Peptic Ulcers

1. Peptic Ulcers By: VvK

2. Definition • A peptic ulcer, can also be known as peptic ulcer disease (PUD) • It is a very common disorder of the digestive system • The word “peptic” comes from “pepsin”, the enzyme that helps to break down food in the presence of the stomach acid • Ulcers develop when tissues have been eaten away by stomach acid and digestive juices, causing an erosion to form in the mucous membrane • Normally, the lining of the stomach and small intestine are protected against the irritating acids, but if this thin lining stops working correctly and breaks down, it results in inflammation and later an ulcer

3. If the ulcer is located in the stomach it is called a gastric ulcer • If it’s located in the duodenum it is called a duodenal ulcer • Peptic ulcers occur most in the duodenum and first layer of the lining, less commonly in the stomach • They often appear as white or pale yellow spots due to surrounding inflammation • They vary in size from a pinhead to one or more inch across, although size has little to do with the intensity of the pain because the high acidity of the stomach can cause intense pain when the acid in the juices touches the open sores

4. History Early 20th Century: • Ulcers were believed to be caused by stress and dietary factors • Treatment focused on bed rest, and prescription of special bland foods • Gastric acid was blamed for ulcer disease, antacids and acid reducing medication were used as treatment 1982: • The link between Helicobacter pylori (H. pylori) and ulcers was identified, learning that the bacteria, not stress or diet, causes ulcers 1994: • Ulcer patients with H. pylori infection were recommended to be treated with antibiotics

5. 1995: • It was found that nearly 90 percent of ulcer sufferers were unaware that H. pylori caused ulcers, yet still most people blamed them on stress 1996: • The first antibiotic for treatment was approved 1997: • A campaign was launched to inform health care providers and consumers about the link between H. pylori and ulcers • This campaign reinforced the news that ulcers are a curable infection, and the fact that health can be greatly improved • This discovery can help scientists better understand the bacterium and design more effective drugs to fight it.

6. Causes • The bacteria called Heliobacter pylori (H.pylori) is the number one cause of peptic ulcers • 50% of the worlds population contain this bacteria, and most people with this do not have any ulcer symptoms • The way in which this bacteria spreads is unknown, but is thought to spread either through contaminated food and water or through direct mouth-to-mouth contact. • About 95% of duodenal and 20-80% of gastric ulcers are caused by H.pylori

7. Pain relievers are the next most common cause of peptic ulcers • Regular use of nonsteiroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and many others are risks of causing or worsening peptic ulcers because they irritate the stomach • Although, not everyone who takes NSAIDs produces ulcers • Alcohol, smoking, or chewing tobacco increases the risks of recurring ulcers • Breathing machines, and radiation treatments are also causes • About 4% of stomach ulcers are caused by a malignant tumor, but duodenal ulcers are generally benign • A small amount of peptic ulcers are caused by the Zollinger-Ellison Syndrome, which produces high levels of stomach acids

8. Symptoms • Stomach discomfort • Abdominal pain, which is common but doesn’t always occur • Burning or gnawing ache or hunger pain in the pit of the stomach, usually in the middle of the night (can be relieved by eating, drinking, antacids, or vomiting) • Feeling of fullness or bloating • OR hunger and feeling empty in the stomach (1-3 hours after a meal) • Mild nausea (vomiting may relieve symptom) • Bloody or tarry stools

9. Chest pain • Fatigue • Excessive burping • Poor appetite • Weight loss • Loss of energy • Chronic gastritis (stomach inflammation), frequently without symptoms • H. pylori infection is also known to cause gastric (stomach) cancer and has been reported in some studies to increase the risk of other types of cancer

10. Diagnosis/Tests • An esophagogastroduodenoscopy (EGD), is when a thin tube with a camera is inserted through your mouth to see your stomach and small intestine, during this a biopsy may be taken • Upper gastrointestinal (GI) series, are barium contrast x-rays • Blood, breath, and stool tests to check for H.pylori • Hemoglobin, a blood test to check for anemia

11. Treatment • While some ulcers heal spontaneously on their own, others can persist for months or recur and cause some serious complications such as bleeding or perforation • Peptic ulcers tend to come back if they’re untreated • Traditional treatment included medications to decrease stomach acid and production • Modern treatment is with antibiotics, acid suppressors and bismuth salts

12. No single bacterial agent alone can extinguish H.pylori infection, more than one antibiotic is used for successful treatment such as: clarithromycin, metronidazole, tetracycline, and amoxicillin, which are used in pairs at high doses • If you need to take pain relievers for health conditions, you should take them with a meal, and switch them to medicines such as: misoprostol and sucralfate (to protect lining tissue) • Combinations of these medications are taken for approximately 5-14 days • Proton pump inhibitors (PPI) such as omeprazole, lansoprazole, or esomeprazole, or H2 blockers may be used

13. Antacids and milk are only used to relieve pain not heal the ulcer • To prevent H.pylori infections, you should wash hands thoroughly after using the bathroom, and before eating • Also, eat food that has been washed well and cooked properly and drink water from a clean, safe source • If peptic ulcers don’t heal, keep coming back, bleed, or perforate the stomach or duodenal wall you may need surgery

14. Future Outlook/Research Hope Through Research: • National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) conducts and supports research into many kinds of digestive disorders, including peptic ulcers Scientists are working to identify: • Antibiotics that will treat H.pylori infection in less time • Antibiotic combinations that get rid of hard-to-treat infections • Ways that the H.pylori germ spreads and infects people • New pain relievers and medicines that offer the same benefits, but that won’t cause ulcers • New medications to increase protection of the lining tissue

15. Reference Page National Digestive Diseases Information Clearing House. (2010). Digestive Diseases. Retrieved: April 11, 2011 from http://digestive.niddk.nih.gov/ diseases/pubs/pepticulcers.ez/ National Center for Biotechnology Information. (2009). Peptic Ulcer. Retrieved: April 4, 2011 from http://www.ncbi.nlm.nih.gov/pubmedhea lth/PMH0001255/ Centers for Disease Control and Prevention. (2010) Research. Retrieved: April 29, 2011 from http://www.cdc.gov/ulcer/history.htm Frey, R.J.(2009). Ulcers.Encyclopedia of Diseases and Disorders. (Volume 5, pp. 1147-1153). Detroit, MI: Gale. Engel, June. (1993). Peptic Ulcers: Digesting More Than Food. Toronto, ON: Key Porter Books.

16. Images: http://www.fullissue.com/index.php/peptic-ulcer-disease.html http://www.anytimehealth.com/fact-sheets/449-Gastritis http://www.patienthealthinternational.com/gerd/502007/?itemId=1620485 http://coursewareobjects.elsevier.com/objects/pathophysiologymccance6e _v1/mod18/18l0124.html