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Encyclopedia > Peptic ulcer disease

Peptic ulcer is a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). By far most instances are now known to be due to Helicobacter pylori, a spiral-shaped bacterium that lives in the acid environment of the stomach. These ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs. An ulcer (from Latin ulcus) is an open sore of the skin, eyes or mucous membrane, often caused by an initial abrasion and generally maintained by an inflammation and/or an infection. ... In anatomy, the stomach (in ancient Greek στόμαχος) is an organ in the alimentary canal used to digest food. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube that connects the stomach to the jejunum. ... Binomial name Helicobacter pylori (Warren & Marshall, 1983) Helicobacter pylori is a bacterium that infects the mucus lining of the human stomach. ... A very old bottle of Aspirin Aspirin or acetylsalicylic acid is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ...

Contents


Signs and symptoms

Symptoms of a peptic ulcer can be:

  • Abdominal pain;
  • Hematemesis (vomiting blood);
  • Melena (tarry feces due to oxidised iron from hemoglobin);
  • Weight loss;
  • Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer are NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase 1, and most glucocorticoids (e.g. dexamethasone). Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Hematemesis or haematemesis is the vomiting of fresh red blood. ... In medicine, melaena or melena is the passage of black tarry motions per rectum. ... The most fundamental reactions in chemistry are the redox processes. ... 3-dimensional structure of hemoglobin Hemoglobin or haemoglobin (frequently abbreviated as Hb, PDB 1A3N) is the iron-containing oxygen-transport metalloprotein in the red cells of the blood in mammals and other animals. ... Gastroesophageal Reflux Disease (GERD, or GORD when -oesophageal, the BE form, is substituted) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Cyclooxygenase (COX) is an enzyme that is responsible for formation of important biological mediators called prostanoids (including prostaglandins, prostacyclin and thromboxane). ... Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... Dexamethasone is a synthetic member of the glucocorticoid class of hormones. ...


In patients over 45 with more than 2 weeks of the above symptoms the odds for peptic ulceration are high enough to warrant rapid investigation by EGD (see below).


In earlier times it was thought that the timing of the symptoms in relation to the meal could differentiate between gastric and duodenal ulcers: a gastric ulcer would give pain during the meal, as gastric acid was secreted, while duodenal ulcers would only hurt after the meal — when acidic chyme was passed down to the duodenum. This theory has not been proved in practice. Gastric acid is, together with several enzymes and the intrinsic factor, one of the main secretions of the stomach. ... Chyme is the liquid substance found in the stomach before passing the pyloric valve and entering the duodenum. ... In anatomy of the digestive system, the duodenum is a hollow jointed tube that connects the stomach to the jejunum. ...


Diagnosis

In patients in whom peptic ulcer is suspected, esophagogastroduodenoscopy (EGD, a form of endoscopy) is indicated. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis. In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ... Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ...


The diagnosis of Helicobacter pylori can be by: Binomial name Helicobacter pylori (Warren & Marshall, 1983) Helicobacter pylori is a bacterium that infects the mucus lining of the human stomach. ...

  • Biopsy during EGD;
  • Breath testing (does not require EGD);
  • Direct culture from an EGD biopsy specimen;
  • Direct detection of urease activity in a biopsy specimen;
  • Measurement of antibody levels in blood (does not require EGD). It is still slightly controversial whether a positive antibody without EGD is enough to warrant eradication therapy.

The possibility of other causes of ulcers, notably malignancy (gastric cancer) needs to be kept in mind. This is especially true in ulcers of the large curvature of the stomach; most are also a consequence of chronic H. pylori infection. Urease (EC 3. ... Schematic of antibody binding to an antigen An antibody is a protein used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ... Red blood cells (erythrocytes) are present in the blood and help carry oxygen to the rest of the cells in the body Blood is a circulating tissue composed of fluid plasma and cells (red blood cells, white blood cells, platelets). ... When normal cells are damaged or old they undergo apoptosis; cancer cells, however, avoid apoptosis. ... In medicine, stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs. ... In anatomy, the stomach (in ancient Greek στόμαχος) is an organ in the alimentary canal used to digest food. ...


