Peptic Ulcer Information

1. What is peptic ulcer disease?

Peptic ulcer disease (PUD) is a chronic, recurrent disorder that is characterized by lesions in the upper gastrointestinal tract which appears as reddish and inflamed, or as small depressions or excavations in the upper gastro-intestinal tract. The most common sites of this disease are the duodenum (duodenal ulcer) and the stomach (gastric ulcer). Duodenal ulcer typically affects persons 25-55 years of age while the peak incidence of gastric ulcer occurs around 55-65 years of age.

2. What are the common complaints of patients with peptic ulcer?

The usual complaints are:

• Epigastric pain or pain in the upper abdomen may be a burning, annoying, or dull in the ache (like hunger pain) that is usually relieved within 5-10 minutes after eating or taking antacids. 50% to 80% of patients reported that they are awakened by pain at night.
• Nausea, vomiting and a sense of fullness, are fairly common with gastric ulcers but less with duodenal ulcers.
  

3. How does ulcer develop?

1. Although acid (from carbonated drinks, juices, alcoholic drinks, etc) may be a major factor for ulcers to develop, other causes are now identified like the presence of Helicobacter pylori and chronic intake of antiarthritic drugs – non-steroidal anti-inflammatory drugs (NSAIDs).
2. Helicobacter pylori (H, pylori) is a bacteria that colonizes the epithelial cells, lining the surface of the stomach and duodenum where it causes inflammation and ulceration. More than 90% of patients with duodenal ulcers and about 75% with gastric ulcers harbor the organism, which are responsible for frequent relapses of ulcers. Up to 805 of patients with ulcers relapse within 1 year after the initial healing with conventional control of acid secretion (antacids and acid inhibitors). More recent drug regimens include eradication of H, pylori, which has resulted to dramatic reduction of ulcer recurrences.
3. Other factors include:

• Smoking
  

• doubles the incidence of peptic ulcer disease
• increases ulcer recurrence
• reduces ulcer healing with anti-ulcer drugs

• Genetic influence – first degree relatives of patients with peptic ulcer have 2-3 fold risk of developing the disease
• Stress – a potent factor in the development of peptic ulcer

4. How do you treat peptic ulcer?

The goals of therapy are to:

• Promote ulcer healing
• Relieve pain
• Prevent complications like bleeding
• Prevent recurrences
  

Treatment of peptic ulcer includes the use of:

1. Antacids – Aluminum and Magnesium hydroxide
2. Antisecretory Agents

H2-receptor Antagonists – inhibit acid secretion by blocking the H2-receptors in the parietal cells (acid-secreting cells in the stomach).

• Cimetidine
• Ranitidine
• Famotidine
  

Proton-Pump Inhibitors – the most potent antisecreting agents which almost completely inhibit acid secretion of parietal cells (acid-secreting cells in the stomach).

• Omeprazole
• Lansoprazole
• Pantoprazole
  

----3. Other Agents

• Sucralfate
• Bismuth subcitrate
• Misoprostol
  

If you have history of ulcer symptoms, consult your doctor. Do not self-medicate, especially if…

1. You are more than 40 years of age
2. You have severe, intractable pain
3. You have blood in stools
4. You vomit ground coffee-like substance, and
5. You have significant weight loss.