Peptic Ulcer Disease – Causes, Symptoms, Diagnosis and Treatment

What is PUD?

PUD or Peptic Ulcer Disease is a medical condition in which the stomach, duodenum or esophagus presents with an ulceration due to an erosion of an area of a 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.

What Causes it?

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

Predisposing factors include:

1. Family history of peptic ulcer.
2. Blood type O.
3. Long – term use of non – steroidal anti – inflammatory drugs (NSAIDs).
4. Excessive smoking and alcohol intake.
5. 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 to acute mucosal ulceration of the duodenal or gastric area. These are termed as stress ulcers.

What are the Signs & Symptoms?

1. Pain characterized as dull, gnawing or a burning sensation at the mid – epigastrium or in the back. A burning sensation may also be felt at the esophagus and stomach which eventually moves up in the mouth occasionally with sour eructation (burping).
2. Pyrosis (heartburn).
3. Nausea and vomiting.
4. Bleeding and black tarry stools.
5. Patients may also feel bloated. Gentle pressure at the epigastrium presents a sharply localized tenderness.
6. Diet and medications may result to diarrhea or constipation.

How is PUD Diagnosed?

Physical examination is done to check for epigastric tenderness and abdominal distention. Endoscopy is preferred, but upper gastrointestinal barium may also be performed in lieu of. Diagnostic tests include analysis of stool specimens for occult blood, gastric secretions and biopsy and histology with culture to detect for H. Pylori.

How is PUD Treated?

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

1. Lifestyle Changes

1. Identify stressful and exhausting activities then implement necessary changes in order to promote adequate rest and reduce stress.
2. Encourage smoking cessation.
3. Dietary modifications would include minimal intake of alcoholic and caffeinated beverages, restriction from milk and cream and compliance to eat three regular meals daily.

2. Pharmacological Therapy

1. Histamine antagonists – Cimetidine (Tagamet), Ranitidine (Zantac)
2. These are given with meals and at bedtime to inhibit gastric secretions. These cannot be given within one hour of antacid therapy.
3. Antacids – Magnesium Oxide (Maalox), Aluminum Hydroxide (Amphogel)
4. These are given one to three hours after meals and at bedtime to neutralize gastric acids.
5. Sucralfate (Caralfate)
6. These drugs provide a local protective coat lining in the stomach, mimicking the mucous secretions. These are given one hour before meals and at bedtime. These must not be given within 30 minutes of antacid therapy.

3. Surgical Management

1. Vagotomy – interruption of Vagus nerve to decrease gastric secretion.
2. Bilroth I
3. Bilroth II