PEPTIC ULCER DISEASE

 

Introduction: A peptic ulcer is an excavation formed in the mucosal wall of the stomach, pylorus, duodenum, or esophagus. It is frequently referred to as a gastric, duodenal, or esophageal ulcer, depending on its location. It is caused by the erosion of a circumscribed area of mucous membrane. Peptic ulcers are more likely to be in the duodenum than in the stomach. They tend to occur singly, but there may be several present at one time. Chronic ulcers usually occur in the lesser curvature of the stomach, near the pylorus. Peptic ulcer has been associated with bacterial infection, such as Helicobacter pylori.  The greatest frequency is noted in people between the ages of 40 and 60 years. After menopause, the incidence among women is almost equal to that in men.

PREDISPOSING FACTORS: Predisposing factors include family history of peptic ulcer, blood type O, chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol ingestion, excessive smoking, and, possibly, high stress. BLOOD GROUPS

Esophageal ulcers result from the backward flow of hydrochloric acid from the stomach into the esophagus. Zollinger–Ellison syndrome (gastrinoma) is suspected when a patient has several peptic ulcers or an ulcer that is resistant to standard medical therapy. This syndrome involves extreme gastric hyperacidity that is; hypersecretion of gastric juice, duodenal ulcer, and gastrinomas (islet cell tumors). About 90% of tumors are found in the gastric triangle. About one third of gastrinomas are malignant. Diarrhea and steatorrhea (unabsorbed fat in the stool) may be evident. In this condition, the most frequent complaint is epigastric pain. Recent research indicates that over 90% of peptic ulcer disease is caused by H. pylori.  Stress ulcer is a term given to acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events, such as burns, shock, severe sepsis, and multiple organ trauma. Shock

CLINICAL MANIFESTATIONS: Symptoms of an ulcer may last days, weeks, or months and may subside only to reappear without cause. Many patients have asymptomatic ulcers. Dull, gnawing pain and a burning sensation in the midepigastrium or in the back are characteristic. Pain is relieved by eating or taking alkali; once the stomach has emptied or the alkali wears off, the pain returns. Sharply localized tenderness is elicited by gentle pressure on the epigastrium or slightly right of the midline. Other symptoms include pyrosis (heartburn) and a burning sensation in the esophagus and stomach, which moves up to the mouth, occasionally with sour eructation (burping). Vomiting is rare in uncomplicated duodenal ulcer; it may or may not be preceded by nausea and usually follows a bout of severe pain and bloating; it is relieved by ejection of the acid gastric contents. Constipation or diarrhea may result from diet and medications. Bleeding (15% of patients with gastric ulcers) and tarry stools may occur; a small portion of patients who bleed from an acute ulcer have only very mild symptoms or none at all.

Pharmacologic Therapy: Antibiotics combined with proton pump inhibitors and bismuth salts to suppress H. pylori. H₂-receptor antagonists to decrease stomach acid secretion; maintenance doses of H₂-receptor antagonists are usually recommended for 1 year. Proton pump inhibitors may also be prescribed. Cytoprotective agents to protect mucosal cells from acid or NSAIDs. Antacids in combination with cimetidine or ranitidine for treatment of stress ulcer and for prophylactic use.

Lifestyle Changes: Stress reduction and rest are priority interventions. The patient needs to identify situations that are stressful or exhausting (eg, rushed lifestyle and irregular schedules) and implement changes, such as establishing regular rest periods during the day in the acute phase of the disease. Biofeedback, hypnosis, behavior modification, massage, or acupuncture may also be useful. Smoking cessation is strongly encouraged because smoking raises duodenal acidity and significantly inhibits ulcer repair. Support groups may be helpful. Dietary modification may be helpful. Patients should eat whatever agrees with them; small, frequent meals are not necessary if antacids or histamine blockers are part of therapy. Oversecretion and hypermotility of the GI tract can be minimized by avoiding extremes of temperature and overstimulation by meat extracts. Alcohol and caffeinated beverages such as coffee (including decaffeinated coffee, which stimulates acid secretion) should be avoided. Diets rich in milk and cream should be avoided also because they are potent acid stimulators. The patient is encouraged to eat three regular meals a day.

RELATED;

1.  ANTIEMETIC AGENTS

2.  PROTON PUMP INHIBITORS

3.  MEDICAL CONDITIONS

REFERENCES