Peptic ulcer

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Overview

Peptic ulcer disease (PUD) is characterized by discontinuation in the inner lining of the gastrointestinal (GI) tract because of gastric acid secretion or pepsin. It extends into the muscularis propria layer of the gastric epithelium. It usually occurs in the stomach and proximal duodenum. It may involve the lower esophagus, distal duodenum, or jejunum. Epigastric pain usually occurs within 15-30 minutes following a meal in patients with a gastric ulcer; on the other hand, the pain with a duodenal ulcer tends to occur 2-3 hours after a meal. Today, testing for Helicobacter pylori is recommended in all patients with peptic ulcer disease. Endoscopy may be required in some patients to confirm the diagnosis, especially in those patients with sinister symptoms. Today, most patients can be managed with a proton pump inhibitor (PPI) based triple-drug therapy.

Symptoms

Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:


Gnawing or burning pain in your middle or upper stomach between meals or at night.

Pain that temporarily disappears if you eat something or take an antacid.

Bloating.

Heartburn.

Nausea or vomiting.

In severe cases, symptoms can include:


Dark or black stool (due to bleeding).

Vomiting.

Weight loss.

Severe pain in your mid- to upper abdomen.

Causes

Ulcers form when digestive juices damage the walls of the stomach or small intestine. If the mucus layer gets too thin or your stomach makes too much acid, your gut will feel it. The two major causes are:

Bacteria. It’s called Helicobacter pylori (H. pylori), and as many as half of us carry it. Most people infected with H. pylori do not get ulcers. But in others, it can raise the amount of acid, break down the protective mucus layer, and irritate the digestive tract. Experts aren’t sure how H. pylori infection spreads. They think it may pass from person to person through close contact, like kissing. You may also get it from unclean food and water.

Certain pain relievers. If you’ve been taking aspirin often and for a long time, you’re more likely to get a peptic ulcer. The same is true for other nonsteroidal anti-inflammatory drugs (NSAIDs). They include ibuprofen and naproxen. NSAIDs block your body from making a chemical that helps protect the inner walls of your stomach and small intestine from stomach acid. Other types of pain meds, such as acetaminophen, won’t lead to peptic ulcers.

Smoking cigarettes and drinking alcohol also can make you more likely to get ulcers.  Stress and eating a lot of spicy food don’t cause ulcers, as experts once thought. But they can make ulcers worse and harder to treat.

Risk factors

Smoke. Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.

Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that's produced.

Have untreated stress.

Eat spicy foods.

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Complications

Left untreated, peptic ulcers can result in:


Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.

A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).

Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring.

Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of gastric cancer.

Prevention

not drinking more than two alcoholic beverages a day.

not mixing alcohol with medication.

washing your hands frequently to avoid infections.

limiting your use of ibuprofen, aspirin, and naproxen (Aleve)