Peptic ulcer is a general term applied to ulcer of the digestive tract. It mainly occurs in the stomach (gastric ulcer) and upper small intestine (duodenal ulcer).
Peptic ulcer is a common disease. Approximately 10 - 20% of persons suffer from an ulcer at some stage of their life.
Causes
Peptic ulcer is a result of the combined action of acid and pepsin (a digestive enzyme) on the stomach or intestinal wall. The acid acts to produce a pH where pepsin is active.
An ulcer may be due to excess acid secretion or to some defect in the mucosal layer of the digestive tract. The mucosal defect is poorly understood, but the bacteria, Helicobacter pylori is believed to have a relevant role.
Classification of Ulcers
Peptic ulcer may be acute or chronic. An acute ulcer usually only involves the very top layer of the mucosal surface. It is of sudden onset, and heals within a few weeks. Symptoms are often trivial or absent. However, an acute ulcer may erode a blood vessel and cause bleeding and on occasions penetrate through the stomach wall and cause perforation. An acute ulcer may also progress to become chronic.
A chronic ulcer penetrates various distances through the stomach/intestinal wall. Its course is characterised by exacerbation (periods where symptoms occur daily, or several times each day) followed by remissions (periods of weeks, months or even years, when the patient is symptom free). A patient with chronic ulcer generally has 2 to 3 exacerbation each year.
Diagnosis of an Ulcer
Before treatment, an ulcer must be firmly diagnosed, especially in patients over 40 years of age. This involves endoscopy in the case of a duodenal ulcer and barium meal or endoscopy in the case of a gastric ulcer.
Endoscopy involves the insertion of a long tube with a monitor at the end of it into the stomach and intestine. This allows the doctor to look at the stomach and intestinal wall, thus allowing them to detect any ulcer present.
Barium meal involves the ingestion of a safe, chemical substance followed by x-ray. The presence of an ulcer will then show up in the x-ray.
A tissue biopsy is taken upon the discovery of an ulcer. A tissue biopsy is the removal of some tissue from the ulcer. It is then placed under a microscope to determine the nature of the ulcer. A biopsy is done at the same time during an endoscopy. Approximately 2% of stomach ulcer is found to be cancerous, which if detected early can be removed with no adverse consequences to the patient.
Symptoms
Pain is the most common symptom. The pain is described as burning, gnawing, or hunger.
Symptoms of gastric ulcers often do not follow a consistent pattern. Eating sometimes exacerbates rather than relieves pain. Other symptoms include bloating, nausea and vomiting.
In duodenal ulcers, pain tends to be consistent. Pain is absent on awakening, but appears in midmorning. Pain is relieved by food but returns 2 to 3 hours after a meal. Pain that awakens a sufferer at night is common.
Warning Symptoms
Seek immediate medical attention if any of the below warning symptoms are present
- Weight loss
- Anaemia
- Dark, tar like stools.
Treatment of ulcer
The most common form of treatment for peptic ulcer involves elevation of the pH of gastric content. This can be done by either taking medicines to inhibit the secretion of acid in the stomach (e.g. Losec, Zantac) or neutralising the stomach acid antacids (e.g. Mylanta, Gaviscon).
Because many ulcers stem from Helicobacter pylori bacteria, Doctors will also use antibiotics to eradicate the infection.
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