Peptic Ulcer Disease

When ulcers or sores develop in stomach or duodenum (beginning of intestine), is called peptic ulcer disease (PUD). One out of eight persons in the United States develops this condition. The stomach produces a very strong acid. This acid helps digest and break down food before it enters the small intestine. The lining of the stomach is covered by a thick protective mucous layer which prevents the acid from injuring the wall of the stomach. When this mucous barrier is overcome by the acid or bacteria such as H. pylori or medications such as aspirin or similar non steroidal anti-inflammatory drugs (NSAIDS), ulcers develop in stomach or duodenum. Ulcers also develop in tumors such as gastrinomas when patients develop large amounts of acid.

Symptoms

Ulcers cause gnawing, burning pain in the upper abdomen. These peptic ulcer disease symptoms frequently occur several hours following a meal, after the food leaves the stomach but while acid production is still high. The burning sensation can occur during the night and be so extreme as to wake the patient. Instead of pain, some patients experience intense hunger or bloating. Antacids and milk usually give temporary relief. Other patients have no pain but have black stools or vomit blood, indicating that the ulcer is bleeding. Bleeding is a very serious complication of ulcers.

A diagnosis of peptic ulcers can be suspected from the patient’s medical history. However, the diagnosis should always be confirmed either by an upper intestinal endoscopy, which allows direct examination of the ulcer or by a barium x-ray which is not very accurate. During endoscopy diagnosis of H. pylori should be made so that, ulcer can be treated effectively. Rarely an ulcer can be malignant. With endoscopy, a biopsy specimen can be obtained to determine if this is so.

Treatment

Peptic ulcer disease treatment has undergone profound changes since eighties. There are now available very effective medications to suppress and almost eliminate the outpouring of stomach acid. These acid-suppressing drugs have been dramatically effective in relieving symptoms and allowing ulcers to heal. If an ulcer has been caused by aspirin or an arthritis drug, not only these acid suppressing medications help to heal them, but also prevent them.

The second major change in PUD treatment has been the discovery of the H. pylori infection. When this infection is treated with antibiotics, the infection and the ulcer do not come back. Increasingly, physicians are not just suppressing the ulcer with acid-reducing drugs, but they are also curing the underlying ulcer problem by getting rid of the bacterial infection. If this infection is not treated, the ulcers invariably recur.

Caffeine and Alcohol stimulate the secretion of stomach acid and should be avoided in the acute phase of an ulcer while cigarettes delay the healing of an ulcer. Stress can aggravate the ulcers and may even cause them. Peptic ulcer disease surgery is used to be a major form of ulcer treatment. Now, it is the exceptional patient who needs surgical treatment of peptic ulcer disease such as perforation, obstruction, or uncontrolled hemorrhaging.

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