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Peptic Ulcer Disease – Symptoms, Treatment, Diet, Causes

What is Peptic Ulcer Disease?

Peptic Ulcer Disease (PUD)  is a medical condition which involves ulceration of in the lining of the stomach, duodenum, or esophagus due to an erosion of the mucous membrane. Depending on its location, it is more frequently referred to as a duodenal, gastric, or esophageal ulcer. Ulcerations are more likely to be found in the duodenum rather than in the stomach.


Peptic Ulcer Image

PUD – presence of ulcer in the esophagus, stomach, and duodenal region

What are the Signs and Symptoms?

  • Pain is characterized as a dull, gnawing, or a burning sensation in the mid epigastrium or in the back. A burning sensation may also be felt in the esophagus and stomach, and eventually in the mouth with occasional sour eructation (burping).

peptic ulcer disease

  • Pyrosis (heartburn)
  • Nausea and vomiting
  • Bleeding and black tarry stools

Black Tarry Stool Image

Black tarry stool  as a symptom of PUD

  • Bloating (Gentle pressure on the epigastrium presents a sharply localized tenderness.)
  • Diarrhea or constipation due to diet and medications

What Causes PUD?

Helicobacter pylori has been associated with PUD and accounts for 95 percent of patients with duodenal ulcers and 70 percent of patients with gastric ulcers; however, it has not been associated with esophageal ulcers.

Predisposing factors include the following:

  • Family history of peptic ulcer
  • Blood type O
  • Long-term use of non-steroidal anti–inflammatory drugs (NSAIDs)
  • Excessive smoking and alcohol intake
  • High levels of stress

An esophageal ulcer results from the backward flow of hydrochloric acid from the stomach into the esophagus.

Physiologically stressful events such as burns, shock, severe sepsis, and multiple organ traumas can result in acute mucosal ulceration of the duodenal or gastric area. These are termed as stress ulcers.

How is PUD Diagnosed?

Initially, a physical examination is done to check for abdominal tenderness and distention. Physicians recommend endoscopy, a procedure that uses a special type of device that is inserted through the mouth and pushed through the stomach to visualize the internal abdominal structures. The upper gastrointestinal barium, a procedure which involves X-rays that are taken after the patient has drank a radio fluorescent liquid, allows visualization of the abdominal structures.

Other diagnostic tests may also include the following:

  • Analysis of gastric secretions for pH and blood
  • Stool specimens for occult blood
  • Biopsy and histology with culture for detection of H. pylori

Management of PUD

Management is targeted at lifestyle modification and compliance with prescribed medications in order to eradicate H. pylori and control gastric acidity. Surgery can be performed in cases when initial efforts have not been successful and the disease has already progressed.

Lifestyle changes (DIET)

  • Identification of stressful and exhausting activities and then implementation of necessary changes in order to promote adequate rest and to reduce stress.
  • Smoking cessation.
  • Dietary modifications would include minimal intake of alcoholic and caffeinated beverages, restriction on milk and cream, and compliance to a regime of eating three regular meals a day.

Pharmacological therapy

  • Histamine antagonists like cimetidine (Tagamet) and ranitidine (Zantac) – These are taken with meals and at bedtime to inhibit gastric secretions. These cannot be taken within one hour of antacid therapy.
  • Antacids like magnesium oxide (Maalox) and aluminum hydroxide (Amphogel) – These are taken one to three hours after meals and at bedtime to neutralize gastric acids.
  • Sucralfate (Caralfate) – These drugs provide a local protective coating in the stomach, mimicking mucous secretions. These are taken one hour before meals and at bedtime. These must not be taken within 30 minutes of antacid therapy.

Surgical management

  • Vagotomy – interruption of the vagus nerve to decrease gastric secretion

vagotomy

Vagotomy to decrease gastric acid secretion

  • Bilroth I

Billroth I - gastroduodenostomy

Billroth I – gastroduodenostomy

  • Bilroth II

Billroth II Image

Billroth II – gastrojejunostomy

Image source: cdn.gastrotraining.com

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