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Peptic Ulcer Disease

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Definition

Peptic Ulcer Disease (PUD) is a general term for ulcers that occur in the stomach or duodenum (Upper part of the small intestines).

An ulcer in the stomach is known as gastric ulcer while that in the first part of the intestines (the duodenum) is known as a duodenal ulcer. PUD is a sore (an open sore) that develops in the lining of the stomach and in the upper portion of the small intestine. The most common symptoms of PUD is stomach pain.

Causes of PUD

  • Helicobacter pylori (H. pylori)
  • Long term use of aspirin or other painkillers such ibuprofen or Non-Steroidal Anti-inflammatory Drugs (NSAIDs)
  • Lifestyle factors such as smoking, alcohol consumption, physiological stress
  • Genetic factors

Patients who do not secrete ABO antigens in their saliva and gastric juices are known to be at higher risk. H. pylori causes an increase in pepsin secretion

Risk Factors

  • Smoking
  • Alcohol consumption
  • Eating spicy foods and
  • Increase in intake of caffeine

Diagnosis

  • Medical History/Family History
  • Physical examination of the individual
  • Breath test: this is used to detect H. pylori. The individual/patients are asked to drink or eat something containing radioactive carbon. H. pylori breaks down the radioactive carbon in the stomach. After an hour, the individual is asked to blow into a bag which is then sealed. If the person is infected with H. pylori the breath sample will contain radioactive carbon dioxide or radioactive carbon in form of carbon dioxide.

If an antacid is being taken prior to the test, depending on the test being done, the individual may be asked to discontinue the medication for a period of time because antacids may lead to false negative results.

  • Endoscopy
  • Biopsy
  • Barium contrasts x-ray
  • Esophagogastroduodenoscopy, a form of endoscopy also called gastroscopy

Complications

  • Gastrointestinal bleeding

Slow blood loss may lead to anaemia, severe blood loss may require blood transfusion, it may also cause black or bloody vomit or black or bloody stools.

  • Infection/Perforation of the wall of the gastrointestinal tract and this may lead to peritonitis (Infection of the abdominal cavity)
  • Gastric outlet obstruction

Signs and Symptoms

  • Abdominal pain
  • Bloating or belching and feeling of fullness
  • Intolerance of fatty food
  • Nausea and vomiting (vomiting of blood/hematemesis)
  • Loss of weight
  • Anorexia (Loss of appetite)
  • Melena (foul smelling faeces due to the presence of oxidised iron from haemoglobin)
  • Heart burn

Prevention

  • Protect yourself from infection by frequent washing of hands with soap and water and by eating properly cooked food.
  • Used pain relievers as prescribed
  • Avoid drinking alcohol when taking medication (pain medication)
  • Eat healthy food, take enough sleep, reduce stress

Treatment

  • Antibiotics to kill H. pylori such as amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), Tinidazole (Tindamax), tetracycline, levofloxacin (Levaquin).
  • Proton Pump Inhibitor (PPI) can be given because it blocks acid production and promote healing e.g. Omeprazole (Prilosec), Pantoprazole (Protonix), Labeprazole (Aciphex), Lansoprazole (Prevacid), Esomeprazole (Nexium).
  • Acid blockers/H-2 blockers to reduce acid production. It is available by prescription or OTC (Over-The-Counter) e.g. Ranitidine (Zantac), Famotodine (Pepcid), Cimetidine (Tagamet HB) and Nizatidine (Axid AR)
  • Antacids to neutralise the acidity of the stomach

Other Preventive Measures

  • Do not smoke
  • Consider food containing probiotics such as yogurt, aged cheeses, Miso
  • Reduce Milk intake.

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