Peptic ulcer disease refers to an erosion in the inner lining of the stomach or the first part of the small intestine called the duodenum. Specifically, these erosions penetrate as deep as the muscular layer of the gastrointestinal tract. The condition affects men and women equally with a lifetime prevalence of 10%.
Causes
Ulcers in the stomach and duodenum form because the inner mucus layer is disrupted. This allows stomach acid to erode the gastrointestinal wall further to the muscular layer. The resulting ulcers can be small (measurable in millimeters) or large (measurable in centimeters).
Two causes of peptic ulcers are very common. One is the bacterium Helicobacter pylori, which uses urease to neutralize stomach acid and induces local inflammation. The other is the family of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which can inhibit production of mucus necessary to protect the lining of the stomach and duodenum. Other causes of peptic ulcer disease include, but are not limited to, smoking, the stress of surgery, and significant illness.
Diagnosis
Patients with peptic ulcer disease may complain of upper abdominal (epigastric) pain with a burning quality. Interesting, food may be an alleviating or aggravating factor depending on the location of the ulcer. Classically, the pain of stomach (gastric) ulcers is worsened with food whereas the pain of duodenal ulcers is relieved with food. Other symptoms may include loss of appetite, vomiting as a result of obstruction of the gastric outlet, vomiting of blood (hematemesis) or black tarry stools (melena) from ulcer bleeding, and severe abdominal pain following perforation through the ulcer.
Diagnosis of peptic ulcer disease is confirmed with upper endoscopy in which the ulcer is visualized with a camera down the esophagus. During this procedure, a biopsy can be taken of the ulcer, which can be analyzed for the presence of H. pylori. Other tests are also available for detection of H. pylori, including testing of urea in breath, antibodies, and fecal antigens.
Treatment
Treatment of peptic ulcer disease requires removal of the cause. Smoking and NSAIDs should be stopped if they are identified as likely causative factors. If H. pylori is involved, treatment involves a proton-pump inhibitor medication, such as omeprazole (Prilosec), and two antibiotics, which may include clarithromycin, amoxicillin, or metronidazole. Surgery, less commonly performed as a result of improved medication regimens for H. pylori, is generally reserved for cases of perforated ulcers.
