PEPTIC ULCER
Peptic ulcers are open sores that develop in the inside lining of the esophagus, stomach and upper portion of small intestine (duodenum) as a result of erosion from stomach acids. A peptic ulcer of the stomach is called a gastric ulcer of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. Peptic ulcers occur when the lining of these organs is corroded by the acidic digestive (peptic) juices which are secreted by the cells of the stomach. A peptic ulcer differs from erosion because it extends deeper into the lining of the esophagus, stomach, or duodenum and excites more of an inflammatory reaction from the tissues that are eroded. It is an ulcer of gastrointestinal tract at an area exposed to the acid pepsin mixture (APM). The mucosa of gastrointestinal tract (GIT) in this area is digested by pepsin (peptic digestion). It is most often caused by Helicobacter pylori infection.
Vast majority of peptic ulcer occurs in
1. Stomach (Gastric ulcer).
2. First part of duodenum (Duodenal
3. Lower end of esophagus (as a result of reflux from the stomach into the oesophagus ulcer).
Pathophysiology
The normal stomach maintains a balance between the protective factors (i.e.: mucus and bicarbonate secretion, blood flow) and aggressive factors (i.e. acid secretion, pepsin). Gastric ulcers develop when aggressive factors overcome the protective mechanism.
NSAID-induced ulcers account for approximately 26% of gastric ulcers, and they are believed to be secondary to a decrease in prostaglandin production resulting from the inhibition of cyclo- oxygenase. The topical effects of NSAIDs are superficial gastric erosions and petechial lesions. However, the risk of gastroduodenal ulcer is not diminished with parental or rectal use of NSAIDs indicating injury occurring from the systemic effect of NSAIDs on the gastrointestinal mucosa. The greatest risk of developing an ulcer occurs during the first three months of NSAID use; thereafter, the risk decreases but continues to be present. Whether concurrent H pylori infection and NSAID use are synergistic in producing gastric ulcers, it remains unclear.
There are two different types of peptic ulcer.
тАв Gastric ulcer, which form in the lining of the stomach.
тАв Duodenal ulcer, which form in the upper small intestine.
Both types of peptic ulcers are most commonly caused either by infection with Helicobactor pylori bacteria or by frequent use of nonsteroidal anti-inflammatory drugs.
Clinical Manifestations
Mild inflammation due to small ulcers may not cause any major symptoms and may heal on their own like mouth ulcers do. However, some ulcers can cause serious symptoms.
Stomach pain is the most common symptom. The type of pain can vary from mild to severe and may occur typically at night. It may become severe as the stomach empties and in some cases may be relieved after having food. In some cases, pain may disappear for a few days and then reappear.
Other less common signs include:
тАв Bloating,
тАв Heartburn,
тАв Nausea or vomiting.
In severe cases, symptoms can include:
тАв Dark or black stool (due to bleeding),
тАв Vomiting blood,
Treatment
The type of treatment is usually determined by what caused the peptic ulcer. Treatment is focused on either lowering stomach acid levels so that the ulcer can heal, or eradicating the Helicobactor pylori infection.
Treatments can include:
Antibiotic medications to kill H. pylori: Antibiotic combination drug therapy regimen commonly used to treat if H. pylorus is found in digestive tract. It likely needs to take antibiotics for two weeks, as well as additional medications to reduce stomach acid.
Medications that block acid production and promote healing: Proton pump inhibitors reduce stomach acid by blocking the action of the parts of cells that produce acid and include: Omeprazole, Lansoprazole, Rabeprazole, Esomeprazole, and pantoprazole.
Antacids that neutralize stomach acid:Antacids neutralize existing stomach acid and can provide rapid pain relief include: Aluminum hydroxide, Magnesium hydroxide, Calcium carbonate and Sodium bicarbonate.
Surgery: In very rare cases, a complicated stomach ulcer will require surgery, especially people who do not respond to medication, or who develop complications.
Vagotomy: It involves cutting the vagus nerve to interrupt messages sent from the brain to the stomach to reduce acid secretion.
Antrectomy: It involves the removing of lower part of the stomach (antrum), which produces a hormone that stimulates the stomach to secrete digestive juices. A Vagotomy is usually done in conjunction with an antrectomy
Pyloroplasty: Pyloroplasty is an elective surgical procedure in which the lower portion of stomach, the pylorus, cut and resutured, to relax the muscle and widen the opening into small intestine, enabling contents to pass more freely from the stomach. It may be performed along with a Vagotomy.
Prevention
Peptic ulcers can be prevented by avoiding things that break down the stomachтАЩs protective barrier and increase stomach acid secretion. These include alcohol, smoking, aspirin, non-steroidal anti- inflammatory drugs and caffeine.
Preventing infection withH. pyloriis a matter of avoiding contaminated food and water and adhering to strict standards of personal hygiene. Wash hands carefully with warm water and soap every time the bathroom is used, diaper changed, and before and after preparing food.
Certain lifestyle changes can reduce risk of developing peptic ulcers by properly managing emotional and physical stress.
