Peptic Ulcer Disease (PUD) refers to the formation of open sores in the lining of the stomach or the upper part of the small intestine (duodenum). These ulcers develop when the natural balance between digestive acids and the protective mucosal layer breaks down. PUD is a common gastrointestinal disorder that can lead to pain, bleeding, and serious complications if untreated. This article explains PUD in simple language, focusing on causes, symptoms, diagnosis, and treatment options.
1. Types of Peptic Ulcer Disease
- Gastric Ulcer: Occurs in the stomach lining
- Duodenal Ulcer: Occurs in the first part of the small intestine
- Stress Ulcer: Caused by severe illness, burns, or trauma
2. Causes of Peptic Ulcer Disease
1. Helicobacter pylori (H. pylori) Infection
This bacteria damages the protective mucous layer and increases acid exposure, leading to ulcer formation.
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Drugs like aspirin, ibuprofen, and naproxen reduce prostaglandins, weakening the stomach’s protective barrier.
3. Excess Stomach Acid
Conditions like Zollinger–Ellison syndrome cause excess acid production.
4. Other Contributing Factors
- Stress
- Smoking
- Alcohol consumption
- Spicy foods (worsen symptoms but do not directly cause ulcers)
3. Risk Factors
- Frequent NSAID use
- Family history of ulcers
- Smoking and alcohol use
- Chronic medical illnesses
- Older age (reduced mucosal defense)
4. Symptoms of Peptic Ulcer Disease
- Burning or gnawing pain in the upper abdomen
- Pain relieved by eating (duodenal ulcer)
- Pain worsened by food (gastric ulcer)
- Nausea and vomiting
- Bloating or fullness
- Unintentional weight loss
Alarm Symptoms (Serious)
- Vomiting blood (hematemesis)
- Black tarry stools (melena)
- Severe abdominal pain
- Sudden dizziness or fainting
5. Diagnosis
Diagnosis is based on symptoms, clinical evaluation, and specific tests.
1. Endoscopy (EGD)
The most accurate test. Helps visualize the ulcer and rule out cancer.
2. H. pylori Testing
- Urea breath test
- Stool antigen test
- Rapid urease test (during endoscopy)
3. Laboratory Tests
CBC, liver function, and stool occult blood tests may be performed.
6. Treatment of Peptic Ulcer Disease
1. Eradication of H. pylori
Combination therapy is essential. Common regimens include:
- Triple Therapy (14 days): PPI + Clarithromycin + Amoxicillin
- Quadruple Therapy: PPI + Bismuth + Metronidazole + Tetracycline
- Sequential Therapy: Amoxicillin → Clarithromycin + Metronidazole
2. Acid Suppression
- Proton Pump Inhibitors (PPIs): Omeprazole, Pantoprazole
- H2 Blockers: Ranitidine, Famotidine
- Antacids: Temporary relief of symptoms
3. Protecting Stomach Lining
- Sucralfate: Forms protective coating
- Misoprostol: Used in NSAID-induced ulcers
4. Stopping NSAIDs
Whenever possible, NSAIDs should be discontinued or replaced with safer alternatives.
7. Complications
- Bleeding
- Perforation
- Gastric outlet obstruction
- Recurrent ulcers
8. Lifestyle and Dietary Recommendations
- Avoid spicy and acidic foods that worsen pain
- Stop smoking and alcohol
- Eat smaller, more frequent meals
- Reduce stress and improve sleep
- Avoid unnecessary NSAID use
9. Role of the Pharmacist
- Educate patients about medication adherence
- Monitor for adverse effects of PPIs and antibiotics
- Counsel on avoiding NSAIDs and irritant foods
- Promote H. pylori testing when appropriate
- Identify drug interactions (e.g., clarithromycin)
Detailed Notes:
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