Peptic Ulcer Disease

Peptic ulcer disease, also commonly known as ulcer, develops when there is too much acid in the stomach relative to the mucus production, which is what covers and protects the stomach wall under normal conditions. Duodenal ulcers are the most common, followed by gastric ulcers, esophageal ulcers and finally ectopic ulcers.

Ulcer incidence increases with age and 70% of ulcers occur between the ages of 25 to 64. Helicobacter pylori bacteria is responsible for most gastric ulcers and almost all duodenat ulcers.

Risk factors for peptic ulcers are:

1. NSAIDs use (e.g. aspirin, ibuprofen, naproxen, indomethacin, acetaminophen)

2, Helicobacter pylori infection

3. Tobacco smoking

4. Family history of ulcers

5. Zollinger-Ellison syndrome

6. Stomach cancer

7. Chron disease

8. Burns

9. Head trauma

10. Stress

11. Poverty

12. Manual labor

13. High dose of steroids

Peptic ulcers can have many different signs and symptoms. Usually people have upper abdominal burning pain with tenderness and rigidity. There's also nausea, hematemesis (blood vomiting) and melena (dark black stool due to the presence of old blood). Many individuals experience only seasonal symptoms in the spring and autumn.

Those with gastric ulcers usually lose weight because they have pain during eating and so to avoid the symptoms they eat less.

Those with duodenal ulcers usually have a burning pain 1-3 hours after eating a meal. The pain is relieved by eating food or the use of antacids.

Untreated peptic ulcers can lead to severe complications such as:

1. Hemorrhage which can present as dizziness, syncope (fainting) and melena.

2. Perforation of the wall which can cause sudden severe upper abdominal pain radiating to the right shoulder.

Regarding treatment, first of all it should be determined if there is infection with Helicobacter pylori. This can easily be determined by either a serology test, urea breath test, stool antigen test or a biopsy. If an infection is present, it should be treated immediately and usually a regimen of 2 antibiotics with a proton pump inhibitor is used.

In young and general healthy individuals treatment with H2 blockers and proton pump inhibitors should be initiated. People older than 45 years with alarm symptoms (weight loss, melena, anemia, abdominal mass, pain on swallowing) need an immediate endoscopy with biopsy in order to rule out gastric cancer. Any person with a bleeding ulcer has to be hospitalized and receive proper treatment.

In order to protect the gastric mucosa, medications such as sucralfate and bismuth subsalicylate can be used. The most important factors that will accelerate the treatment is to stop any NSAID medication, as well as alcohol intake and tobacco smoking.