Peptic ulcer

A peptic ulcer (stomach or

duodenal) is a sore in the
inner lining of the
esophagus, stomach, or
duodenum.

An ulcer of the stomach Gastric ulcer;

An ulcer of the duodenum Duodenal ulcer;
An ulcer of the esophagus Esophageal ulcer.
Peptic ulcers occur when the lining these organs is eroded by the acidic
digestive (peptic) juices that the cells of the stomach lining secretes.
Peptic ulcer disease is common, affecting millions of Americans yearly.
Moreover, peptic ulcers are a recurrent problem; even healed ulcers
can recur unless treatment is directed at preventing their recurrence.
Are Ulcers painful?
The pain of ulcer disease correlates poorly with the presence or severity of active
ulceration. Some individuals have persistent pain even after an ulcer is almost completely
healed by medication. Others experience no pain at all. Ulcers often come and go
spontaneously without the individual ever knowing that they are present unless a serious
complication (like bleeding or perforation) occurs.
What Causes Ulcers?

 Helicobacter pylori (H. Pylori), a type of bacteria that

can cause a stomach infection and inflammation
 Frequent use of aspirin, ibuprofen and other anti-inflammatory
drugs (risk associated with this behavior increases in women and
people over the age of 60)
 Smoking
 Drinking too much alcohol
 Radiation therapy
 Stomach cancer
What are the Signs and Symptoms?
The most common symptom of a peptic ulcer is burning abdominal pain
that extends from the navel to the chest, which can range from mild to
severe. Peptic ulcers may not produce any symptoms in the early
phases. Other common signs of a peptic ulcer include:
 Changes in appetite
 Nausea
 Bloody or dark stools
 Unexplained weight loss
 Indigestion
 Vomiting
 Chest pain
How is it Diagnosed?
Two types of tests are available to diagnose a peptic ulcer.
 Upper endoscopy- Not all cases require an upper endoscopy. However, this
procedure is recommended for people with a higher risk of stomach cancer.
This includes people over the age of 45, as well as people who experience:
o Anemia
o Weight loss
o Gastrointestinal bleeding
o Difficulty swallowing

 Upper gastrointestinal GI series- This is a type of X-ray. The patient is given

a chalky liquid to drink that increases the contrast on the X-ray, making
certain features easier to see. Because this liquid contains barium, this test is
sometimes called a barium swallow.
 H. pylori Test-Because H. pylori is a cause of peptic ulcers, a test should be
carried out to check for this infection in stomach. Three types of tests are
available to detect H pylori.
o Blood tests: These tests detect the bacteria by measuring antibodies to
the bacteria. Antibodies are proteins produced by the immune system
to defend against an "invader" such as H pylori.

o Breath test: This test detects H pylori by measuring carbon dioxide in

the breath of a person who has drunk a special liquid. H pylori
bacteria break down the liquid, increasing the amount of carbon in the
blood. The body gets rid of this carbon by breathing it out as carbon
dioxide. This test is more accurate than the blood test.

o Tissue tests: These tests are used only if an endoscopic biopsy has
been done, because a sample of tissue from the stomach is needed to
detect the bacteria.
What are the Complications of Peptic Ulcer?
Untreated ulcers can become worse over time. They can lead to other
more serious health complications such as:

Perforation Internal Bleeding Scar Tissue

A hole develops in the Bleeding ulcers can This is thick tissue

lining of the stomach result in significant that develops after an
or small intestine and blood loss and thus injury. This tissue
causes an infection. A require makes it difficult for
sign of a perforated hospitalization. Signs food to pass through
ulcer is sudden, of a bleeding ulcer your digestive tract.
severe abdominal include Signs of scar tissue
pain lightheadedness, include vomiting and
dizziness, and black weight loss.
stools.

All three complications are serious and may

require surgery.
Complications of esophageal, duodenal or
stomach ulcers include bleeding, perforation
and blockage to the passage of food due to
gastric obstruction from the swelling or scaring
that surrounds the ulcer

Special Dietary Concerns

Since coffee stimulates gastric acid secretion, and alcohol can cause
gastritis, moderation in alcohol and coffee consumption is recommended
 What is the treatment of Peptic Ulcer?

Proton Pump
Inhibitors Medications that block acid production and promote healing
• Proton pump inhibitors — also called PPIs — reduce stomach acid by
blocking the action of the parts of cells that produce acid. These drugs
include the prescription and over-the-counter medications omeprazole,
lansoprazole, rabeprazole, esomeprazole and pantoprazole.

Histamine
blockers Medications to reduce acid production
• Acid blockers — also called histamine (H-2) blockers — reduce the
amount of stomach acid released into your digestive tract, which relieves
ulcer pain and encourages healing. These include the medications
ranitidine, famotidine, cimetidine and nizatidine.

Antibiotics Medications to kill H. pylori

• NICE recommends a one-week triple therapy regimen as first-line
eradication therapy. The optimum regimen, consists of a full dose proton
pump inhibitor, with amoxicillin 1g and either clarithromycin 500mg, or
(in the case of penicillin hypersensitivity) metronidazole 400mg and
clarithromycin 250mg, all given twice daily.
Cytoprotective Medications that protect the lining of your stomach
agents and small intestine
• They helps protect the tissues that line your stomach and small intestine.
Options include the prescription medications sucralfate and misoprostol
References:
https://www.healthline.com/health/peptic-ulcer#causes
https://www.medicinenet.com/peptic_ulcer/article.htm#what_causes_peptic_ulcers
https://www.emedicinehealth.com/peptic_ulcers/article_em.htm#what_tests_diagnose_a_peptic_ulcer
https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229