Peptic Ulcers

Introduction
Peptic ulcer disease is a formation of painful open sores or ulcers in the inside
lining of the esophageus (esophageal ulcers), stomach (gastric ulcers) or first
part of the small intestine called duodenum (duodenal ulcers). Most of the
peptic ulcers are caused by infection with a type of bacteria called Helicobacter
Pylori (H Pylori).

Signs & Symptoms

Burning pain in the middle or upper part of stomach

Bloating and abdominal fullness
Heartburn
Nausea and vomiting
Dark or black colored stool
Unexplained weight loss
Loss of appetite
Vomiting of blood

Causes
Peptic ulcers occur due to the erosion of inner surface of esophagus, stomach
or duodenum. A bacterial infection of Helicobacter Pylori (H Pylori) which
usually lives in the mucus layer of digestive tract may cause inflammation of
inner layer producing ulcers. Long term use of certain anti inflammatory drugs
such as Aspirin, Ibuprofen etc can leads to ulcer formation.

Risk Factors

Infection of H Pylori bacterium

Long term intake of NSAIDs such as Aspirin, Ibuprofen etc
Family history of peptic ulcers
Smoking
Alcohol consumptions
Age 50 years or older

Complications
A hole in the digestive tract: Perforation caused by the erosion of wall of
the gastrointestinal tract, is a serious complication which may leads to acute
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peritonitis. This hole in digestive tract may leads to spillage of gastric or

intestinal content in to abdominal cavity.
Obstruction of Gastric outlet: Due to the scarring and swelling around
pyloric canal the gastric outlet becomes narrow and obstructed. Patient will
experience severe vomiting.
Stomach cancer: peptic ulcers if left untreated may leads to stomach cancer.
Gastrointestinal bleeding: bleeding from the ulcers is the most common
complication. If large amount of blood loss occurs it can be a life threatening
situation.

Diagnosis
X ray of upper digestive tract: In this procedure you have to swallow a
contrast liquid and the x-ray technician visualizes the upper digestive tract
making an ulcer more visible.
Endoscopy: In this procedure doctor passes a hollow tube equipped with a
lens through your mouth into your esophagus, stomach and small intestine.
This procedure helps in detecting ulcers and small tissue samples can also be
removed for further examination in lab.
Tests to identify Helicobacter Pylori (H Pylori):

Urea breath test

Culture taken from endoscopic biopsy
Measurement of antibody levels in blood
Stool antigen test
Histological examinations

Treatment
Lifestyle modifications: Changes or elimination of substances causing ulcer
can help prevent peptic ulcers such as smoking, drinking alcohol, stress etc.
Antibiotics: Antibiotics are used to treat H Pylori infection. A combination of
antibiotics can be used to kill the bacteria.
Acid blockers: Proton pump inhibitors are the drugs that blocks the
production of acid in stomach thereby prevents ulcer formation. These drugs
include Pantoprazole, Omeprazole, Lansoprazole, Rabeprazole etc.
Drugs to reduce acid production: Histamine (H-2) blockers reduce the
amount of stomach acid released into your digestive tract thereby reducing
ulcer pain and promoting healing. H-2 blockers include Ranitidine, Famotidine,
Cimetidine etc.
Antacids to neutralize stomach acid: These drugs neutralize the existing
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stomach acid content and can provide instant relief from ulcer pain. It includes
sucralfate, misoprostol, bismuth subsalicylate etc.

Dr. Sanjiv Haribhakti

Gisurgery.info