Understanding Peptic Ulcer Disease

Peptic ulcer disease is a condition in which sores or ulcers occur in the lining of the stomach or first portion of the small intestine called duodenum. Normally, our digestive tract is protected by a mucosa layer that produces mucus that protects against digestive juices. An ulcer may develop if for some reasons, this protective layer is compromised.

In the United States, peptic ulcer affects around 4.5 million people every year. One out of ten people may have an ulcer at one point in time. Increasing age and the growing use of aspirin or other non steroidal anti inflammatory drugs (NSAIDs) contributes to the incidence of peptic ulcer disease. In the past, males were more likely to be affected. However, current evidence shows that women are almost as likely to develop peptic ulcer disease as men. The prevalence tends to increase in older female population and decrease in young male population.

How does a peptic ulcer develop?

When the mucosa layer is broken down, digestive juices that contain hydrochloric acid and an enzyme called pepsin can damage the stomach or duodenal tissue. In contrary to popular belief, spicy foods and daily lifestyle stress do not cause peptic ulcers. They can make the symptoms worse, but diet and psychological factors are not causative factors.

The known causes of peptic ulcers are:

• Infection by bacteria called Helicobacter pylori (H. pylori)
• Use of non steroidal anti-inflammatory drugs (NSAIDs) like aspirin (Anacin, Bufferin, Empirin), naproxen (Aleve), ibuprofen (Advil, Motrin, Excedrin), and many others
• Abnormal gastric acid production such as in Zollinger Ellison syndrome where a tumor called gastrinoma produces excessive acid
• Physiologic (not psychological) stress like severe burns, head trauma, major surgery, systemic infection, and respiratory failure may cause deep ulcers associated with high acid production
• Smoking and excessive alcohol consumption may worsen symptoms and prevent ulcers from healing. However, it is still inconclusive whether or not they are really causative factors. 

 

What are the types of peptic ulcer?

Ulcers that develop in the stomach are called gastric ulcers, where those that develop in the duodenum are called duodenal ulcers. Often times, gastric and duodenal ulcers cannot be differentiated based on the history alone.

What are the symptoms of peptic ulcer?

The most common symptom of a peptic ulcer is abdominal pain that usually occurs in the upper part of the abdomen (epigastric pain) with gnawing or burning quality. In gastric ulcer, pain usually follows shortly after meal. In duodenal ulcer, it occurs several hours after meal and typically happens in the night and awakens the patient from sleep. However, ulcers may not always cause noticable symptoms, especially in the elderly. 

 

a gastric ulcer as seen in endoscopy

Other than abdominal pain, other symptoms that may accompany peptic ulcer disease are:

• Bloating and belching
• Nausea or vomiting
• Chest discomfort or heartburn
• Dark, black, or tarry stool due to bleeding ulcer
• Vomiting blood
• Anemia
• Loss of appetite and weight loss

Danger signs in peptic ulcer

If you experience any of the following symptoms related to your ulcer, seek immediate medical attention.

• Severe abdominal pain
• Bleeding or anemia
• Unexplained weight loss
• Progressive difficulty in swallowing foods or liquid

What are the complications of peptic ulcer?

Untreated ulcer can cause chronic bleeding or sudden massive hemorrhage associated with perforation. Mortality is higher in patients with gastric perforation compared to duodenal perforation. People with gastric ulcers are also at a higher risk to develop stomach cancer.

How are ulcers diagnosed?

A complete medical history and physical examination will usually help your doctor in making the diagnosis. However, to confirm it, you may need to have a blood or breath test to check for Helicobacter pylori infection or even a more elaborate procedure like endoscopy. Upper gastrointestinal endoscopy will allow your doctor to view the inner surface of your stomach or duodenum through a small tube inserted through your mouth.

What are the treatments for ulcers?

Lifestyle changes like stop taking NSAIDs and quit smoking will help the healing process. Ulcers can heal on their own, but if the symptoms are severe or if H. pylori infection is not treated, they will develop into complication.

Medications used to treat ulcers may include:

• Antibiotics to treat H. pylori infection
• Proton pump inhibitors (PPI) like omeprazole (Prilosec), lanzoprazole (Prevacid) or esomeprazole (Nexium) to reduce acid production
• H2 receptor blockers like ranitidine (Zantac) or famotidine (Pepcid)
• Cytoprotective agents like misoprostol or sucralfate to increase mucus production

In severe cases such as in massive bleeding and perforation, endoscopic procedure or open surgery will have to be preformed to control the symptoms. 

 

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Other articles related to peptic ulcer disease:

• Use of non steroidal anti-inflammatory drugs (NSAIDs), especially for long periods of time, is one of the cause of peptic ulcer disease. Read more about over-the-counter (OTC) painkillers
• Abdominal pain is one of the most common reasons for doctor visit with severity ranging from mild to life threatening. Read more about common causes of abdominal pain
• The digestive system consists of two main components: the digestive tract-which starts from the mouth and ended up in the anus, and internal organs that are not part of the digestive tract. Read more about how your digestive system works

Common Causes of Abdominal Pain

Abdominal pain is one of the most common reasons for doctor visit with severity ranging from mild to life threatening. Everyone experiences abdominal pain from time to time. As with the other common symptoms, it’s important to recognize whether or not the pain requires immediate medical attention.

