Peptic ulcer disease refers to the presence of open sores or ulcers in the lining of the stomach (gastric ulcers) or the first part of the small intestine (duodenal ulcers). The most common cause of peptic ulcers is infection with the bacterium Helicobacter pylori (H. pylori) or the use of nonsteroidal anti-inflammatory drugs (NSAIDs)
Etiopathogenesis
- Helicobacter pylori (H. pylori) Infection:
- H. pylori is a bacteria that can weaken the protective mucous lining of the stomach and duodenum, allowing stomach acid to create ulcers.
- Infection is common and can be transmitted through contaminated food or water.
- NSAID Use:
- Long-term use of NSAIDs (such as aspirin, ibuprofen, or naproxen) can irritate and erode the lining of the stomach and duodenum, leading to ulcers.
- Acid Production and Hypersecretion:
- Excessive stomach acid production or hypersecretion due to conditions like Zollinger-Ellison syndrome can contribute to ulcer formation.
- Smoking:
- Smoking is associated with an increased risk of developing peptic ulcers.
- Genetic Factors:
- Genetic predisposition may contribute to susceptibility to peptic ulcers.
Clinical Manifestations
- Burning Pain:
- Most common symptom is a burning or gnawing pain in the upper abdomen, typically between meals and at night.
- Pain is relieved by eating or taking antacids.
- Nausea and Vomiting:
- Some individuals may experience nausea and vomiting.
- Weight Loss:
- Unintentional weight loss may occur in severe cases.
- Bleeding:
- Gastrointestinal bleeding can lead to symptoms such as dark, tarry stools (melena) or vomiting of blood (hematemesis).
- Perforation:
- A perforated ulcer can cause sudden, severe abdominal pain and may lead to life-threatening complications.
Non-Pharmacological Management
- Lifestyle Modifications:
- Quit smoking, as it can contribute to the development and worsening of peptic ulcers.
- Limit or avoid alcohol consumption.
- Manage stress through relaxation techniques.
- Dietary Changes:
- Avoid foods and beverages that may irritate the stomach lining, such as spicy foods, caffeine, and acidic foods.
- H. pylori Eradication:
- Antibiotic therapy is used to eradicate H. pylori infection when present.
Pharmacological Management
- Proton Pump Inhibitors (PPIs):
- Reduce stomach acid production and promote ulcer healing.
- Examples include omeprazole, esomeprazole, lansoprazole.
- Histamine-2 (H2) Receptor Blockers:
- Reduce stomach acid production.
- Examples include ranitidine, famotidine.
- Antacids:
- Provide quick relief by neutralizing stomach acid.
- Examples include aluminum hydroxide, magnesium hydroxide.
- Cytoprotective Agents:
- Enhance the protective mucosal lining of the stomach.
- Sucralfate is an example.
- Prostaglandin Analogs:
- Protect the stomach lining and reduce acid secretion.
- Misoprostol is an example.
- H. pylori Eradication Therapy:
- Combination antibiotics, such as amoxicillin, clarithromycin, and metronidazole, along with a PPI or an H2 blocker, are used to eradicate H. pylori.
- Cytoprotective Agents:
- Enhance the protective mucosal lining of the stomach.
- Sucralfate is an example.
In cases of severe bleeding, perforation, or obstruction, hospitalization and more aggressive interventions may be necessary, including endoscopic therapy or surgery.
Management of peptic ulcer disease aims to alleviate symptoms, promote healing, prevent complications, and address underlying causes such as H. pylori infection or NSAID use. Treatment plans should be individualized based on the specific characteristics and needs of each patient. Regular follow-up with healthcare providers is essential for monitoring progress and adjusting treatment as needed.
