin which stimulates the production of acids
  • Other causes like alcohol, injuries & any other infections

 

Symptoms

The most common symptoms of Peptic Ulcers are Dyspepsia – this includes a feeling of pain, bloating and discomfort in the stomach.

This may be accompanied by nausea, heartburn and frequent belching.

Along with it one can have certain problems like:-

 

  • 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
  • Water brash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus)
  • Nausea and lots of 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)
  • Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery

 

 Diagnosis

In most cases, the doctor may prescribe acid blocking medication to see if the ulcers heal by themselves.


If they still persist, then tests like endoscopy may need to be done.


In addition to this, a complete blood count (CBC) and a Stool occult blood test may be used to detect the presence of blood in the stools.

 

Treatment & Medication

  • If the cause is the use of NSAIDs, then they should be discontinued immediately. If the cause is h. pylori infection, then the doctor prescribes drugs like are Omeprazole, Amoxicillin and Clarithromycin, Metronidazole which have to taken in combination for a very long time
  • In cases where endoscopy is not successful, operation may need to be done
  • In this surgical procedure called Vagotomy, this leads to reduction in acid production
  • However, this surgery may impair the emptying of stomach contents. Surgery is not recommended if the ulceration is caused due to NSAID use

 

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