PEPTIC ULCER

PEPTIC ULCER

A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum.

A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.

Normally, the lining of the stomach and small intestines is protected against the irritating acids produced in your stomach. If this protective lining stops working correctly and the lining breaks down, it results in inflammation (gastritis) or an ulcer.

Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation. A perforation is a medical emergency.

The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori(H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following also raise your risk for peptic ulcers:

-Drinking too much alcohol

-Regular use of aspirin, ibuprofen, naproxen, or other nonsteroidal anti-inflammatory drugs (NSAIDs). 

-Smoking cigarettes or chewing tobacco

-Being very ill, such as being on a breathing machine

-Having radiation treatments

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas. This tumor releases high levels of a hormone that increases stomach acid.

Many people believe that stress causes ulcers. It is not clear if this is true, at least for everyday stress at home.

Symptoms

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain is a common symptom, but it doesn't always occur. The pain can differ from person to person.

Other symptoms include:

-Feeling of fullness -- unable to drink as much fluid

-Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal

-Mild nausea (vomiting may relieve this symptom)

-Pain or discomfort in the upper abdomen

-Upper abdominal pain that wakes you up at night

Other possible symptoms include: bloody or dark tarry stools, chest pain, fatigue, vomiting, possibly bloody and weight loss.

Treatment

Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.

Antisecretory drugs and mucosal protectants

1. H2 receptor antagonists: Histamine H-receptor antagonists heal gastric and duodenal ulcers by reducing gastric acid, they are also used to relieve symptoms of gastro-oesophageal reflux disease.

-Cimetidine (Cimetidine, Tagamet)

-Famotidine (Famotidine, Pepcid)

-Nizatidine (Nizatidine, Axid)

-Ranitidine (Ranitidine, Zantac)

2. Chelates and complexes:

-Tripotassium Dicitratobismuthate (De-Noltab)

-Sucralfate (Antepsin)

3. Prostaglandin analogues:

-Misoprostol (Citotec)

4. Proton pump inhibitors:

-Esomeprazole (Nexium)

-Lansoprazole (Zoton)

-Omeprazole (Losec)

-Pantoprazole (Protium)

-Rabeprazole sodium (Pariet)

Sources:

-http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm

-BNF 57 March 2009