Pathophysiology

Classical causes of ulcers (tobacco smoking, blood groups, spices and a large array of strange things) are of relatively minor importance in the development of peptic ulcers. 1: cigar box 2: cigar 3: various pipes 4: waterpipe 5: joss stick 6: bong Various smoking equipment including different pipes, and cigars. ... A blood type is a description an individuals characteristics of red blood cells due to substances (carbohydrates and proteins) on the cell membrane. ... S.P.I.C.E. - SouthFlorida People Involved in Consensual Endeavors. A not for profit BDSM / Fetish support and educational organization based in southeast Florida. ...


A major causative factor (90% of gastric and 75% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori, a spirochaete that inhabits the antral mucosa and increases gastrin production. Gastrin, in turn, stimulates the production of gastric acid by parietal cells. Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... Binomial name Helicobacter pylori (Warren & Marshall, 1983) Helicobacter pylori is a bacterium that infects the mucus lining of the human stomach. ... Families Brachyspiraceae Leptospiraceae Spirochaetaceae The spirochaetes are a phylum of distinctive bacteria, which have long, helically coiled cells. ... In humans, gastrin is a hormone that stimulates secretion of gastric acid by the stomach. ... In humans, gastrin is a hormone that stimulates secretion of gastric acid by the stomach. ... Gastric acid is, together with several enzymes and the intrinsic factor, one of the main secretions of the stomach. ...


Another major cause is the use of NSAIDs (see above). The gastric mucosa protects itself from gastric acid with a layer of prostaglandins. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins. Newer NSAIDs (celecoxib, rofecoxib) only inhibit cox-2, which is less essential in the gastric mucosa, and roughly halve the risk of NSAID-related gastric ulceration. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... Gastric acid is, together with several enzymes and the intrinsic factor, one of the main secretions of the stomach. ... A prostaglandin is any member of a group of lipid compounds that are derived from fatty acids and have important functions in the animal body. ... Cyclooxygenase (COX) is an enzyme that is responsible for formation of important biological mediators called prostanoids (including prostaglandins, prostacyclin and thromboxane). ... Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) used in the treatment of osteoarthritis, rheumatoid arthritis, acute pain, painful menstruation and menstrual symptoms, and to reduce numbers of colon and rectum growths polyps in patients with familial adenomatous polyposis. ... Rofecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that was used in the treatment of osteoarthritis, acute pain conditions, and dysmenorrhoea. ...


Glucocorticoids lead to atrophy of all epithelial tissues. Their role in ulcerogenesis is relatively small. Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... In zootomy, epithelium is a tissue composed of a layer of cells. ...


Stress in the psychological sense has not been proven to influence the development of peptic ulcers. Burns and head trauma, however, can lead to "stress ulcers", and it is reported in many patients who are on mechanical ventilation. Evolution of a 2nd degree burn — One hour Evolution of a 2nd degree burn — One day Evolution of a 2nd degree burn — two days This article describes a type of injury. ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ... ventilation balloon In medicine, mechanical ventilation method to assist or replace spontaneous breathing. ...


Smoking leads to atherosclerosis and vascular spasms, causing vascular insufficiency and promoting the development of ulcers through ischemia. 1: cigar box 2: cigar 3: various pipes 4: waterpipe 5: joss stick 6: bong Various smoking equipment including different pipes, and cigars. ... In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ...


A family history is often present in duodenal ulcers, especially when blood group O is also present. Inheritance appears to be unimportant in gastric ulcers. In medicine, a family history consists of information about disorders that a patients direct blood relatives have suffered from. ... A blood type is a description an individuals characteristics of red blood cells due to substances (carbohydrates and proteins) on the cell membrane. ...


Macroscopically: Gastric ulcer is most often localized on the lesser curvature of the stomach. It is a round to oval parietal defect ("hole"), 2 to 4 cm diameter, with a smooth base and perpendicular borders. These borders are not elevated or irreguliar as in gastric cancer - ulcerative form. Surrounding mucosa may present radial folds, as a consequence of the parietal scarring.


