Peptic ulcer disease
Introduction
Peptic ulcer disease (PUD) is a common digestive disorder characterized by the occurrence of ulcers, or sores, in the lining of the stomach, lower esophagus, or upper part of the small intestine, known as the duodenum. These ulcers are typically caused by the erosion of the mucosal lining due to an imbalance between the digestive fluids in the stomach and duodenum.
Etiology
The primary causes of PUD are Helicobacter pylori (H. pylori) bacterial infection and the use of non-steroidal anti-inflammatory drugs (NSAIDs). Other factors such as smoking, alcohol consumption, stress, and certain dietary factors can also contribute to the development of PUD.
Helicobacter pylori
H. pylori is a gram-negative, microaerophilic bacterium that colonizes the stomach. It is responsible for the majority of peptic ulcers. The bacterium disrupts the protective mucous layer of the stomach and duodenum, allowing acid to get through to the sensitive lining beneath. This leads to inflammation and the formation of ulcers.
Non-steroidal anti-inflammatory drugs
NSAIDs, such as aspirin and ibuprofen, are another common cause of PUD. These drugs inhibit the production of prostaglandins, substances that help protect the stomach lining from the effects of acid. This increases the risk of damage to the stomach and duodenal lining, leading to ulcer formation.
Pathophysiology
The pathogenesis of PUD involves an imbalance between aggressive factors, such as gastric acid and pepsin, and defensive factors, including the mucus-bicarbonate barrier, prostaglandins, and blood flow to the gastric mucosa. When the balance is disrupted, ulcers can form.
Clinical Manifestations
The most common symptom of PUD is abdominal pain, often described as burning or gnawing. Other symptoms may include bloating, belching, nausea, vomiting, and weight loss. In severe cases, complications such as bleeding, perforation, and gastric outlet obstruction may occur.
Diagnosis
Diagnosis of PUD typically involves a combination of patient history, physical examination, and diagnostic tests. The gold standard for diagnosing PUD is endoscopy, which allows direct visualization of the ulcers. Other tests may include urea breath test, stool antigen test, and blood test for H. pylori.
Treatment
Treatment of PUD aims to relieve symptoms, heal ulcers, and prevent complications. This typically involves a combination of medications to reduce acid production, protect the lining of the stomach and duodenum, and eradicate H. pylori if present. Lifestyle modifications, such as avoiding NSAIDs, smoking cessation, and limiting alcohol intake, are also recommended.
Prognosis
With appropriate treatment, the prognosis for PUD is generally good. However, if left untreated, PUD can lead to serious complications, including bleeding, perforation, and gastric outlet obstruction.
Epidemiology
PUD is a common condition, affecting millions of people worldwide. It is more common in older adults and in populations with high prevalence of H. pylori infection.
Prevention
Prevention strategies for PUD include avoiding risk factors such as NSAIDs and smoking, and treating H. pylori infection when present.