PEPTIC ULCER
PEPTIC ULCER:
In the Modern world, large advancements in technology have been achieved by humans. This has not come easily. Workplace stress, deadlines, and a large number of people dependent on outside food have all combined to cause an increasing trend of Peptic Ulcer Disorder.
A peptic ulcer is otherwise known by several names, most commonly as gastritis, acidity, stomach ulcer, etc.
Digestive system health is often neglected by several people because of misconceptions about what food is correct to take, how much to take, modern unhealthy lifestyle or junk food, fried foods intake, etc
Peptic Ulcer :
Peptic ulcers are wounds that develop on the inner lining of your stomach and the proximal part of the small intestine called duodenum. The most common symptom of a peptic ulcer is stomach pain.
- Gastric ulcer- occurs in the stomach usually the distal portion
- Duodenal ulcer: Occurs in the starting part called the first part of the duodenum
Causes:
When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food. The food is partially digested in the stomach and then moves on to the duodenum to continue the process. The inner lining of the stomach has several defense mechanisms to this acid like mucosal lining secretes bicarbonate, good blood flow. Peptic ulcers occur when the acid overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall.
- H.pylori: Helicobacter pylori infection has been found to be the most common cause of the peptic ulcer. 90 percent of gastric ulcers are due to this.
- H. pylori cause chronic infection and break down the mucosal barrier of the stomach and cause gastritis and finally peptic ulcers
- NSAIDs- painkillers and certain anti-inflammatory drugs lead to peptic ulcers
- Other causes-
Stress( hospitalization, burns patients, severe injuries), Anxiety disorder, Zollinger-Ellison syndrome, etc
SYMPTOMS:
Abdomen pain is the most common symptom. The pain is usually in the upper middle part of the abdomen, and below the breastbone. The ulcer pain can feel like burning or gnawing, and it may go through to the back. The pain usually occurs immediately after food intake or a few hours later (on empty stomach )
All this can be relieved by proper Timely Healthy food intake
Poor appetite because of pain,
nausea or vomiting,
bloating, feeling easily full
burping or acid reflux,
heartburn, which is a burning sensation in the chest)
- pain that may improve when you eat, drink, or take antacids
Risk Factors that May Increase Risk-
Risk factors
In addition to taking NSAIDs, you may have an increased risk of peptic ulcers if you:
- Smoke. Smoking may increase the risk of peptic ulcers in people
- Drink alcohol. Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
- Have untreated stress.
- Eat spicy foods.
- High-Stress Lifestyle, lack of sleep
Complications:
Bleeding-Bleeding usually occurs as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black stools.
Perforation: Long-standing untreated peptic ulcers may completely erode the gastric wall leading to this complication
Obstruction: The ulcer may heal leading to scar formation and the outlet may get partially blocked leading to recurrent vomiting, weight loss, etc
Diagnosis:
- Endoscopy: Upper GI Endoscopy is best to diagnose and detect Peptic ulcers or any gastritis which is the previous stage. Also detects any bleeding from the ulcer
- Endoscopic biopsy – for H.pylori infection, gastritis
- Urease breath test- to detect H.pylori
Treatment :
Medical management:
There is a huge advancement in the measures available for treating peptic ulcers
PPIs- Tablet Pantoprazole group drugs. This is the gold standard now and directly acts on the proton pump to decrease acid secretion and relieves acidity. Superior healing rates of duodenal ulcer is seen.
Tab pantoprazole is usually taken once daily – half an hour before food
H2 antagonists- Tablet Ranitidine. Acts to decrease acid secretion
Tab ranitidine is taken twice daily- before food
Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid- Sucralfate syrup
H.Pylori infection treatment: combining antibiotics against H. pylori with antacid medications. This results in long term cure and prevents any recurrence.
Surgical Management:
Surgery is required in case of long-standing and intractable ulcers only. After the advent of newer antacid drugs, surgery has become very rare.
Truncal vagotomy, Highly selective vagotomy are some procedures done.
Complications of peptic ulcer usually require surgery based on each individual condition and status of Disease.
Prevention :
HEALTHY DIET HABITS :
Try to eat five separate meals each day, rather than three large ones.
Finish up eating at least two hours before bedtime, and try to stay upright for a few hours after that
Avoid Smoking, alcohol
Choose a healthy diet. Choose a healthy diet full of fruits, especially with vitamins A and C, vegetables, and whole grains. Not eating vitamin-rich foods may make it difficult for your body to heal your ulcer.
Try to get enough sleep. Sleep can help your immune system, and therefore counter stress. Also, avoid eating shortly before bedtime.
High Fibre diet- Nutritious fruits, vegetables
Lifestyle modifications- Plenty of physical exercises, avoid sedentary life, Good sleep for 7 hours