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What causes peptic ulcer?

BY: Enoch Darfah Frimpong

Dear Mirror Doctor, I am a 39-year-old working in one of the financial institutions. I have been having recurrent episodes of severe stomach pains, especially when hungry.
I consulted a general practitioner and he diagnosed peptic ulcer.

Please doctor, Can you tell me about the peptic ulcer disease and what brings it on? How can I prevent this condition?
Akweley, D.C.

Dear Akweley, Peptic ulcer disease (PUD) is an erosion of the lining of the intestinal tract. Normally, there are cells in the lining of the intestinal tract that secrete protective mucus.

Certain glands in the lining of the stomach secrete acid and some enzymes to help break down food for digestion.

Without the protective mucus, the acid quickly eats away the stomach and the first part of the small intestine connected directly to the stomach (duodenum).

When damaging influences overcome this protective mucus in the stomach or duodenal lining, the tissue in the stomach becomes eroded and an ulcer forms.

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Peptic ulcers are typically found in the lower half of the stomach or the first part of the duodenum. Ulcers of the lower esophagus occur when there is reflux of acid from the stomach.

Although rare, ulcers may occur in the lower part of the small intestine (jejunum or ileum) when a large amount of gastric acid is produced in the stomach.

The majority of peptic ulcers are caused by an infection of the stomach with a bacterial species called Helicobacter pylori, and about 25 per cent of cases are caused by irritation of the stomach lining by aspirin or nonsteroidal anti-inflammatory drugs (NSAID's).

Some individuals may have a genetic predisposition toward developing peptic ulcers. Although psychological stress and excessive alcohol use may aggravate an existing ulcer, there is no evidence that they can cause peptic ulcers.

Epigastric pain is the most common symptom of peptic ulcers. It is characterised by a gnawing or burning sensation and occurs after meals. In uncomplicated PUD, the clinical findings are few and nonspecific.

“Alarm features" that warrant prompt evaluation include, bleeding, anaemia, early fullness, unexplained weight loss, progressive painful swallowing, recurrent vomiting, and family history of stomach cancer.

Patients with perforated PUD usually present with a sudden onset of severe, sharp abdominal pain.

In most patients with uncomplicated PUD, routine laboratory tests usually are not helpful; instead, documentation of PUD depends on X-ray and endoscopic (use of a telescope to visualise the ulcer) confirmation.

Testing for H pylori infection is essential in all patients with peptic ulcers. This could be done on blood or on faeces. The fecal antigen testing is more accurate than antibody testing.

Endoscopy is the preferred diagnostic test in the evaluation of patients with suspected PUD. It provides an opportunity to visualise the ulcer, to determine the presence and degree of active bleeding, and to attempt to stop the bleeding by direct measures, if required.

Endoscopy is done early in patients between 45 and 50 years and in patients with associated so-called alarm features.

Most patients with PUD are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of medicines to reduce acid production in the stomach.

The recommended primary therapy for H pylori infection is called triple therapy. These regimens result in a cure of infection and ulcer healing in approximately 90 per cent of cases. Ulcers can recur in the absence of successful H pylori eradication.  

In patients with NSAID-associated peptic ulcers, discontinuation of NSAIDs is paramount, if it is clinically feasible. Sometimes surgery is done for patients with PUD.

The indications for urgent surgery include failure to achieve stoppage of a bleeding ulcer endoscopically, recurrent bleeding despite endoscopic attempts to stop the bleeding and perforation.

Patients with stomach ulcers are also at risk of developing stomach cancer.

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