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 Dr. Sanjiv Haribhakti
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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 Dr. Sanjiv Haribhakti
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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