What are the symptoms that accompany abdominal pain?

Often times, abdominal pain is accompanied by changes in bowel movement (either diarrhea or constipation), blood or mucus in the stool, flatulence, bloating, nausea and vomiting, fever, back pain, urinary pain and urgency, chest pain, shortness of breath and cough. In women, abdominal pain may be accompanied by changes in menstrual pattern and vaginal bleeding or discharge. In these cases, the possibility of pregnancy or other diseases related to the female reproductive organs must be considered.

What are the causes of abdominal pain?

In mild cases, the causes of abdominal pain can be indigestion, constipation, food poisoning, food intolerance, gastro esophageal reflux disease, irritable bowel syndrome, gas, muscle strain, and menstrual cramps in women. More serious cases include peptic ulcers, gastroenteritis, appendicitis, gall stone, kidney stone, urinary tract infection, hernia, inflammatory bowel diseases, pancreatitis, hepatitis, and diverticulitis. The really serious problems are bowel or intestinal obstruction, perforation, peritonitis, ectopic pregnancy, ruptured abdominal aortic aneurysm, cancer of the stomach, pancreas, colon, liver, or other organs, and intestinal ischemia.

How can you tell if the abdominal pain is a sign of serious disease?

Evaluation of the onset, duration, location, quality, and other characteristics of the abdominal pain, along with the accompanying symptoms may give a clue whether or not it is caused by a serious underlying disease that requires emergency treatment. 

 

The characteristics, duration, and causes of abdominal pain can vary greatly.

Seek medical attention of you experience any of the following:

• Severe pain that restricts your movement or made you so uncomfortable that you can’t sit still.
• Pain that occurs after a recent trauma or injury
• Severe tenderness when you touch your abdomen
• A rigid, board-like abdomen
• Pain accompanied by fever over 38.3 C (101F)
• Vomiting blood or coffee grounds appearing substance
• Blood in the stool, either fresh blood or black tarry stool
• Worsening bloating or constipation or inability to pass stool
• Blood in the urine or cloudy urine
• Inability to take down food or liquid
• Shortness of breath
• Chest pain or discomfort
• Vaginal bleeding
• Pain that occurred during pregnancy
• Worsening symptoms that do not improve after 2 days
• Unexplained weight loss over a period of time

 

Other considerations regarding abdominal pain

 

Sometimes the degree of pain may not reflect the seriousness of the condition. Early appendicitis or pancreatic cancer may elicit only vague pain. In contrary, you may have severe pain from gas or muscle cramps. However, it’s better to be safe than sorry and seek medical help for all severe pain.

Generalized pain is usually caused by indigestion, gas, viral gastroenteritis, food poisoning or intolerance, and irritable bowel syndrome. Usually, the cause of generalized pain is less serious than localized pain. However, severe generalized pain with rigid abdomen is a sign of a serious problem like perforation, peritonitis, or intestinal blockage.

Depending on the location, localized pain is usually caused by abnormalities of the internal organs. Upper abdominal pain may be caused by peptic ulcers, gastro-esophageal reflux disease, or other diseases in the chest cavity like pneumonia or angina. Pancreatitis and early appendicitis usually cause pain in the central area of the abdomen. In late appendicitis, the pain will migrate to lower right abdomen. Diverticulitis causes pain in the lower left area. Location for the rest of the causes of abdominal pain may vary.

Finding out the cause of abdominal pain

 

Physical examination by a health care professional is still the most important diagnostic step. A good history taking by a doctor will give a clue to aid the diagnosis and saves you from undergoing expensive and unnecessary medical procedures. Depending on your condition, after physical examination your doctor may order stool, urine, or blood test, ultrasound, CT-scan, and endoscopy.

Treatment of abdominal pain

The management of abdominal pain depends on the cause. Mild pain from indigestion, viral gastroenteritis, or food poisoning can be treated with home treatment. Antacids, antibiotics, and other oral medications may be given for ulcers or conditions related to infection. Surgery is often needed for more serious causes like appendicitis, hernia, or perforation.

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Other articles in common symptoms:

• Everyone has had a fever at least once in their lifetime. Like pain, fever is an important sign that tells you something wrong is happening in your body. Read more about fever and when to seek help when you have one
• Coughing is basically a protective reflex to clear the lungs and airways from foreign material. It's A cough is only but a symptom, not a disease. Read more about the cough reflex
• The skin is our body's largest organ. Changes in skin appearance may be caused by something as minor as acne or they can signal a more serious underlying condition. Read more about common skin problems

How Your Body Works: The Digestive System

The human digestive system breaks down food from larger molecules into smaller components that can be used by the cells as sources of energy and to build and repair tissues. The digestion process itself involves complex mechanical and chemical action that requires energy. The digestive system consists of two main components: the digestive tract-which starts from the mouth and ended up in the anus, and internal organs that are not part of the digestive tract, but play important roles in food digestion.