Microscopically: Gastric peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and muscularis propria, produced by acid-pepsin aggression. Ulcer margins are perpendicular and present chronic gastritis. During the active phase, the base of the ulcer shows 4 zones: inflammatory exudate, fibrinoid necrosis, granulation tissue and fibrous tissue. The fibrous base of the ulcer may contain vessels with thickened wall or with thrombosis. 1


Epidemiology

In Western countries the prevalence of Helicobacter pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80 etc). Prevalence is higher in third world countries. Transmission is by food and human contact, sharing food utensils etc. The prevalence of a disease in a statistical population is defined as follows: Prevalence is useful because it is a measure of the commonality of disease. ... Binomial name Helicobacter pylori (Warren & Marshall, 1983) Helicobacter pylori is a bacterium that infects the mucus lining of the human stomach. ... An infection is the detrimental colonization of a host organism by a foreign species. ... For the Jamaican reggae band, see Third World (band). ...


A minority of cases of Helicobacter infection will eventually lead to an ulcer and a larger proportion of people will get non-specific discomfort, abdominal pain or gastritis. Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. ... Gastritis is a medical term for inflammation of the lining of the stomach. ...


Treatment

Younger patients with ulcer-like symptoms are often treated with antacids or H2 antagonists before EGD is undertaken. Bismuth compounds may actually reduce or even clear organisms. An antacid is any substance that counteracts stomach acidity. ... An H2-receptor antagonist, often shortened to H2-antagonist, is a drug used to block the action of histamine on parietal cells in the stomach, decreasing acid production by these cells. ... General Name, Symbol, Number bismuth, Bi, 83 Chemical series poor metals Group, Period, Block 15, 6, p Appearance lustrous reddish white Atomic mass 208. ...


When H. pylori infection is present, the most effective treatments are combinations of antibiotics (Erythromycin, Ampicillin, Tetracycline, Metronidazole) and proton pump inhibitors (PPI). In the absence of H. pylori, long-term higher dose PPIs are often used. Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar or slightly wider to that of penicillin, and is often used for people who have an allergy to penicillins. ... Ampicillin (C16H18N3O4S) Ampicillin (C16H18N3O4S ; CAS No. ... This article deals with the specific Tetracycline antibiotic. ... Metronidazole is an antibiotic and antiparasitic drug classified as a nitroimidazole. ... Proton pump inhibitors are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid production. ...


Treatment of Helicobacter usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics.


External links

  • Image of Gastric ulcer


Health science - Medicine - Gastroenterology
Diseases of the esophagus - stomach
Halitosis - Nausea - Vomiting - GERD - Achalasia - Esophageal cancer - Esophageal varices - Peptic ulcer - Abdominal pain - Stomach cancer - Functional dyspepsia
Diseases of the liver - pancreas - gallbladder - biliary tree
Hepatitis - Cirrhosis - NASH - PBC - PSC - Budd-Chiari syndrome - Hepatocellular carcinoma - Pancreatitis - Pancreatic cancer - Gallstones - Cholecystitis
Diseases of the small intestine
Peptic ulcer - Intussusception - Malabsorption (e.g. celiac disease, lactose intolerance, fructose malabsorption, Whipple's disease) - Lymphoma
Diseases of the colon
Diarrhea - Appendicitis - Diverticulitis - Diverticulosis - IBD (Crohn's disease and Ulcerative colitis) - Irritable bowel syndrome - Constipation - Colorectal cancer - Hirschsprung's disease - Pseudomembranous colitis

  Results from FactBites:
 
Peptic Ulcer Disease (470 words)
A peptic ulcer is an open wound or raw area on the lining of the upper part of the small intestine (duodenal ulcer) or the stomach (gastric ulcer).
Ulcers develop when an imbalance occurs between the digestive juices used by the stomach to break down food and the various factors that protect the lining of the stomach and duodenum.
PUD was once thought to be caused by stress, spicy food and alcohol and the treatment was bedrest and a bland diet.
  More results at FactBites »

 
 

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