Peptic ulcer is mucosal erosion (ulceration) of the inner lining of the gastro intestinal tract, i.e. the lower end of the oesophagus, the stomach, the duodenum; the small intestine anastomosed to the stomach and is caused by the acid-pepsin digestion of the mucosa. If peptic ulcer is located in the stomach it is called gastric ulcer while in the duodenum is called duodenal ulcer. Peptic ulcer is a painful condition and is more common in persons with habit of hurry, worry and curry. In about 70 to 90% cases of peptic ulcer, Helicobacter pylori, a spiral shaped bacteria is isolated which lives in acidic pH of stomach.
Risk factors of Peptic ulcer:
A person at risk for peptic ulcer is as follows:
• Hurry, worry and curry is prediposing factor of ulcer. A person always in hurry in his routine habits like eating food and drink, always in worry i.e. in stress and eating too much curry (spicy food), is always at risk for peptic ulcer.
• Avoid too hot and too cold items like tea, coffee, cold drink, ice cream etc.
• Stop smoking cigarettes
• Avoid drinking alcohol
• Regular user of ulcerogenic drugs like Aspirin, Ibuprofen, and Non steroidal anti inflammatory drugs (NSAID)
• Habit of chewing tobacco
• Blood group 'O' has striking association of peptic ulcer
• A strong family history is often found in patients who develop ulcers in childhood, or soon after puberty.
Pathology of Peptic Ulcer:
Ulcers occurring in the stomach and duodenum may be acute or chronic. Acute ulcers are usually multiple and occur at irregular sites while chronic once occur near the lesser curvature of stomach above the angulus or less commonly, near the pylorus. Both types of peptic ulcer are found less frequently near the cardia and rarely on the greater curvature or on the anterior wall of stomach. Peptic ulcer usually occurs in the first part of the duodenum.
Clinical manifestations of Peptic ulcer:
Peptic ulcer may occur in various ways and most common way is as follows:
• History of chronic dyspepsia over month or years.
• Ulcer may be noticed as an acute episode with bleeding or perforation with or without previous history.
• Rarely the patient may present with pyloric obstruction.
• Dyspepsia is intermittent in early stage (with intervals of relief) which later lessen and discomfort becomes continuous (persistent). Dyspepsia may be accompanied by heart burn and followed by regurgitation of stomach content into the pharynx.
• Vomiting in peptic ulcer always relieves pain.
• Pain in abdomen is common factor of peptic ulcer but always not present. It can vary in severity from person to person.
• Nocturnal pain is frequent in duodenal ulcer but rare in gastric ulcer. It may waking up the patient between 2 and 3 A.M.
• Relief in pain is noted by patient in three conditions: 1.with food 2.After antacid and 3. After vomiting.
• Weight loss occur due to persistent vomiting
• Bloody or dark tarry stool may be seen due to internal haemorrhage
• Fatigue, chest pain and vomiting with blood are other symptoms of peptic ulcer.
Physical signs of Peptic ulcer :
The exact location of pain, localised tenderness and rigidity over one rectus muscle, when pressed together are diagnostic of ulcer.
Diagnosis of Peptic ulcer:
Diagnosis of peptic ulcer is done by:
1.Proper history and physical examination
• Gastric secretion test
• stool test for occult blood
3 Radiology: A series of X ray of gastro intestinal tract is taken after Barium meal.
4.Oesophago Gastro Duodenoscopy (OGD) is done which is a special test in which a thin tube with a camera at the end is inserted through patient's mouth into the GIT to visualise stomach and small intestine. During this process a biopsy from stomach wall is done to isolate H. pylori and to exclude carcinoma.
Treatment of Peptic ulcer:
Treatment of Peptic ulcer comprises:
• Bed rest
• Drugs treatment
• Surgical treatment
Bed rest : To relief in ulcer pain and promotion of healing, rest in bed is the most effective measure.
Diet :Suitable diet should be mechanically and chemically non- irritating and should be small and frequent. Avoid too hot and too cold drinks.
Drug treatment :
In Peptic ulcer with H. pylori bacteria following drugs are given for 7 to 14 days
Two different antibiotics are given to kill H. pylori and they are: Metronidozole, Amoxicillin, Clarithromycin and Tetracycline.
Proton pump inhibitors like Omeprazole, Lamoprazole or Esomeprazole is given.
Bismuth (Pepto-Bismol) may be given to kill H. pylori bacteria.
Peptic ulcer without H. pylori bacteria or due to Aspirin intake, proton pump inhibitors is advised for 8 weeks.
Misoprostol may be given to prevent ulcers secondary to Aspirin intake.
Tranquillisers or anti anxiety drugs are useful in the treatment of ulcer patients who are over anxious.
Surgical treatment :
Surgical treatment is given in the following conditions:
• Ulcer which fails to heal and when symptoms persist or recur so as to interfere with enjoyment of life.
• Ulcer with pyloric or duodenal stenosis or hourglass stomach.
• An ulcer with malignancy
• A jejunal ulcer following gastro jejunostomy
• Perforation of peptic ulcer
• Haemorrhage, sever anaemia or recurrent ulcer.
Preventions of Peptic ulcer:
Avoid risk factors as much as you can.
Complications of Peptic ulcer:
• Haemorrhage (internal bleeding)
• Perforation of stomach and intestine
• Pyloric obstruction
• Ulcer cancer