Peptic ulcer: what is it, symptoms, treatment, prognosis

What is Peptic Ulcer Disease?

Peptic ulcer is a round or oval wound surface in which the mucous membrane of the stomach or duodenum is eaten away by stomach acid and digestive juices. A peptic ulcer can result from an infection caused by Helicobacter pylori, or exposure to drugs that weaken the lining of the stomach or duodenum.

The diagnosis of peptic ulcer disease is based on symptoms of stomach pain and results of examination of the stomach with with a flexible viewing tube (upper gastrointestinal endoscopy) path). To reduce the acidity of the stomach, antacids and other drugs are used, and to eliminate Helicobacter pylori antibiotics are used.

Ulcers invade the lining of the stomach or duodenum (the initial segment of the small intestine). Ulcers can range in size from a few millimeters to several centimeters. Ulcers can develop at any age, including infancy and childhood, but they are most common in middle-aged adults.

Gastritis (stomach inflammation) can develop into a peptic ulcer.

The names given to certain ulcers make it possible to identify them by anatomical location or by the circumstances under which they developed.

Duodenal ulcers, the most common type of peptic ulcer, is localized over the first few centimeters of the duodenum.

Stomach ulcers less common and usually seen in the lower stomach.

If part of the stomach is surgically removed, where the rest of the stomach connects to the intestine can develop marginal ulcers.

Like ulcers in acute stress gastritis, stress ulcers can develop as a result of stress caused by serious illness, skin burns, or injury. Stress ulcers are found in the stomach and duodenum.

Signs and symptoms

The symptoms of peptic ulcer disease can vary depending on the location of the ulcer and the age of the person. For example, children, the elderly, and people with ulcers caused by NSAIDs may not have the usual signs and symptoms, or they may not have any symptoms at all. In such cases, ulcers are found only when complications develop.

The most common symptom peptic ulcer:

• mild to moderate pain in the upper abdomen.

The pain is usually described as constantly aching, burning, dull, or painful or sometimes hungry, and is usually felt in the upper abdomen just below the sternum. It usually gets better with food or antacids. A typical ulcer usually heals and recurs. Thus, pain may be felt for days or weeks, then diminish or disappear, and then reappear with recurrence of the ulcer. Only half of people have typical symptoms.

Duodenal ulcer symptoms usually have patterns. Patients usually do not have pain on waking, but it appears by mid-morning. Drinking milk or consuming foods (which buffer stomach acid) or using antacids often relieve pain, but pain usually returns after 2 or 3 hours. Pain that interferes with sleep is common. Often, pain occurs one or more times a day for one to several weeks and then may go away without treatment. However, pain usually recurs, often within the first 2 years, and in some cases after several years. People usually notice patterns appear and can often predict from their own experience when a relapse is more likely (usually in the spring and fall, and during times of stress).

The symptoms of stomach ulcers, marginal ulcers and stress ulcers, unlike duodenal ulcers, do not reveal any patterns. Food may temporarily relieve pain, or food may cause pain rather than relieve it. Stomach ulcers sometimes cause scars and edema tissues leading to the small intestine, which can act as an obstacle to the removal of food from the stomach. Such blockage of the passage can cause after eating bloating, nausea, or vomiting.

Causes and risk factors

Peptic ulcer disease develops when the normal defense and mechanisms of constant renewal of the gastric mucosa or duodenum weakened, which increases the likelihood of damage to the mucous membrane of stomach acid.

Two the most common reasons peptic ulcers are:

• infection Helicobacter pylori stomach;
• application non-steroidal anti-inflammatory drugs (NSAIDs).

Infection caused by H. pylori, is present in 50–70% of patients with duodenal ulcers and in 30–50% of patients with gastric ulcers. Infection Helicobacter pylori rarely occurs in people under the age of 40.

NSAIDs are responsible for more than 50% of peptic ulcers. However, most people who take NSAIDs do not develop peptic ulcers.

