A Family Doctor's Tale - PEPTIC ULCER

DOC I HAVE PEPTIC ULCER

Peptic ulcer is a ulcer or hole in the lining of the stomach or duodenum.

Two main causes of Peptic ulcer are
1..helicobacter pylori infection - this bacteria damages the protective lining of the stomach making the underlying stomach tissue more vulnerable to the acidic gastric juice.

2.excessive production of acidic gastric juice
Excessive production of acidic gastric juice burns into the protective lining of the stomach and cause inflammation of the underlying stomach tissue.

The causes of excessive production of acidic gastric juice are:
1. Most common is stress and anxiety which automatically increase the production of the acid as a result of sympatheic nervous reaction


2.hereditary- some gastric patient has family history of gastric problem. Blood group O tends to have more gastitis while Blood group A has a tendency towards stomach cancer.


3.irregular meals tend to cause more acidic gastric juice to form at regular meal time.


4.alcohol and smoking has been associated with increased acid formation


5.Drugs: prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen,

Most gastric ulcers occur on the lining of the lesser curvature of the stomach while dudenal ulcers occur on the first part of the duodenum

What are the Symptoms of Peptic ulcer?
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The most common symptoms are
1.upper abdominal upset or pain.

2. belching, abdominal bloating,

3.nausea, and vomiting especially if there is obstruction as pyloric stenosis

4.indigestion or of burning in the upper abdomen or in the chest(heart burn).

5. Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.

Signs:
6.epigastric tenderness on examination

7.anorexia

6.loss of weight due to poor digestion and absorption

Peptic ulcer is diagnosed through one or more medical tests:
1.Upper gastrointestinal endoscopy.

The doctor eases an gastroscope, a thin tube containing a tiny camera, through the mouth  and down into the stomach to look at the stomach lining.
The doctor will check for inflammation (gastritis) and ulcers and may remove a tiny sample of tissue for tests(biopsy). The biopsy will detect how bad is the inflammation or whether there are underlying cancer cells.
In additional if any polyps (benign swelling of the lining of the stomach) are detected, they are removed at the same time and sent for biopsy.

2.Blood test. The doctor may check your blood for any evidence of H.pylori infection and the red blood cell count to check for anemia (not enough iron in the red blood cells.
Anemia can be caused by bleeding from the stomach.

3.Urea breath test can also determine whether there is H.pylori infection

4.Stool test. This test checks for the presence of blood in the stool, a sign of bleeding. Stool test may also be used to detect the presence of H. pylori in the digestive tract.

The main treatment of Peptic ulcer is usually
1.reduce stress

2.reorganisation of work in such a way as to be able to handle the pressure of work better as well as to have regular meals

3.Control of diet - avoid hard foods such as peanuts , tough meat, spicy food, cold food, black coffee, strong tea,citrus fruits and their juices,carbonated beverages, deep fried or oily food.

4. Take more frequent and smaller meals.

5. Avoid alcohol and smoking

6. Avoid drugs such as aspirin, painkillers,steroids which may irritate your stomach and cause increase in acid production

Medications:
Treatment usually involves taking drugs
1.Antacids:to reduce stomach acid and thereby help relieve symptoms and promote healing. (Stomach acid irritates the inflamed tissue in the stomach.)

2.H2 Antagonist: to reduce to production of acidic gastric juice.(cimetidine, ranididine,omeprazole, Nexium etc)

3. Antispasmodics: anticholinergic drugs like buscopan.librax reduce the spasm in the stomach and dudenum

4.If your Peptic ulcer is caused by an infection, antibiotics are given  to clear up H. pylori infection. Once the underlying problem disappears, the Peptic ulcer usually does too.

Surgery:
Surgical treatment is the last resort if the above treatment do not work.

Resection of the ulcers and vagotomy(cutting of the vagal nerve to reduce acid secretion) may be necessary in rare cases.

The Complications of untreated Peptic ulcer are:

1.bleeding

2.pyloric stenosis

3.perforated stomach and peritonitis

Prognosis of Peptic ulcer:
Healing occurs with 6 to 12 weeks .

However recurrence is common.