Peptic Ulcer Diagnosis and Treatment

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Before moving on to the main theme, let’s know what exactly is an ‘ulcer‘. In common words, ulcer is an open sore. By definition, ulcer is the breach in the continuity of skin, epithelium or mucous membrane which fails to heal.

Peptic ulcers are the areas of degeneration developing in that part of gastrointestinal tract which is exposed to gastric acid and pepsin, i.e., the inner lining of stomach, the first part of small intestine or occasionally in lower esophagus.

An ulcer in the stomach is termed as “gastric ulcer“, while an ulcer affecting the first part of intestine is called “duodenal ulcer“.

CAUSES

Peptic ulcer results probably due to an imbalance between the aggressive (acid, pepsin, bile and H. pylori) and the defensive (gastric mucus and bicarbonate secretion, prostaglandins, nitric oxide, high mucosal blood flow, innate resistance of the mucosal cells) factors. These factors are discussed below:

  1. Helicobacter pylori (H.pylori) – colonisation of epithelial mucus layer with H.pylori provokes an inflammatory response in the gastric mucosa leading to mucosal damage.
  2. NSAIDS (Nonsteroidal anti-inflammatory drugs) – intake of NSAIDS (painkillers) can increase the risk of developing peptic ulcer, as it interferes with the production of prostaglandins and affects the mucosal barrier.
  3. Stress – stress due to serious health problems can lead to peptic ulcer and are often known as ‘stress ulcers‘.
  4. Smoking and alcohol consumption
  5. Gastric acid hypersecretion – a significant factor in duodenal ulcer
  6. Reflux of bile and intestinal contents into stomach
  7. Tobacco use
  8. Genetic factors – strong family history witj gastric ulcers

SIGNS AND SYMPTOMS

  • Epigastric pain with strong correlation with meal time (food relieves pain in duodenal ulcer, whereas food intake aggravates pain in gastric ulcer)
  • Night pain common with duodenal ulcer
  • Nausea and vomiting
  • Waterbrash (excessive salivation)
  • Loss of appetite and weight loss in gastric ulcer
  • Weight gain in duodenal ulcer
  • Bloating and indigestion 
  • Hematemesis (vomiting of blood)
  • Melena (dark tarry stool more often with duodenal ulcer)

COMPLICATIONS

  1. Gastrointestinal bleeding
  2. Perforation
  3. Gastric outlet obstruction
  4. Gastric carcinoma

PREVENTION

Stop smoking, avoid consuming alcohol and tobacco, as these are the risk factors. Also use caution while on aspirin, other NSAIDS (painkiller) therapy. Rather than a big meal, eat small meals more frequently. Protect yourselves from infections by proper handwashing and intaking thoroughly cooked food.

TREATMENT

Approaches for the treatment of peptic ulcer are:

  1. Reduction of gastric acid secretion: Proton pump inhibitors like omeprazole, pantoprazole ; H2 antihistamines like ranitidine ; Prostaglandin analogue like misoprostol ; Anticholinergics like pirenzepine
  2.  Neutralization of gastric acid : Antacids containing Magnesium hydroxide and Aluminium hydroxide
  3. Ulcer protectives: Sucralfate, Colloidal
    bismuth subcitrate
  4. Anti-H. pylori drugs: Amoxicillin,
    Clarithromycin, Metronidazole, Tinidazole,
    Tetracycline (triple drug or quadruple drug regime to be followed)

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