Smokers are more likely to develop peptic ulcers than non-smokers, heal more slowly and are more likely to recur. Although alcohol increases stomach acid production, drinking moderate amounts of alcohol does not appear to cause ulcers or slow down ulceration. Psychological stress can cause ulcers. Doctors have identified a higher incidence of peptic ulcer disease in Japan after the earthquake and in New York after the 9/11 attacks.

A rare cause of peptic ulcers is a type of cancer that releases a hormone called gastrin, which causes excess acid production. Zollinger-Ellison syndrome). The symptoms of malignant ulcers are very similar to those of non-malignant ulcers. However, cancerous ulcers usually respond poorly to the treatment used for non-cancerous ulcers.

Approximately 50-60% of children with duodenal ulcers have relatives with peptic ulcer disease. Recent evidence suggests that this is because an infection H. pylori transmitted between family members. Doctors doubt that the increased risk of contracting this infection is hereditary.

Diagnostics

When a person suffers from characteristic stomach pain, the doctor suspects an ulcer. Sometimes the doctor simply treats the patient for the ulcer to see if the symptoms go away (called "empiric therapy"). If symptoms resolve, then the person most likely has an ulcer.

Tests may be necessary to confirm the diagnosis, especially when symptoms persist after several weeks of treatment, or when they first appear in a person over the age of 45 or in a person who has other symptoms such as weight loss, because the stomach cancer can cause similar symptoms. In addition, when severe peptic ulcer disease does not respond to treatment, especially if the person has multiple ulcers or ulcers located in unusual locations, the doctor may suspect an underlying medical condition causing the stomach to produce excessive amounts of acid.

To diagnose peptic ulcer disease and determine its cause, the doctor performs endoscopy of the upper gastrointestinal tract (a procedure performed with a flexible viewing tube called endoscope).

During an endoscopy, a doctor may do a biopsy (taking a tissue sample for examination under a microscope) to determine if a stomach ulcer is cancerous and check for the presence of bacteria Helicobacter pylori. An endoscope can also be used to stop active bleeding and reduce the chance of re-bleeding from the ulcer.

Blood tests to measure gastrin levels are done in people with possible Zollinger-Ellison syndrome.

Treatment

Since bacterial contamination H. pylori is the main cause of ulceration, treatment of infection H. pylori a combination of two antibiotics together with bismuth subsalicylate and a proton pump inhibitor is prescribed after the infection is diagnosed. Several different antibiotics can be used, including amoxicillin, clarithromycin, metronidazole, and tetracycline.

Drugs that reduce acidityblock the production of stomach acid. The most commonly used acid lowering drugs include proton pump inhibitors and histamine H2 (H2) receptor blockers. Proton pump inhibitors promote ulcer healing in a greater percentage of patients in a shorter period of time than use of H2 receptor blockers and are therefore generally preferred over blockers for ulcer treatment H2 receptors.

Antacids, for example, liquids or tablets containing calcium carbonate or the like neutralize stomach acid but do not block its production.

Neutralizing or reducing acidity in the stomach promotes healing of ulcers, whatever the cause. In most patients, treatment continues for 4–8 weeks. While gentle diets can help lower acidity, there is no evidence that confirming the opinion that such diets increase the rate of healing or prevent relapses peptic ulcer. However, it is advisable to avoid the consumption of foods that, as it seems to the patient himself, contribute to increased pain and bloating. It is also important to rule out possible stomach irritants such as NSAIDs, alcohol and nicotine.

Surgical intervention ulcers are rarely required at present, because drugs are very effective in treating peptic ulcers, and endoscopy is very effective in stopping active bleeding. Surgery is used primarily to treat complications of peptic ulcers, such as:

• perforation;
• obstruction that does not respond to medication, or recurs;
• two or more serious episodes of ulcerative bleeding;
• suspicion of a malignant stomach ulcer;
• severe and frequent relapses of peptic ulcers.

A number of surgical procedures can be performed to treat these complications. Surgery can also be done to reduce acid production and ensure proper drainage of the stomach. However, ulcers can recur after surgery, and each such procedure can cause own problems such as weight loss, poor digestion, frequent bowel movements (syndrome dropping) and anemia.

