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Today in Health & Wellness
HEALTH CONDITIONS

Peptic Ulcer Disease

Overview
Symptoms
Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Doctors to Consult
Overview

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.

 

 

Symptoms
  • Burning pain on the epigastrium
  • Feeling of fullness, bloating or belching
  • Fatty food intolerance
  • Heartburn
  • Nausea

Severe symptoms:

  • Vomiting with or without blood
  • Bloody, black or tarry stools
  • Difficulty breathing
  • Feeling faint
  • Unexplained weight loss
  • Appetite changes
Risk Factors
  • Smoking
  • Alcohol consumption. Alcohol increases the gastric acid and causes the irritation and erosion of the stomach’s mucous lining
  • Untreated and constant stress
  • Eating spicy foods. Do not cause ulcers but worsen existing ulcers

 

Complications

  • Ulcers can cause internal bleeding. This leads to anemia and eventually requires hospitalization and blood transfusion.
  • Ulcers can cause the formation of a hole on the walls of the stomach or small intestine. This leads to an infection in the abdominal cavity.
  • Ulcers may block the passage of food to the digestive tract when these become inflamed or form scar tissues.
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
Treatment and Management
  • Management depends on the diagnosed cause of PUD. It is important to determine the cause of PUD prior to starting treatment to ensure an effective treatment approach.
  • A healthy and balanced diet enables the body to heal ulcers faster. Patients are encouraged to eat probiotics like those found in yogurt and aged cheese.
  • Milk consumption can be reduced or eliminated. It causes a late increase in acid production that worsens the symptoms.
  • Address or cope with stress because it worsens the symptoms of PUD. Determine the sources of stress to eliminate or manage these causes.
  • Avoid smoking because it increases gastric acid production and affects the protective lining of the stomach.
  • For patients who cannot avoid taking NSAIDs, minimize symptoms by taking the medication with meals. Consult a physician to identify what is the lowest possible dose that provides pain relief.
Home Remedies
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