Peptic ulcer disease (PUD), also known as a peptic ulcer or stomach ulcer, is a break in the lining of the stomach, first part of the small intestine, or occasionally the lower esophagus. An ulcer in the stomach is known as a gastric ulcer while that in the first part of the intestines is known as a duodenal ulcer. The most common symptoms are waking at night with upper abdominal pain or upper abdominal pain that improves with eating. The pain is often described as a burning or du
ll ache. Other symptoms include belching, vomiting, weight loss, or poor appetite.
Facts
■ Peptic ulcers are sores in the lining of the stomach or duodenum.
■ Ulcer pain may not correlate with the presence or severity of ulceration.
■ The main symptom of peptic ulcer is upper abdominal pain which can be dull, sharp, or burning. (Bloating and burping are not symptoms of peptic ulcer, and vomiting, poor appetite, and nausea are uncommon symptoms of peptic ulcer.)
■ Diagnosis of ulcer is made with upper GI series or endoscopy.
■ Complications of ulcers include bleeding, perforation, and blockage of the stomach (gastric obstruction).
■ If a person with peptic ulcers smokes or take NSAIDs, the ulcers may recur after treatment.
Causes
☞ Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen.
☞ Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output
☞ Excessive drinking of alcohol
☞ Smoking or chewing tobacco
☞ Serious illness
☞ Radiation treatment to the area
Signs and Symptoms
♦ Epigastric pain
♦ Abdominal pain
♦ Bloating and abdominal fullness
♦ Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus - although this is more associated with gastroesophageal reflux disease)
♦ Nausea, and copious 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 presence of oxidized iron from hemoglobin)
Diagnosis
1. The diagnosis is mainly established based on the characteristic symptoms.
2. Confirmation of the diagnosis is made with the help of tests such as endoscopies or barium contrast x-rays.
3. An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected.
4. One of the reasons that blood tests are not reliable for accurate peptic ulcer diagnosis on their own is their inability to differentiate between past exposure to the bacteria and current infection.
Differential Diagnosis
1. Gastritis
2. Cholecystitis
3. Stomach cancer
4. Gastroesophageal reflux disease
5. Pancreatitis
6. Inferior myocardial infarction
7. Biliary colic
Treatment
1. Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before endoscopy is undertaken.
2. People who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (misoprostol) in order to help prevent peptic ulcers.
3. Acid reducing medication :
- Ranitidine and famotidine, which are both H2 antagonists, provide relief of peptic ulcers, heartburn, indigestion. They decrease the amount of acid in the stomach helping with healing of ulcers.
- In the absence of H. pylori, 4 weeks of a PPIs are also often used.
4. H. pylori :
- When H. pylori infection is present, the most effective treatments are combinations of 2 antibiotics (e.g. clarithromycin, amoxicillin, tetracycline, metronidazole) and a proton pump inhibitor (PPI), sometimes together with a bismuth compound. In complicated, treatment-resistant cases, 3 antibiotics (e.g. amoxicillin + clarithromycin + metronidazole) may be used together with a PPI and sometimes with bismuth compound. An effective first-line therapy for uncomplicated cases would be amoxicillin + metronidazole + pantoprazole (a PPI).
- Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete.
5. Surgery :
- Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery, injection, or clipping.
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- Ranitidine (Zantac, Aciloc)
ll ache. Other symptoms include belching, vomiting, weight loss, or poor appetite.
Facts
■ Peptic ulcers are sores in the lining of the stomach or duodenum.
■ Ulcer pain may not correlate with the presence or severity of ulceration.
■ The main symptom of peptic ulcer is upper abdominal pain which can be dull, sharp, or burning. (Bloating and burping are not symptoms of peptic ulcer, and vomiting, poor appetite, and nausea are uncommon symptoms of peptic ulcer.)
■ Diagnosis of ulcer is made with upper GI series or endoscopy.
■ Complications of ulcers include bleeding, perforation, and blockage of the stomach (gastric obstruction).
■ If a person with peptic ulcers smokes or take NSAIDs, the ulcers may recur after treatment.
Related Article :
Causes
☞ Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen.
☞ Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output
☞ Excessive drinking of alcohol
☞ Smoking or chewing tobacco
☞ Serious illness
☞ Radiation treatment to the area
Signs and Symptoms
♦ Epigastric pain
♦ Abdominal pain
♦ Bloating and abdominal fullness
♦ Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus - although this is more associated with gastroesophageal reflux disease)
♦ Nausea, and copious 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 presence of oxidized iron from hemoglobin)
Diagnosis
1. The diagnosis is mainly established based on the characteristic symptoms.
2. Confirmation of the diagnosis is made with the help of tests such as endoscopies or barium contrast x-rays.
3. An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected.
4. One of the reasons that blood tests are not reliable for accurate peptic ulcer diagnosis on their own is their inability to differentiate between past exposure to the bacteria and current infection.
Differential Diagnosis
1. Gastritis
2. Cholecystitis
3. Stomach cancer
4. Gastroesophageal reflux disease
5. Pancreatitis
6. Inferior myocardial infarction
7. Biliary colic
Treatment
1. Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before endoscopy is undertaken.
2. People who are taking nonsteroidal anti-inflammatories (NSAIDs) may also be prescribed a prostaglandin analogue (misoprostol) in order to help prevent peptic ulcers.
3. Acid reducing medication :
- Ranitidine and famotidine, which are both H2 antagonists, provide relief of peptic ulcers, heartburn, indigestion. They decrease the amount of acid in the stomach helping with healing of ulcers.
- In the absence of H. pylori, 4 weeks of a PPIs are also often used.
4. H. pylori :
- When H. pylori infection is present, the most effective treatments are combinations of 2 antibiotics (e.g. clarithromycin, amoxicillin, tetracycline, metronidazole) and a proton pump inhibitor (PPI), sometimes together with a bismuth compound. In complicated, treatment-resistant cases, 3 antibiotics (e.g. amoxicillin + clarithromycin + metronidazole) may be used together with a PPI and sometimes with bismuth compound. An effective first-line therapy for uncomplicated cases would be amoxicillin + metronidazole + pantoprazole (a PPI).
- Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI's in the 1990s, surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete.
5. Surgery :
- Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery, injection, or clipping.
Related Article :
- Heartburn ( Pyrosis )
- Abdominal pain
- Ranitidine (Zantac, Aciloc)
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