7/28/2019 Peptic Ulcer 1

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What is a peptic ulcer?

A peptic ulcer is a sore in the lining of your stomach orduodenum. The duodenum is the first part

of your small intestine. A peptic ulcer in the stomach is called a gastric ulcer. One that is in the duodenum

is called a duodenal ulcer. A peptic ulcer also may develop just above your stomach in theesophagus, the

tube that connects the mouth to the stomach. But most peptic ulcers develop in the stomach or duodenum.

An ulcer occurs when the lining of these organs is corroded by the acidic digestive juices which

are secretedby the stomach cells.

H. pylori is the most common cause of peptic ulcers. Doctors think H. pylori may be spread

through unclean food or water or by mouth-to-mouth contact, such as kissing. Even though many people

have an H. pylori infection, most of them never develop an ulcer.

Use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen is the

second most common cause of peptic ulcers. But not everyone who takes NSAIDs gets a peptic ulcer.NSAIDs are medications forarthritis and other painful inflammatory conditions in the body. Prostaglandins

are substances which are important in helping the gut linings resist corrosive acid damage. NSAIDs cause

ulcers by interfering with prostaglandins in the stomach. Ulcers caused by NSAIDs are more often found in

people who are age 60 or older, are female, have taken NSAIDs for a long time, and have had an ulcer

before.

Other causes of peptic ulcers are rare. One rare cause is Zollinger-Ellison syndromea disease

that makes the body produce too much stomach acid, which harms the lining of the stomach or duodenum.

Stress or spicy food does not cause peptic ulcers, but either can make ulcer symptoms worse.Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer

complications such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also aleading cause of ulcer medication treatment failure.

Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer

formation. Similarly, there is no conclusive evidence to suggest that life stresses or personality types

contribute to ulcer disease.

Pathophysiology:

Diagnostic Evaluation:1.) Upper GI series usually outlines ulcer or area of inflammation.

2.) Endoscopy (esophagogastroduodenoscopy) visualizes duodenal mucosa and helps identify

inflammatory changes, lesions, bleeding sites, and malignancy (through biopsy and cytology).3.) Gastric secretory studies ( gastric acid secretion test, serum gastrin level test) are elevated in Zollinger-

Ellison syndrome.

4.) H. pylori antibody titer may be positive, especially in recurrent ulcers; however, there is high rate of

false positive results; C-urea breath test or biopsy testing is more definitive test for H. pylori.

Signs and Symptoms:

1.) Abdominal pain

-Occurs in the epigastric area radiating to the back; described as dull, aching, and gnawing.

-Pain may increase when the stomach is empty, at night, or approximately 1 to 3 hours after

eating. -Pain is relieved by taking antacids (common with duodenal ulcers).

2.) Nausea, anorexia, early satiety (common with gastric ulcers), belching.3.)Dizziness, syncope, hematemesis, melena with GI hemorrhage:

-Positive fecal occult blood-Decreased hemoglobin and hematocrit, indicating anemia.

-Orthostatic blood pressure and pulse changes.

4.) Peptic ulcer disease may be asymptomatic in up to 50% of persons affected

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