PEPTIC ULCER DISEASE (PUD)-Causes, Clinical features, Diagnosis, Treatment, and Diet

Introduction

An ulcer is the discontinuation of a surface or inner lining of the cavity (Stomach or Duodenum etc)

Peptic ulcer disease includes ulcers in the lower esophagus, stomach and duodenum.

Chronic gastric ulcer is usually situated on the lesser curve within the antrum or at the junction between the body and antral mucosa.

The chronic duodenal ulcer usually occurs in the first part of the duodenum and 50% are on the anterior wall.

In modern societies, ulcer become a very common health disorder, no doubt because of our modern living denied the importance of healthy eating, it is the root cause of all health problems.

 

What are the causes and risk factors of Peptic ulcer disease?

Risk Factors and Causes

• The most common cause of ulcer disease is the Helicobacter pylori bacterium.
• NSAIDs (Non-Steroidal Anti-inflammatory  Drugs) are the second most common such as ASPIRIN

NSAIDs inhibit the production of Prostaglandin, a major stimulant for mucous production in the stomach that forms the protective barrier hence leading to ulcer formation by acid.

• Tobacco smoking
• Alcohol
• Stress
• Spicy foods

What clinical features a patient with PUD can get?

 Clinical Features

• Recurrent Epigastric pain

Pain due to Gastric ulcer is aggravated with food

Pain due to Duodenal ulcer is relieved with food

• Nausea and vomiting
• Heartburn and Bloating
• Melena (dark stools)
• Weight loss (unexplained)
• Abdomen tenderness occasionally  

Diagnosis

• Upper endoscopy with biopsy (best diagnosis)
• Serology (sensitive)
• Urea breath test
• Stool antigen test
• Microbiological Culture

 

Urea breath test, stool antigen test, and serology don’t perform in patients who are taking Proton pump inhibitors and antibiotics. Testing for H. pylori can result in false-negatives.

Treatment

If H. pylori is positive treat with Eradication Therapy which includes:

• Proton pump inhibitors (PPIs) (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, dexlansoprazole) combined with Clarithromycin and amoxicillin.
• This combination is effective in >90% of patients. The other two choices of antibiotics are Tetracycline and Metronidazole.

If H. pylori is negative treat with Acid Suppression Therapy which includes:

• Proton pump inhibitors (PPIs)
• Discontinue ASPIRIN or NSAIDs
• Smoking cessation

What if a patient doesn't recover from drug therapy?

Most patients recover from medical treatment, rare cases of chronic non-healing gastric ulcers require Partial gastrectomy (ulcer bearing area is resected).

What complications can occur due to PUD?

Complications

• Upper gastrointestinal bleeding
• Perforation
• Gastric obstruction
• Gastric cancer

What type of food to take or to avoid in ulcers?

Diet

Food to take in ulcers:

• Honey: helps to heal the ulcers
• Cabbage Juice: rich in vitamin C, antioxidants, and has an antibiotic effect against H.pylori.
• Aloe vera: reduces acid production
• Garlic: have anti-inflammatory and antibiotic effects. 
• Yogurt: helps in healing the ulcers
• Tumeric: anti-inflammatory effects
• Boiled vegetables except for potato

Food to avoid in ulcers:

• Alcohol: an ulcer irritant
• Fried foods: decrease gastric emptying results in the worsening of ulcers. 
• Caffeine (tea and coffee) and chocolate: These increase acid production
• Fatty food: takes more time to digest
• Salty Food: increases the bacterial growth
• Spicy food
• Citrus fruits and juices: lemon, Grapefruit, Tomatoes, they aggravate acid production

Have a great and healthy life ahead