Adult Medicine Children's Health Dental Health Emotional Well Being/Psychiatric Dysfunction Health,Prevention, & Care HIV Issues and Topics Nutritional Consultation Sexual Health Issues

Peptic Ulcer Disease (PUD)

Basic Information

Peptic ulcer disease (PUD) affects the stomach, esophagus or, more usually, the duodenum. In fact, duodenal ulcers are four times more likely to occur than gastric ulcers (stomach ulcers). Peptic ulcers are a very common occurrence affecting 10% of men and 5% of women in the U.S. during their lifetimes, though women tend to be more affected by duodenal ulcers than ulcers of the stomach or esophagus.

Ulcers can be defined as erosions in the lining of the stomach, esophagus or duodenum and the causes are thought to be due to several factors or multi factors.

An infection with the bacteria H. pylori is thought to be one of the major causes -- it is found both in the stomach and duodenum -- and is present in 90% of patients with duodenal ulcers. PUD occurs because of a lack of balance between mucosal protective factors and mechanisms that are defined as damaging to the mucosa. These damaging factors are thought to include, and (besides H. pylori bacteria) are thought to contribute to causing PUD:

  • the use of medications such as aspirin and NSAIDs (nonsteroidal antiinflammatory drugs)
  • a lessening of blood flow to gastric mucosa
  • an increase in basal acid secretion (in 30% of patients)
  • alcohol
  • smoking
  • nocturnal acid secretion increase

Symptoms

Some patients do not present with symptoms except for a mild epigastric tenderness.

But most patients experience (no matter where the ulcer is located):

  • pain in the area of the upper abdomen, varying in intensity from patient to patient, and variously described as:
  • dull
  • boring
  • burning
  • gnawing

And often described as appearing in clusters. The pain is usually experienced on an empty stomach, a few hours after meals and is often relieved by food or by taking antacids. Sometimes the patient may be awakened by pain, especially late at night, that can radiate to the back, reminiscent of the experiences of the patient with GERD (gastroesophageal reflux disease).

Patients may also experience:

  • gastrointestinal bleeding (often the first sign)
  • abdominal bloating
  • nausea
  • vomiting, anorexia and weight loss (usually in patients with outflow obstruction)

It is important to seek treatment for PUD as certain complications may occur if left untreated such as:

  • hemorrhage
  • perforation (which can be asymptomatic in patients with HIV or in older patients) and occurs in 1% of PUD patients -- in less than 5% of patients with perforation peritonitis occurs.

Diagnosis/Treatment

The presence of the bacteria H. pylori is fairly common in the U.S. population and there is a test that indicates the presence of this bacteria in the stomach or duodenum but the test does not differentiate between the patient with PUD from, say, a patient with non-ulcer dyspepsia, therefore other diagnostic tests (besides specific antibody test for H. pylori) are indicated including:

  • a comprehensive medical history
  • physical exam
  • UGI (upper GI)
  • series including X-ray
  • endoscopy -- the test that gives the most information about your ulcer and is a necessity in diagnosing gastric ulcers. The test has an accuracy rate of 90 to 95% and can identify tiny ulcerations and can be used to biopsy ulcers and diagnose gastritis or duodenitis -- as well as esophagitis.

The goal of treatment is not only to heal the ulcer and relieve pain and discomfort but also to prevent ulcers from recurring. Treatment usually consists of both making lifestyle changes and the use of medications.

What you should do if you are diagnosed with PUD:

  • Stop smoking -- smoking not only decreases healing but increases recurrences.
  • Restrict alcohol intake.
  • Avoid all NSAIDs including aspirin.
  • No special diets are required but if there is a food you feel is responsible for discomfort, avoid it.
  • Try to eat balanced meals. Don't eat at bedtime.

Medications used to treat PUD caused by, or mainly caused by, infection by H. pylori usually include the triad of:

  • antibiotics
  • bismuth
  • proton pump inhibitors (suppresses acid secretions)

In patients who do not have H. pylori, a slightly different triad of medications is recommended:

  • proton pump inhibitors
  • antacids
  • H2-receptor antagonists

Pregnant or lactating women are not advised to use proton pump inhibitors. There may be other contraindications, side effects and drug interactions associated with medications used to treat PUD. Be certain you ask your health care provider about them.

Because of the efficacy of new medications, surgery is infrequently performed. It is an option for patients whose ulcers are not healed by medications.

Follow-up is important for patients with gastric ulcers. An endoscopy is usually indicated after 4 to 6 weeks of treatment to make certain healing is occurring. Healing should occur in 12 weeks with treatment for gastric ulcers and in 8 weeks for duodenal ulcers.

If your ulcer does not heal, usually re-treatment is advised followed by maintenance therapy.

If you have symptoms of PUD, please see your health care provider promptly.