Peptic Ulcer Disease

Peptic Ulcer Disease

Peptic ulcer disease (PUD) is damage to the lining of the stomach, the first part of the small intestine, or sometimes the lower esophagus. Gastric ulcers are called digestive ulcers and ulcers in the first part of the intestine are duodenal ulcers. Common causes are the bacterial Helicobacter pylori and non-steroidal anti-inflammatory drugs (NSAIDs). Other less common causes include smoking, stress from other serious medical conditions, Behcet’s disease, Zollinger-Ellison syndrome, Crohn’s disease, and liver cirrhosis.

Diagnosis is usually suspected based on the symptoms present and confirmed by either endoscopy or barium swallowing. Helicobacter pylori can be diagnosed by a blood antibody test, a urea breath test, a stool test for bacterial signs, or a stomach biopsy. Other diseases that cause similar symptoms include gastric cancer, coronary artery disease, and inflammation of the lining of the stomach and gallbladder.

Gastric ulcers occur in about 4% of the population. In 2015, approximately 87.4 million people worldwide were diagnosed with new ulcers. About 10% of people develop stomach ulcers at some point in their lives. Gastric ulcers resulted in 267,500 deaths in 2015, compared to 327,000 in 1990. The first description of a perforated gastric ulcer was in Princess Henrietta of England in 1670. H. pylori was first identified as the cause of gastric ulcers by Barry Marshall and Robin Warren in the late 20th century. This discovery won the Nobel Prize in 2005.

Peptic ulcer disease symptoms

The most common symptoms of duodenal ulcers are waking up at night, pain in the upper abdomen, and pain in the upper abdomen, which improves with eating.

1. Abdominal pain, classically epigastrium, strongly correlates with diet. Duodenal ulcers cause pain about 3 hours after eating a meal, awakening a person from sleep.
2.  Bloating and abdominal fullness.
3. Waterbrash, (This is more associated with gastroesophageal reflux disease, but post-episode salivation for diluting esophageal acid).
4. Nausea and copious vomiting.
5. Loss of appetite and weight loss in case of stomach ulcer.
6. If you have a duodenal ulcer, eating it will relieve the pain, and you will gain weight.
7. Hematemesis (vomiting of blood), This can be caused by direct bleeding from a gastric ulcer or damage to the esophagus due to severe/long-term vomiting.
8. Melena tarry, foul-smelling feces because of the presence of oxidized iron from hemoglobin).
9. In rare cases, ulcers may cause perforation of the stomach or duodenum, causing acute peritonitis and extreme stinging pain, requiring immediate surgery.

A history of heartburn or gastroesophageal reflux disease (GERD) and the use of certain medications can cause suspicion of digestive ulcers. Drugs related to gastric ulcers include cyclooxygenase and NSAIDs (non-steroidal anti-inflammatory drugs) that block most glucocorticoids (such as dexamethasone and prednisolone). 

Individuals over the age of 45 who have the above symptoms for more than 2 weeks are highly likely to have a gastric ulcer and should be evaluated promptly by esophagogastric duodenal endoscopy.

The timing of diet-related symptoms may differ between gastric and duodenal ulcers. Stomach Ulcer causes nausea and vomiting, as well as upper abdominal pain during meals due to increased gastric acid production when food enters the stomach. Pain from duodenal ulcers is exacerbated by starvation, relieved by diet, and associated with nocturnal pain.

Symptoms of digestive ulcers depend on the location of the ulcer and the age of the person. In addition, typical ulcers tend to heal and relapse, resulting in pain that lasts days to weeks and can then subside or disappear. Children and the elderly usually do not develop symptoms unless complications occur.

Treatment 

If the ulcer bleeds, the doctor can treat the ulcer by injecting a drug during endoscopy. Doctors may also use a clamp or cautery (burning tissue) to seal it and stop bleeding. 

For most people, physicians treat pharmaceuticals and ulcers, including: 

1. Proton Pump Inhibitor (PPI): These drugs reduce acid, which can heal ulcers. 
2. PPIs include PRILOSEC®, PREVACID®, Aciphex®, Protonix®, and NEXIUM®. 
3. Histamine receptor blocker (H2 blocker): These drugs also reduce acid production and include Tagamet®, PEPCID®, Zantac®, and AXID (registered trademark). 
4. Antibiotics: These medicines kill bacteria. Doctors use H. H. Helicobacter pylori. Protective 
5. Agents: Like liquid bandages, these agents cover the ulcer with a protective layer to prevent further damage from digestible acids and enzymes. Doctors often recommend Carafate® or Pepto Bismol.

Conclusion

Helicobacter pylori, was identified as the causative agent of ulcers in 1982 by two Australian scientists, Robin Warren and Barry J. Marshall. In their original paper, Warren and Marshall argue that most digestive ulcer diseases and gastritis were caused by colonization of this bacterium rather than the stress and spicy foods previously thought. Bottom. H. pylori’s hypothesis was not yet fully accepted, so in a self-experimental act, Marshall drank a Petri dish containing a culture of organisms taken from a person with an ulcer and developed gastritis 5 days later. His symptoms disappeared after two weeks, but bad breath is one of the symptoms of the infection, so he took antibiotics at the recommendation of his wife to kill the remaining bacteria. This experiment was published in the Australian Medical Journal in 1984 and is one of the most cited articles in the journal.