Peptic Ulcer Disease (PUD) – A brief note

Introduction

Peptic Ulcer Disease (PUD) is a gastrointestinal disorder characterized by sores or lesions in the lining of the stomach or duodenum. It is a significant health concern worldwide, affecting a broad demographic.

Pathophysiology

Peptic ulcers result from an imbalance between mucosal defensive factors (like mucus and bicarbonate secretion) and aggressive factors (such as gastric acid and pepsin). This imbalance leads to mucosal damage and ulcer formation.

Key Causes

1. Helicobacter pylori Infection: This bacterium colonizes the gastric mucosa, causing chronic inflammation and increasing vulnerability to acid, leading to ulcers. It’s the most common cause of PUD [1-3].
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These drugs inhibit the production of prostaglandins, which protect the gastric mucosa. Their prolonged use disrupts mucosal integrity, leading to ulceration [1-3].
3. Other Factors: Additional causes include hypersecretory conditions like Zollinger-Ellison syndrome, lifestyle factors (smoking, alcohol), stress, and other medications (corticosteroids) [2, 3].

Clinical Manifestations

Symptoms vary, ranging from asymptomatic to severe, including [1-4]:

• Persistent burning or gnawing stomach pain, often relieved by eating or antacids.
• Bloating, belching, and nausea.
• Vomiting, sometimes with blood.
• Dark or bloody stools.
• Weight loss and reduced appetite in severe cases.

Diagnostic Approach

Diagnosis involves a combination of clinical assessment and diagnostic tests:

• Endoscopy: Direct visualization of the ulcer; biopsy may be performed for H. pylori detection.
• Barium X-ray: Less commonly used, provides images of the upper digestive system.
• H. pylori Testing: Includes urea breath test, stool antigen test, and blood serology [4].

Treatment Modalities

Treatment depends on the cause and severity of the ulcer:

• Eradicating H. pylori: Combination therapy with two antibiotics and a proton pump inhibitor (PPI) or bismuth subsalicylate.
• Reducing Acid Production: PPIs and H2-receptor antagonists.
• Protecting the Mucosa: Medications like sucralfate and misoprostol.
• Lifestyle Modifications: Avoiding NSAIDs, reducing alcohol intake, quitting smoking.
• Surgery: Rarely required, used in cases of complications like perforation or uncontrolled bleeding [1-4].

Complications

Potential complications include:

• Gastrointestinal bleeding, evident from hematemesis or melena.
• Perforation, leading to acute peritonitis.
• Gastric outlet obstruction due to scarring and swelling.
• Increased risk of gastric cancer, particularly with chronic H. pylori infection [2, 3].

Prevention and Management

Preventive strategies focus on reducing risk factors:

• Limiting NSAID use.
• Lifestyle changes like smoking cessation and moderate alcohol use.
• Effective management of H. pylori infection [1-4].

Conclusion

Peptic ulcer disease, primarily driven by H. pylori infection and NSAID use, is a manageable condition. Early diagnosis, appropriate treatment, and lifestyle modifications are key to effective management and prevention of complications.

References

1. Mayo Clinic. Peptic Ulcer [Internet]. Mayo Clinic; 2022 [cited 2023 Nov 20]. Available from: https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223
2. Cleveland Clinic. Peptic Ulcer Disease [Internet]. Cleveland Clinic; 2023 [cited 2023 Nov 20]. Available from: https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease
3. National Institute of Diabetes and Digestive and Kidney Diseases. Peptic Ulcers (Stomach Ulcers) [Internet]. NIDDK; 2023 [cited 2023 Nov 20]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes
4. WebMD. Peptic Ulcer Overview [Internet]. WebMD; 2023 [cited 2023 Nov 20]. Available from: https://www.webmd.com/digestive-disorders/peptic-ulcer-overview

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