Common Name/Other Name
Stomach ulcer (Eng.)
Peptic ulcer disease (PUD) involves the formation of open lesions on the areas of the gastrointestinal tract exposed to gastric juice. This causes a burning pain in the epigastrium or the upper middle area of the abdomen that worsens when fasting and improves after eating.
Ulcers can form when the amount of gastric acid increases or the amount of mucosal barrier of the gastrointestinal tract decreases. The most common cause of PUD is the bacteria Helicobacter pylori. It produces urease which metabolizes urea into ammonia and carbon dioxide. Ammonia is responsible for damaging the mucous layer and underlying cells of the stomach causing ulcers. Ammonia and the enzyme catalase protects the bacteria from the stomach acidity and phagocytosis of neutrophils, respectively. PUD can be a side effect of taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. Also, a condition known as Zollinger-Ellison syndrome causes the increased secretion of hydrochloric acid.
Types of Peptic Ulcer Disease:
- Gastric ulcers occur inside the stomach.
- Duodenal ulcers are found in the first portion of the small intestine, the duodenum.
Diagnosis of PUD starts with a medical history and a physical exam. A breath test can be done to confirm the presence of H. pylori. The physician can view the upper gastrointestinal tract through endoscopy to determine the presence of ulcers.
Commonly Prescribed Drugs
- Antibiotics are used to eliminate Helicobacter pylori in the gastrointestinal tract. A combination of antibiotics is prescribed and taken for around two weeks. Antibiotics for PUD include amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline, and levofloxacin. Side effects: nausea, diarrhea, metallic taste in mouth
- Bismuth therapy is often used with antibiotics for H. pylori infections. Bismuth stops the bacteria from growing but does not eliminate it. Bismuth therapy typically involves bismuth subsalicylate and colloidal bismuth subcitrate.
- Proton pump inhibitors (PPIs) inhibit the gastric cells from producing gastric acid. It also allows ulcers to heal. PPIs are given with antibiotics for PUD caused by H. pylori. Other cases of PUD are treated with PPIs alone. Examples of PPI include omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole. Complications: increased risk of hip, wrist, and spine fracture
- H2-receptor blockers decrease the amount of stomach acid released into the GI tract. Examples include ranitidine, famotidine, cimetidine, and nizatidine. Side effects: diarrhea, headache, rashes, tiredness
- Antacids can be used to provide quick relief of GI symptoms. However, it does not reduce the amount of gastric acid or heal ulcers. These are not used alone to treat PUD. Side effects: constipation, diarrhea, flatulence
- Cytoprotective agents shield the tissues on the linings of the stomach and small intestine to reduce the risk of ulcer formation. Sucralfate is a common cytoprotective agent. Side effects: constipation, dry mouth, upset stomach