Peptic ulcers are sores that develop in the upper portion of the small intestine, lower esophagus, or in the lining of the stomach (Marks, 2016). It includes gastric ulcers and duodenal ulcers. Usually, peptic ulcers are formed as a result of inflammation caused by the bacteria H. pylori. H pylori which are a common type of bacteria that is found in the digestive tract and tends to attack the lining of the stomach (Marks, 2016). It also occurs when the lining of the stomach, esophagus, and stomach is eroded by stomach acids through the frequent use of anti-inflammatory drugs such as aspirin (Bayer) and ibuprofen (Advil). Other causes include drinking too much alcohol, smoking, stomach ulcer, and radiation therapy.
The most common symptom of peptic ulcer is stomach pain, which is worsened by stomach acids and can be worse especially between meals and at night. Taking an acid-reducing medication or eating certain food that buffer stomach acid can help relieve the pain, but it may come back. Approximately three-thirds of individuals with peptic ulcers do not show any signs and symptoms. However, sometimes it can result in severe signs and symptoms like; difficulty swallowing food, loss of appetite, feeling unwell after eating, weight loss, nausea or vomiting, and feeling faint. It is advisable to see a doctor in case an individual shows the symptoms listed above.
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Physicians can conduct a physical exam to diagnose a peptic ulcer. Doctors often check for bloating in the patient’s abdomen during the physical exam. They use a stethoscope to listen to sounds within the abdomen by tapping it to check for tenderness and pain. Physicians also will conduct lab tests, such as blood tests, urea breath tests, and stool tests, to check for H. pylori infection. To carry out the blood test, the physician draws blood from the patient and test the sample to see if the test results fall within the normal range for the different infections or disorders. To conduct the urea test, the patient is given a special liquid that contains urea to drink, a waste product produced by the body as it breaks down protein. The bacteria will change this waste product into carbon dioxide if H. pylori are present. The doctor will then take a sample of the patient’s breath and take it to the lab for testing. Higher levels of carbon dioxide in the breath than the normal indicates that the patient has H. pylori in his or her small intestine or stomach. To conduct the stool test, physicians study a sample of a patient’s stool. The doctor takes a stool sample to the lab for testing and analysis. Stools can show the presence of H. pylori.
Other diagnostic protocols include radiological diagnosis and endoscopic diagnosis. Doctors use an endoscope to see inside of the upper gastrointestinal (GI) tract. A small camera attached to the endoscope sends a message to the monitor. Through this, the lining of the GI tract can be examined. The physician may also perform a biopsy. A small sample of tissue from the lining of the esophagus will be taken to be examined in the lab. Radiologists can perform an x-ray. The patient will be given barium to drink to enhance the output of the x-ray images. This is because the barium coats the organs making them be seen more clearly on the x-rays.
Treatment of peptic ulcer aims at relieving pain, healing the ulcer, and preventing further complications. It involves two steps; reduction of risk factors (NSAIDs and Cigarettes) and medications. The type of treatment usually depends on the cause of peptic ulcer and focusses mainly on either eradicating the H. pylori or lowering the acid levels in the stomach. For instance, the use of proton pump inhibitors (PPIs) reduces the level of stomach acid and are given to a patient who tests negative for H. pylori (Mayo Clinic, N.d) . The patients may also be given antibiotics like amoxicillin, tetracycline, tinidazole, and metronidazole. If the ulcer comes from non-steroidal anti-inflammatory drugs (NSAIDs), the patient is not advised to take antibiotics. Alternatively, they will be given acetaminophen. The doctor may minimize the dosage as well as review the patient’s need for them later if he/she cannot stop taking NSAIDs. Dietary and lifestyle changes can be made, and if symptoms persist, the doctors have to prescribe H2 receptor antagonists and low-dose PPI. The physician may also prescribe a medication called cytoprotective agents that will protect the lining of the small intestine and stomach (Mayo Clinic, N.d). In severe cases with bleeding, the bleeding at the ulcer site will have to be stopped through an endoscopy.
Peptic ulcer is a serious medical problem. Each year, 500, 000 new cases of peptic ulcer are reported in the US and statistics indicate that approximately 5 million people are infected in the United States (US News, 2009). A research done by Katz (2018) indicate that the mortality rate for peptic ulcer disease has reduced significantly in the last few years, is approximately one death per 100,000 cases. Katz also indicates that the use of intravenous PPIs after successful endoscopic therapy has significantly decreased the mortality rate.
According to Stabile and Passaro (1976), peptic ulcer is more recurrent in male patients. “Recurrent ulceration at or near the anastomosis development is approximately 5% of patients after surgery” (Stabile and Passaro, 1976). Depending on the type of peptic ulcer the recurrence rate can vary. For instance, Stabile and Passaro indicate that the recurrent rate for a patient who has undergone surgical procedures for duodenal ulcers is 95% whereas that for a gastric ulcer is between 2 and 4%.
References
Katz, P. (2018). What is the Mortality Rate for Peptic Ulcer Disease (PUD)? [Online]. Available at: https://emedicine.medscape.com/article/181753-overview#a3 .
Marks, J. (2016). Peptic Ulcer Disease (Stomach Ulcer) Symptoms, Causes, Treatment, and Diet. [Online]. Available at: https://www.medicinenet.com/peptic_ulcer/article.htm#proton-pump_inhibitors_ppis .
Stabile, B., and Passaro, Edward. (1976). Progress in Gastroenterology. [Online]. Available at: https://www.gastrojournal.org/article/S0016-5085(76)80415-5/pdf .
US News. (2009). Peptic Ulcer. [Online]. Available at: https://health.usnews.com/health-conditions/digestive-disorders/peptic-ulcer/overview .
