- What is Peptic Ulcer Disease?
Gastric and duodenal ulcers are breaks in the gastric and duodenal mucosa. Both gastric and duodenal ulcers relate to the corrosive action of pepsin and
hydrochloric acid on the mucosa of the upper gastrointestinal tract. Ulcers generally range between 3 mm and several centimeters in diameter.
Peptic Ulcer Disease: Causes
“No gastric acid, no peptic ulcer” is a misconception. Excessive gastric acid secretion is only one factor in the pathogenesis of peptic ulcer disease. Decreased mucosal defense against gastric acid is another cause. The integrity of the upper gastrointestinal tract is dependent upon the balance between “hostile” factors such as gastric acid, H. pylori, NSAIDs and pepsin, and “protective” factors such as prostaglandins, mucus, bicarbonate, and blood flow to mucosa affecting gastrointestinal mucosa.
H. pylori is the etiologic factor in most patients with peptic ulcer disease and may predispose individuals to the development of gastric carcinoma. H. pylori colonizes
in the human stomach . The method of H. pylori transmission is unclear, but seems to be person-to-person spread via a fecal-oral route. The prevalence of H. pylori in adults appears to be inversely related to the socioeconomic status. It is also thought that water is a reservoir for transmission of H. 2)pylori.
3)Gastrinoma (Zollinger-Ellison Syndrome)
8)Alcohol and Diet
- Therapy Overview
- Mostpeptic ulcers heal if gastric acid production is adequately suppressed. The rationale behind the treatment of peptic ulcer disease is twofold. The reduction of hostile factors is essential, as is augmentation of protective factors. Antacids, histamine H2-receptor antagonists, proton pump inhibitors (e.g., omeprazole,
lansoprazole), and surgery succeed by neutralization or reduction of gastric acid. Sucralfate and prostaglandin agents boost mucosal protection. The eradication of H.pylori infection restores normal mucosal resistance, but unlike other treatment options, does not require maintenance therapy to prevent ulcer recurrence.Patients should avoid factors known to contribute to peptic ulcer disease, such as NSAIDs and smoking.
The goal of therapy for peptic ulcer disease is to relieve symptoms, heal craters, prevent recurrences, and prevent complications. Medical therapy should include treatment with drugs, and attempt to accomplish the following:
1) reduce gastric acidity by mechanisms that inhibit or neutralize acid secretion,
2) coat ulcer craters to prevent acid and pepsin from penetrating to the ulcer base,
3) provide a prostaglandin analog,
4) remove environmental factors such as NSAIDs and smoking, and 5)reduce emotional stress (in a subset of patients).Antacids neutralize gastric acid and are more effective than placebo in healing gastric and duodenal ulcers. However, antacids have to be taken in relatively large doses 1 and 3 hours after meals and at bedtime, and may cause side effects. The major side effect of magnesium-containing antacids is diarrhea caused by magnesium hydroxide.
Note: Don’t take any medicine without consulting with your physician.