Parts of the digestive system

The components of the digestive tract are the mouth, pharynx, esophagus, stomach, small intestines, large intestines, rectum, and the anus. These hollow organs are lined with a mucosal layer that contains glands that produce protective mucus, acid, and digestive juices. The pancreas is an organ that produce enzymes that help break down the food. Besides producing digestive enzymes, the liver also serves functions related to detoxification, metabolism, and energy storage. The gallbladder stores bile acid until it is needed in the intestines.

Food passes from the mouth through the esophagus into the stomach where acid and digestive enzymes break it down before it passes to the small intestines. In the small intestines, most of the digestion process takes place and food components are absorbed. The remnants of the food passed to the large intestines and the indigestible components are expelled through the anus.

Mouth and pharynx

The mouth is the start of the digestive tract. Chewing is a mechanical process that breaks down food into smaller pieces. Salivary glands produces saliva that contains enzymes that starts to break down food chemically. However, because food only stays in your mouth for a short time, the enzymatic reaction is minimal. It is still important to chew properly and not swallow too quickly, though. Doing this will ensure the subsequent digestion process runs more smoothly as the food travel down the pharynx (throat) to the esophagus.

Esophagus

The esophagus connects the pharynx to the stomach. It is a tube lined with muscle tissue that propels the food by contractive movements called peristaltic. There is no enzymatic process that takes place in the esophagus. At the lower end, there is a ‘gate’ called the lower esophageal sphincter that prevents food from going backwards into the esophagus.

Stomach

Also known as the gaster, the stomach is a round sac-like structure that holds the food for mechanical and chemical processing. It mixes up the food with acid and enzymes that continue breaking down the food. Gastric acid kills the majority of bacteria that got eaten, but our stomach is protected against it by the mucosal layer. When it leaves the stomach into the first part of the small intestines, the food will be in paste-like form. The stomach emptying rate depends on the type of food we eat. Carbohydrates spend the least amount of time in the stomach, protein stays longer, and fats the longest.

Anatomy of digestive system

Small intestines

The small intestine is a very long tube that is coiled inside the abdomen. Spread out, the length of our small intestines will reach over 20 feet long. It is made up of three parts: the duodenum, jejunum, and ileum. With the help of pancreatic enzymes and bile from the liver, the small intestine continues the process of breaking down food as it mixes everything up by peristaltic contractions. Usually after the food passed the duodenum, it is already broken down into small molecules that are ready to be absorbed in the jejunum and ileum into the bloodstream. Once the nutrients have been absorbed, the leftover liquid passed into the large intestine.

Large intestines

Also known as the colon, the large intestine is a 5 feet long tube that extends from the end of ileum to the rectum. It is made up of four parts: the ascending colon, the transverse colon, the descending colon, and the sigmoid. The undigested leftovers of food are passed through the colon and excess water is reabsorbed from them. The stool, which consists mainly of debris, fiber, and bacteria, is accumulated inside the sigmoid colon until a bowel movement empties it into the rectum.

Rectum

The rectum connects the colon to the anus. When the rectum receives the stool from the sigmoid colon, you will feel a sensation that prepares you for stool evacuation. Sensors from the rectal mucosa signal the brain which then decides whether or not it’s okay to release the rectal content. If the brain allows, the sphincter muscle relaxes and the stool will be propelled into the anus.

Anus

The anus is the end of the digestive tract. It is made up of internal and external sphincters and supported by the pelvic muscular tissue. The sphincters control the evacuation process so we don’t defecate when we’re not supposed to. The pelvic floor muscle supports the sphincter function by creating an angle between the rectum and the anus that holds the stool inside.

As mentioned before, besides the digestive track, some internal organs play an important role in digestion. They are the pancreas, the liver and gallbladder.

Pancreas

The pancreas secretes enzymes that break down protein, fat, and carbohydrates from the food we eat. Besides producing enzymes, the pancreas also serves an endocrine function-that is, producing hormones. The alpha and beta cells of the pancreas respectively produces glucagon and insulin that act against each other to control blood sugar level.

Liver and gallbladder

The liver produces bile which then stored inside the gallbladder. The bile is a compound that helps to the digest fat and eliminates waste products from the blood. During a meal, especially a fatty one, the gallbladder contracts and sends bile to the small intestine. The liver also serves to detoxify the things we digest. Nutrient-rich blood from the small intestines flows to the liver through a blood vessel called the portal vein where it is cleansed from metabolic wastes.

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Other articles on how your body works:

• The cardiovascular or circulatory system is made up of two components: the heart and the blood vessels. Read more about how your cardiovascular system works 
• The human respiratory system consists of a complex set of organs and tissues designed to capture oxygen from the environment and transport the it into the lungs. Read more about how your respiratory system works
• Everyone experience pain at some point of their life. Pain is the most common reason for physician consultation in the United States. Read more about physiology and psychology of pain