Introduction
Ulcer is a term that refers to denudation of the epithelium. A peptic ulcer refers to a sore formed in the GIT lining due to the corrossive effect of digestive juices. In PUD, there is discontinuation of the inner gastro-intestinal tract lining. This occurs due to secretion of pepsin or gastric acid. The sites/regions affected are the lower esophagus, stomach and the duodenum.
Epidemiology
PUD is a condition that affects individuals from across the whole world.
Lifetime risk of development ranges between 5-10%.
Researchers have estimated that in 2019, 8.1% of the global population had at least one peptic ulcer.
Generally, the incidence of PUD has declined globally. Several factors contribute to the decrease
These are;
- Improvement in sanitary conditions.
- Careful use of NSAIDs.
It should be noted that apart from duodenal ulcers being more common among men than in women, it is also four times more common than gastric ulcers.
Types
- Duodenal ulcers
- Gastric/ Stomach ulcers
- Esophageal ulcer
- Jejunal ulcer
Risk Factors
- Sex- PUD is more common in people assigned male at birth
- Smoking
- Drinking alcohol
- Stress
- Spicy foods
Causes
Most common causes of PUD are;
- Microbes such as bacteria. The specific bacteria implicated in peptic ulcers is Helicobacter pylori
- Chronic use of medications such as NSAIDs. Non-Steroidal Anti-Inflammatory Drugs such as asprin. These can cause ulcers when taken on a regular basis
Rare causes include;
- Genetics
- Consuming alcoholic drinks
- Use of corticosteroids
- Radiotherapy
- Chemotherapy
- Ischaemia and vascular insufficiency
- Stress due to acute illness and burns
- Zollinger-Ellison syndrome
- Crohn’s disease
- Malignancies such as Stomach cancer, lymphomas and cancer of the lungs
- Smoking
Signs & Symptoms
- Epigastric pain which occurs in less than half an hour after intake of food in patients with gastric ulcer or after 2 hours in patients with duodenal ulcers
- Nausea
- Intolerance to fatty foods
- Heartburn
- Bloating
- Trouble breathing
- Vomiting red or black blood
- Feeling of faintness
- Changes in appetite
Complications
- Perforation of stomach wall
- Bleeding internally
- Penetration
- Gastric cancer
- Gastric outlet obstruction
Diagnosis & Tests
- Proper history-taking.
- Physical examination which may show abdominal tenderness and signs of anaemia.
- Investigative tests;
- H.pylori test
- Endoscopy examination
- Endoscopic biopsy
- Serology
- Urea breath test
- Check for antibodies to H.pylori
- Stool antigen test
- Urine-based ELISA (enzyme-linked immunosorbent assay) test
- Stomach biopsy for test for H.pylori .This biopsy can be taken during an endoscopy.
- Computer tomography scan
- Gastrointestinal series X-ray exam
- Esophagogastroduodenoscopy- EGD
- Barium swallowing. This test is conducted when Esophagogastroduodenoscopy is contra-indicated.
Differential Diagnosis
Conditions that can present with signs and symptoms related to PUD are;
- GERD, which is gastro-esophageal reflux disease.
- Gastric cancer
- Pancreatitis
- Biliary colic
- Gastritis
Treatment & Management
- Proton pump inhibitors such as omeprazole, esomeprazole, lansoprazole, rabeprazole
- Cytoprotective agents such as sucralfate, bismuth subsalicylate, misoprostol. Misoprostol is contraindicated in pregnancy.
- Histamine receptor antagonists/ H2 blockers such as famotidine and ranitidine
- Surgery in cases of bleeding
- Antibiotics for H.pylori;
- Tripple therapy; Rifabutin, Amoxicillin and Omeprazole.
- Quadrupple therapy; Colloidal bismuth salicylate, Metronidazole, Tetracycline, and Omeprazole(PPI)
Prevention
- Early treatment of infections such as H.pylori infection.
- Proper use of NSAIDs.
- NSAID alternatives such as paracetamol.
- Diet. Avoid fast foods and fried foods.