updated PEPTIC ULCER DISEASE: CAUSES, SYMPTOMS AND SIGNS

PEPTIC ULCER DISEASE

Imagine a small sore forming on the inner lining of your stomach or the first part of your small intestine. This sore is called a peptic ulcer, and it happens when the protective layers of your digestive tract are damaged, allowing stomach acid to eat into the lining. Peptic Ulcer Disease (PUD) is a common condition that affects millions of people worldwide. The two main places ulcers develop are:

1. The stomach – called gastric ulcers.
2. The first part of the small intestine (duodenum) – called duodenal ulcers.

Peptic Ulcers are referred as breaks / erosion in the mucosal surface (about 5 mm in size) with depth to the submucosal of Stomach and Duodenum.

The most important causes of Peptic Ulcers is Infection with Helicobacter Pylori, long term use of group of medications such as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Lifestyle factors like smoking, excessive alcohol, or stress (though stress alone rarely causes ulcers).

• Helicobacter Pylori (H. Pylori).

H. Pylori is the bacterium (Gram Negative micro-aerophilic rod) found in most common in the deeper portion of the mucosa gel coating Stomach mucosa or between the mucosa layer and the gastric epithelium. People who are infected with H. pylori are at higher risk of developing Peptic Ulcers. It confirmed in laboratory by number of tests depend on the situation. Treatment of Helicobacter Pylori consisting of taking three to four drugs. 

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs).

NSAIDS represent a group of the most commonly used medications worldwide for the management of Pain and Inflammatory conditions. There are many drugs such as Aspirin, Ibuprofen, Naproxen, Ketoralac and Oxaprozin. Also NSAIDs includes combination of some medications such as BC Powder, Goody’s Powder and Alka-seltzer. 
NSAIDs cause Peptic Ulcer by  interrupt the natural ability of the stomach and duodenum to protect themselves from Stomach Secretions products such as Gastric Acid and Pepsin, can also Interfere with blood clot which is obvious important when Ulcers bleed.

Individuals who take NSAIDs for a long time or at higher doses are at risk of developing Peptic Ulcer. These individuals should discuss various options for preventing ulcer with their Doctors. Acetaminophen is not an NSAIDs drug and is therefore the preferred non prescription treatment for the pain in patient at risk of Peptic Ulcer Disease.

PREDISPOSING FACTORS FOR PEPTIC ULCER.

• Cigarette smoking – not only smoker have been found to have Peptic Ulcers but more frequent than nonsmokers. Also it reduce Ulcer healing rate and increase Ulcer related complications.

• Excessive Alcohol Consumption: Drinking too much alcohol irritates and inflames the stomach lining. It increases acid production and reduces protective mucus, making the lining more susceptible to ulcers. Even moderate drinking can worsen an existing ulcer or delay healing.

• Psychological stress – has been thought to play role in Peptic Ulcer Disease.
• Genetic Predisposition – may also play role in Ulcer development. people with Blood Group O are at genetic risk for Peptic diathesis but the role of genetic predisposition in common Peptic Ulcer has not been established yet.
• Diet – Also has been thought to play role in Peptic Ulcer Disease, certain food and drinks cause Dyspepsia ( indigestion). Alcohol And Caffeine drinks has been thought to contribute on indigestion.

SINGS AND SYMPTOMS OF PEPTIC ULCERS

Abdominal pain

The most common Symptoms of Peptic Ulcer is Abdominal pain in both Gastric and Duodenum Ulcers. The pain is often in Upper Part of Abdomen known as Epigastric Pain described as burning sensation or gnawing discomfort, The discomfort described as Ill-defined, aching sensation or as hunger pain. Patient with Peptic Ulcer Disease can present with serious medical complications such as:

• penetration - this happens when the ulcer burrows through the stomach or duodenal wall into a nearby organ (like the pancreas or liver). The patient may feel severe, deep pain that can radiate to the back, different from the usual stomach discomfort.
• Perforation - The ulcer creates a hole in the stomach or duodenum wall, allowing contents to spill into the abdominal cavity. This is a medical emergency, the patient usually develops sudden, severe abdominal pain, sometimes with rigidity, shock and cause peritonitis (infections or inflammation of peritoneum).
• Bleeding - the ulcer can erode into blood vessels, causing internal bleeding. Signs include vomiting blood (hematemesis), black or tarry stools (melena), or weakness and dizziness from blood loss. Severe bleeding can be life-threatening if not treated promptly (hemorrhagic shock).
• Obstruction - Chronic ulcers can cause swelling or scarring, narrowing the stomach or duodenum. Patients may experience persistent vomiting, bloating, early fullness, and weight loss because food cannot pass easily.

Variation in intensity and distribution of Abdominal pain as well as associated symptoms such as nausea and vomiting, feeling bloating or full may be indicative of the complications;

• Dyspepsia (indigestion) that is no longer relieved by food or antacids and radiate to the back may indicate a Penetrating Ulcer.
• sudden onset of severe generalized Abdominal pain and Vomiting of undigested eaten food suggest Gastric Outlet Obstruction.
• Tally stool or coffee ground emesis (vomiting) indicated bleeding which may lead to anemia and can be life threatening.

Epigastric tenderness – pain on touch at Upper Abdomen is most frequent sign/finding in patient with Gastric Ulcer and Duodenal Ulcer when conducting abdominal examination.

Pain on palpation at upper Abdomen