Peptic Ulcer Disease (PUD): Causes, Development, Diagnosis Treatment And Preventions

  What is Peptic Ulcer Disease?

Peptic Ulcers are sores or eroded areas that form in the lining of the digestive (gastrointestinal) tract. They usually occurs in the stomach ( gastric ulcer) or in the duodenum (duodenal ulcer) which is the upper region of the small intestine.

What causes Peptic Ulcers?

The two primary causes of peptic ulcers are infection with specific bacteria called Helicobacter pylori and use of Non Steroidal Anti-inflammatory Drugs (NSAID) medications.

1. Helicobacter pylori: Is a bacteria that is frequently found in the stomach of human being.

H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori infection, often without any symptoms. Researchers believe people can transmit H. pylori from person to person, especially during childhood.

The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissue.

However, for most people the presence of H. pylori doesn’t have a negative impact. Only 10% to 15% of people with H. pylori end up developing ulcers .

2. Non Steroidal Anti-inflammatory Drugs

Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These medications have the potential to cause peptic ulcers to form:

Aspirin (even those with a special coating).

Naproxen (Aleve, Anaprox, Naprosyn and others).

Ibuprofen (Motrin, Advil, Midol and others).

Prescription NSAIDs (Celebrex, Cambia and others).

Acetaminophen (Tylenol) is not an NSAID and won’t cause damage to your stomach. People who can’t take NSAIDs are often directed to take acetaminophen.

Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H. pylori infection is potentially the most dangerous. People who have H. pylori and who frequently use NSAIDs are more likely to have damage to the mucus layer, and their damage can be more severe.

 

Developing an ulcer from NSAID use also increases if you:

. Take high doses of NSAIDs.

. Are 70 years or older.

. Are female.

. Use corticosteroids (drugs your doctor might prescribe for asthma, arthritis or lupus) at the same time as taking NSAIDs.

. Use NSAIDS continuously for a long time.

. Have a history of ulcer disease.

What are the risk factors of Peptic Ulcer Disease?

Infrequently, other situations increase the risk of developing Peptic Ulcer Disease. These includes:

* Smoking.

* Certain genetics.

* Psychological stress.

* Dietary habit.

* Being seriously ill from various infections or diseases.

* Having surgery.

* Taking other medications, such as steroids.

* Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of acid that damages stomach tissue.

Can  spicy foods and coffee cause ulcers?

It is a common misconception that coffee and spicy foods can cause ulcers. In the past, you might have heard that people with ulcers should eat a bland diet. But now we know that if you have an ulcer, you can still enjoy whatever foods you choose as long as they don’t make your symptoms worse.

How Ulcer develop?

The duodenal and stomach lining have several mechanisms that helps prevent ulcers from developing, these includes:

1. Mucous layer: A coating of mucus protects the stomach lining from the effects of of acidic digestive juice.

2. Food: Foods and other substances in the stomach neutralize acid thereby reducing the negative effects of acids to stomach.

If the mucous layer is damaged or if acid neutralizing substances are not present in normal amounts, digestive juice can cause irritation and breakdown of the stomach or duodenal lining, allowing an ulcer to form.

What are the symptoms of Peptic Ulcer Disease?

people with peptic ulcers may have a wide variety of symptoms, have no symptoms, or merely develop potentially life threatening complications such as bleeding. Other symptoms includes:

. Epigastric pain/discomfort

. Loss of appetite

. Bloating

. Nausea and vomiting

. An early sense of fullness with eating

. Black/Dark stool

. Abdominal pain that relieved after eating food

How Peptic Ulcer Disease is diagnosed?

Your healthcare provider may be able to make the diagnosis just by talking with you about your symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H. pylori infection. To confirm the diagnosis, you’ll need one of these tests:

1. Endoscopy

If you have severe symptoms, your provider may recommend an upper endoscopy to determine if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with a tiny camera) through your throat and into your stomach to look for abnormalities.

2. Helicobacter Pylori tests

Tests for H. pylori are now widely used and your provider will tailor treatment to reduce your symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your provider can also look for it with a blood or stool test, or by taking a sample during an upper endoscopy.

3. Imaging tests

Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the imaging machines.

Does peptic ulcers develop a complications?

Most of ulcers heal while others worsen over a time. Complications of peptic ulcers can be serious or even life threatening, sometimes without warning signs. This is most common in elderly patients and those who takes NSAIDs. The most common complications of peptic ulcers are:

. Perforation: A hole develops in the lining of the stomach or small intestine and causes an infection. A sign of a perforated ulcer is sudden, severe abdominal pain.

. Internal bleeding: Bleeding ulcers can result in significant blood loss and thus require hospitalization. Signs of a bleeding ulcer include lightheadedness, dizziness, and black stools.

. Scar tissue: This is thick tissue that develops after an injury. This tissue makes it difficult for food to pass through your digestive tract. Signs of scar tissue include vomiting and weight loss.

Treatment of Peptic Ulcer Disease.

Most ulcers can healed with medications, surgery is very rarely needed except when complications have developed.

The initial step in treating the ulcer is to identify the cause. NSAID should be stopped and people who have Helicobacter pylori are treated with antibiotics and a medications that reduces acid production.

* Most of the treatment regimens include a medication called Proton Pump Inhibitor (PPI). This medication decreases acid production in the stomach which allows the tissues damaged by the infections to heal. Example of these drugs includes:

Omeprazole (Prilosec)

Rabeprazole (aciphex)

Esomeprazole (nexium)

Pantoprazole (protonix)

Lansoprazole (prevacid)

* Two antibiotics are generally recommended, this reduces the risk of treatment failure and antibiotics resistance.

How to prevent Peptic Ulcer Disease?

Certain lifestyle choices and habits can reduce your risk of developing peptic ulcers. These include:

Quit alcohol

Not mixing alcohol with medication

Washing your hands frequently to avoid infections

Limiting your use of ibuprofen, aspirin, and naproxen (Aleve)

Maintaining a healthy lifestyle by quitting smoking cigarettes and other tobacco use and eating a balanced diet rich in fruits, vegetables, and whole grains will help you prevent developing a peptic ulcer.

Sources:

Community Health unpublished lecture notes.

https://www.healthline.com/health/peptic-ulcer

https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease