PEPTIC ULCER DISEASE

PEPTIC ULCER DISEASE

Peptic ulcer disease refers to painful sores or ulcers in the lining of the stomach or first part of the small intestine, called the duodenum.

Peptic ulcer disease represents a serious medical problem. 

Ulcer disease has become a disease predominantly affecting the older population, with the peak incidence occurring between 55 and 65 years of age. 

In men, duodenal ulcers were more common than gastric ulcers; in women, the converse was found to be true. Thirty-five percent of patients diagnosed with gastric ulcers will suffer serious complications. Although mortality rates from peptic ulcer disease are low, the high prevalence and the resulting pain, suffering, and expense are very costly.

Where do ulcers develop?

esophagus, 
stomach or duodenum, 
at the margin of a gastroenterostomy, 
in the jejunum, 
in Zollinger-Ellison syndrome, 
and in association with a Meckel's diverticulum containing ectopic gastric mucosa. 

Peptic ulcer disease is one of several disorders of the upper gastrointestinal tract that is caused, at least partially, by gastric acid. Patients with peptic ulcer disease may present with a range of symptoms, from mild abdominal discomfort to catastrophic perforation and bleeding.

What is Peptic Ulcer Disease?

Gastric and duodenal ulcers are breaks in the gastric and duodenal mucosa. Both gastric and duodenal ulcers relate to the corrosive action of pepsin and hydrochloric acid on the mucosa of the upper gastrointestinal tract. Ulcers generally range between 3 mm and several centimeters in diameter.

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Symptoms

Most patients with peptic ulcer disease present with abdominal discomfort, pain or nausea. The pain is located in the epigastrium and usually does not radiate. However, these symptoms are neither sensitive nor specific. Pain radiating to the back may suggest that an ulcer has penetrated posteriorly, or the pain may be pancreatic in origin. Pain radiating to the right upper quadrant may suggest disease of the gallbladder or bile ducts.

Patients may describe the pain of peptic ulcer as burning or gnawing, or as hunger pains slowly building up for 1–2 hours, then gradually decreasing. Use of antacids may provide temporary relief. Classically, gastric ulcer pain is aggravated by meals, whereas the pain of duodenal ulcers is relieved by meals. Hence, patients with gastric ulcers tend to avoid food and present with weight loss, while those with duodenal ulcers do not lose weight. It is important to remember that although these patterns are typical, they are not pathognomonic. The nature of the presenting symptoms alone does not permit a clear differentiation between benign ulcers and gastric neoplasm.

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:

·         Infection with a type of bacteria called Helicobacter pylori (H. pylori)

·         Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even safety-coated aspirin and aspirin in powered form can frequently cause ulcers.

·         Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output (seen in Zollinger-Ellison syndrome).

What Are the Symptoms of an Ulcer?

An ulcer may or may not have symptoms. When symptoms occur, they may include:

·         A gnawing or burning pain in the middle or upper stomach between meals or at night

·         Bloating

·         Heartburn

·         Nausea or vomiting

In severe cases, symptoms can include:

·         Dark or black stool (due to bleeding)

·         Vomiting blood (that can look like "coffee-grounds")

·         Weight loss

·         Severe pain in the mid to upper abdomen

Who Is More Likely to Get Ulcers?

You may be more likely to develop ulcers if you:

·         Are infected with the H. pylori bacterium

·         Take NSAIDs such as aspirin, ibuprofen, or naproxen

·         Have a family history of ulcers

·         Have another illness such as liver, kidney, or lung disease

·         Drink alcohol regularly

·         Are 50 years old or older