Peptic Ulcer, Also Known As PUD or Peptic Ulcer Disease

Peptic ulcer, also known as PUD or peptic ulcer disease, Is the most common ulcer of an area of the gastrointestinal
tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm. As many as 7090% of such ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach. Causes 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 non-steroidal anti-inflammatory drugs (NSAID s), 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 Complications Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be lifethreatening. It occurs when the ulcer erodes one of the blood vessels, such as the gastroduodenal artery. Perforation (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity. Perforation at the anterior surface of the stomach leads to acute peritonitis, initially chemical and later bacterial peritonitis. The first sign is often sudden intense abdominal pain. Posterior wall perforation leads to bleeding due to involvement of gastroduodenal artery that lies posterior to the 1st part of duodenum. Penetration is when the ulcer continues into adjacent organs such as the liver and pancreas. Scarring and swelling due to ulcers causes narrowing in the duodenum and gastric outlet obstruction. Patient often presents with severe vomiting. Cancer is included in the differential diagnosis (elucidated by biopsy), Helicobacter pylori as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer. Diagnostic test To diagnose an ulcer, your doctor will order one of the following tests: Esophagogastroduodenoscopy (EGD or upper endoscopy) is a special test performed by a gastroenterologist. A thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. Upper GI is a series of x-rays taken after you drink a thick substance called barium. Upper endoscopy is also done on people who are at high risk for stomach cancer. Risk factors include being over age 45 or having symptoms such as: Anemia Difficulty swallowing Gastrointestinal bleeding Unexplained weight loss Testing for H. pylori is also needed. The diagnosis of Helicobacter pylori can be made by: Urea breath test (noninvasive and does not require EGD);
Direct culture from an EGD biopsy specimen; this is difficult to do, and can be expensive. Most labs are not set up to perform H. pylori cultures; Direct detection of urease activity in a biopsy specimen by rapid urease test; Measurement of antibody levels in blood (does not require EGD). It is still somewhat controversial whether a positive antibody without EGD is enough to warrant eradication therapy; Stool antigen test; Histological examination and staining of an EGD biopsy.
Your doctor may also order these tests: Hemoglobin blood test to check for anemia Stool occult blood test to test for blood in your stool Treatment Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back. Take all of your medications exactly as prescribed. If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days: Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl) Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium) Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks. You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions. Other medications that may be used for ulcer symptoms or disease are: Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis Medications that protect the tissue lining (such as sucralfate)

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Peptic ulcer, also known as PUD or peptic ulcer disease, Is the most common ulcer of an area of the gastrointestinal

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