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. "Peptic Ulcer" is the term used to
describe either or both of these two types of ulcers.
In the end, 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 (H. pylori)
This
funny-sounding name identifies the basic cause of most peptic ulcers, excluding
those caused by aspirin or arthritis 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 from a drinking glass. It is only after H.
pylori bacteria injure the protective mucous layer of the stomach, allowing
damage by stomach acid, that an ulcer develops.
Aspirin and Arthritis Medications
Arthritis medications include ibuprofen (Advil), Feldene, Naprosyn, Voltaren,
Indocin, Aleve, Lodine, and many others. As with aspirin, they can damage the
mucous layer of the stomach, after which the stomach acid causes the final
injury.
So, H. pylori and certain drugs are the two major factors that cause ulcers.
In rare cases, a patient will produce very large amounts of acid and develop
ulcers. This condition is called Zollinger -Ellison syndrome. Finally, some
people get ulcers for 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
A diagnosis of peptic ulcers can be suspected from the patient's medical
history. However, the diagnosis should always be confirmed either by an upper
intestinal endoscopy, which allows direct examination of the ulcer or by a
barium x-ray of the stomach. Rarely an ulcer can be malignant. With endoscopy, a
biopsy specimen can be obtained to determine if this is so.
Treatment
Therapy of PUD has undergone profound changes. There are now available very
effective medications to supress and almost eliminate the outpouring of stomach
acid. These acid-suppresssing drugs have been dramatically effective in
relieving symptoms and allowing ulcers to heal. If an ulcer has been caused by
aspirin or an arthritis drug, then no subsequent treatment is usually needed.
Avoiding these latter 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 the 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:
Caffeine and Alcohol - Both of these stimulate the secretion of stomach
acid and should be avoided in the acute phase of an ulcer.
Cigarettes - Nicotine will delay the healing of an ulcer. There are
many good reasons to stop cigarette smoking. Healing an ulcer is one of them.
Antacids - These agents, purchased over the counter, can be used for
relief of peptic ulcer symptoms. Except for bismuth (Pepto Bismol),which
actually is used as one of the antibiotics, they do not help heal ulcers.
Stress - In the past, stress and emotion were felt to be a major
cause of ulcers. Now it is known that, by itself, stress rarely causes an
ulcer although it probably can aggravate the symptoms.
Surgery - Surgery used to be a major form of ulcer treatment. Now,
it is the exceptional patient who needs surgery for an ulcer complication such
as perforation, obstruction, or uncontrolled hemorrhaging.
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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