Forecast

With successful treatment of the infection Helicobacter pylori peptic ulcer disease returns in only 10% of patients. However, peptic ulcer disease recurs in 70% of infected patients who are treated only with drugs that suppress acid production.

Complications

Most peptic ulcers can be healed without complications. However, in some cases, with peptic ulcers, potentially life-threatening complications can develop, such as:

• bleeding (haemorrhoids);
• penetration;
• perforation;
• blockage (blockage);
• oncological diseases;

- Bleeding.

Bleeding (hemorrhage) is the most common complication of peptic ulcer disease, even when pain is not associated with it (gastrointestinal bleeding). Symptoms of a bleeding ulcer may be vomit containing bright red blood or reddish-brown clumps of partially digested blood that looks like coffee grounds (haematemesis) and black, tarry stool (melena) or apparently bloody stool (hematochezia). Loss of blood can also lead to weakness, low blood pressure while standing, sweating, thirst, and fainting. However, small amounts of blood in the stool can go unnoticed, but if repeated, they can lead to anemia.

Bleeding can also be due to other diseases of the digestive system, but doctors begin the examination by looking for the source of the bleeding in the stomach and duodenum. If the bleeding is not massive, the doctor uses a flexible optical probe (endoscope) to perform endoscopy of the upper GI tract. If a bleeding ulcer is noticed, then to cauterize it (i.e. (i.e., stopping bleeding with heat) an endoscope can be used. The doctor may also use an endoscope to inject material that will coagulate the bleeding ulcer.

If the source cannot be found, and the bleeding is not severe, then treatment includes the use of medicinal drugs that suppress acid production, such as histamine H2 receptor (H2) blockers or inhibitors proton pump. Patients are also given fluids through a vein (intravenously) and do not take anything orally, which allows the digestive tract to rest. If these measures are ineffective, surgical intervention is necessary.

- Penetration.

An ulcer can penetrate (penetrate) the muscular wall of the stomach or duodenum (the initial segment of the small intestine) and spread to an adjacent organ such as liver or pancreas. This penetration causes intense, penetrating, persistent pain that may be felt in an area of ​​the body other than the affected area. For example, when a duodenal ulcer invades the pancreas, your back may hurt. When a person changes position, the pain may worsen.

To diagnose penetrations, doctors use imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI).

If drugs do not heal the ulcer, surgery may be necessary.

- Perforation.

Ulcers on the anterior surface of the duodenum, or less commonly the stomach, can pass through the organ wall, creating an opening (perforation) into the free space of the abdominal cavity. The result is sudden, intense, or persistent pain. The pain quickly spreads to the entire abdominal cavity. The person may feel pain in one or both shoulders. Deep breathing and changes in position increase the pain, so the person often tries to lie still. On palpation, the abdomen is painful and the soreness worsens if the doctor presses deeply on the abdomen and then suddenly releases the pressure. (Doctors call this soreness when the pressure is suddenly released.)

Perforation symptoms may be less severe in the elderly, in people taking corticosteroids or immunosuppressants, or in critically ill patients. An elevated temperature indicates the development of an infection in the abdominal cavity. If the disease is not treated, it may develop shock.

Doctors do x-rays or computed tomography to confirm the diagnosis.

This emergency (called an acute abdomen) requires urgent surgery and intravenous antibiotics.

- Obstruction.

Swelling of the inflamed tissue around the ulcer or scarring from previous flare-ups of a peptic ulcer can narrow the stomach outlet or duodenum. Patients with this type of obstruction may suffer from frequent vomiting, in which large amounts of food taken several hours before are often vomited. Feeling full after eating, bloating and lack of appetite are symptoms of obstruction. Over time, vomiting can lead to weight loss, dehydration, and an imbalance of chemicals (electrolytes) in the body.

Doctors diagnose obstruction based on x-rays.

Treating peptic ulcers and swelling in most cases relieves obstruction caused by scars, but severe cases may require endoscopic enlargement or surgery.

- Oncological diseases.

In people with peptic ulcer disease caused by Helicobacter pylori, the likelihood of developing stomach cancer in the future is 3-6 times higher. There is no increased risk of developing cancer from ulcers from other causes.