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Peptic Ulcer Disease
Peptic ulcer disease (PUD) is a very common ailment, affecting one out of
eight persons in the United States. The causes of PUD have gradually
become clear. With this understanding have come new and better ways
to treat ulcers and even cure them.
Anatomy and Function of the Stomach
The stomach produces a very strong acid. This acid helps digest and break
down food before it enters the small intestine (duodenum). The lining of
the stomach is covered by a thick protective mucous layer which prevents
the acid from injuring the wall of the stomach.
What Causes Peptic Ulcers?
An ulcer is an open sore in the lining of the stomach or intestine,
much like mouth or skin ulcers. Peptic ulcers are eventually caused
by acid and pepsin, a digestive stomach enzyme. These ulcers can
occur in the stomach, where they are called gastric ulcers.
Or they can occur in the first portion of the intestine.
These are called duodenal ulcers.
In other words, it is acid that causes the injury to the stomach or bowel lining. However, a revolutionary and startling recent discovery is that most peptic ulcers result from a stomach infection caused by the bacteria, Helicobacter pylori. Helicobacter Pylori
This funny-sounding name identifies the basic cause of most peptic ulcers,
excluding those caused by aspirin or arthritics drugs. This bacteria has
a twisted spiral shape and infects the mucous layer lining of the stomach.
This infection produces an inflammation in the stomach wall called gastritis.
The body even develops a protein antibody in the blood against it.
The bacteria is probably acquired from contaminated food or water. It is only after H. pylori bacteria injure the protective mucous layer of the stomach, that an ulcer develops. Aspirin and Arthritis Medications
Arthritis medications include ibuprofen(Advil), Feldene, Naprosyn,
Voltaren, Indocin, Aleve, Lodine, Aspirin, and many others,
can damage the mucous layer of the stomach. Gastric acid
causes the final injury to the stomach lining.
H.pylori and certain drugs are the two major factors that cause ulcers. In rare cases, a patient will produce very large amounts of gastric acid and develop ulcers. This condition is called Zollinger-Ellison syndrome. Finally, some people get ulcers from unknown reasons. Symptoms
Ulcers cause gnawing, burning pain in the upper abdomen.
These symptoms frequently occur several hours following a meal,
after the food leaves the stomach but while acid production is
still high. The burning sensation can occur during the night
and be so extreme as to wake the patient. Instead of pain,
some patients experience intense hunger or bloating.
Antacids and milk usually give temporary relief.
Other patients have no pain but have black stools,
indicating that the ulcer is bleeding. Bleeding is
a very serious complication of ulcers.
Diagnosis
Therapy of PUD has undergone profound changes. There are now very
effective medications to suppress and almost eliminate the
outpouring of stomach acid. These acid-suppressing drugs
have been dramatically effective in relieving symptoms
and allowing ulcers to heal. If an ulcer was caused by
aspirin or arthritics drug, then no subsequent treatment
is needed. Avoiding these drugs, should prevent ulcer recurrence.
The second major change in PUD treatment has been the discovery of the H.pylori infection. When this infection is treated with antibiotics, the infection, and the ulcer, do not come back. Increasingly, physicians are not just suppressing the ulcer with acid-reducing drugs, but they are also curing the underlying ulcer problem by getting rid of bacterial infection. If this infection is not treated, the ulcers invariably recur. There are a number of antibiotic programs available to treat H.pylori and cure ulcers. Working with the patient, the physician will select the best treatment program available. What else can be Done?
The factors discussed above have altered the approach to
ulcers in a dramatic way. Still, other factors are important:
Summary
A new era of peptic ulcer disease is at hand. A firm understanding
of how ulcers occur, new potent acid-suppressing drugs, and
the implications of H.pylori infection have revolutionized
the treatment of peptic ulcers. The future is indeed bright
for patients with peptic ulcer disease.
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