Stomach Problem/Ulcer

Peptic ulcer (stomach, duodenum) definition and facts 

1) Peptic ulcer are sores in the lining of the esophagus, stomach or duodenum.

2) The main symptom of a stomach or duodenal ulcer is upper abdominal pain, which can be dull, sharp, or burning (a hunger-like feeling). (Bloating and burping are not symptoms of peptic ulcer, and vomiting, poor appetite, and nausea are uncommon symptoms of peptic ulcer.)

3) Other associated symptoms may include:

– Acid reflux or heartburn

– Feeling satiated (full) when eating
4) Peptic ulcer formation is related to H. pylori bacteria in the stomach     and nonsteroidal anti-inflammatory medications (NSAIDs) in 50% of patients. For the remaining 50% there are miscellaneous causes such as drugs, lifestyle factors (smoking), severe physiological stress, and genetic factors, but less frequently the cause is unknown.
5) Ulcer pain may not correlate with the presence or severity of ulceration.Diagnosis of an ulcer can be made with an upper GI series or endoscopy.
6) Treatment of the esophagus, stomach or duodenal ulcersaims to relieve pain, heal the ulcer, and prevent complications. Medical treatment involves antibiotic combinations along with stomach acid suppression medication, for example, antacids, proton pump inhibitors (PPIS) to eradicate H. pylori eliminating precipitating factors such as NSAIDs or suppressing stomach acid alone.
7) Complications of esophageal, duodenal or stomach ulcers include bleeding, perforation, and blockage to the passage of food due to gastric obstruction from the swelling or scaring that surrounds the ulcer.
8) If a person with peptic ulcers smokes or takes NSAIDs, the ulcers may recur after treatment.

What is a peptic ulcer? 
A peptic ulcer (stomach or duodenal) is a break in the inner lining of the esophagus, stomach, or duodenum. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. Peptic ulcers occur when the lining these organs is eroded by the acidic digestive (peptic) juices that the cells of the lining secrete of the stomach secrete. A peptic ulcer differs from an erosion because it extends deeper into the lining and incites more of an inflammatory reaction from the tissues that are involved, occasionally with scaring. Peptic ulcer also is referred to as peptic ulcer disease.

Peptic ulcer disease is common, affecting millions of Americans yearly. Moreover, peptic ulcers are a recurrent problem; even healed ulcers can recur unless treatment is directed at preventing their recurrence. The medical cost of treating peptic ulcer and its complications runs into billions of dollars annually. Recent medical advances have increased our understanding of ulcer formation. Improved and expanded treatment options now are available.
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Bleeding Ulcers Symptoms and Causes 
Bleeding ulcers are a big deal. Often having endoscopy is diagnostic and therapeutic. A gastroenterologist can use a fiberoptic camera to view the inside of the stomach and duodenum, searching for a source of bleeding.

Symptoms of a bleeding ulcer include: 
– Indigestion
– Abdominal discomfort after eating
– Upper abdominal burning or hunger pain 1 to 3 hours after eating or in the middle of the night

What are the signs and symptoms of peptic ulcers? 
Symptoms of esophageal, duodenal or stomach ulcer disease vary. Many people with ulcers experience minimal indigestion, abdominal discomfort that occurs after meals or no discomfort at all. Commonly people complain of upper abdominal burning or hunger pain one to three hours after meals or in the middle of the night. Food or antacids that neutralize stomach acid often promptly relieve these symptoms.

Are peptic ulcers painful?
The pain of ulcer disease correlates poorly with the presence or severity of active ulceration. Some individuals have persistent pain even after an ulcer is almost completely healed by medication. Others experience no pain at all. Ulcers often come and go spontaneously without the individual ever knowing that they are present unless a serious complication (like bleeding or perforation) occurs.

What causes peptic ulcers? 
For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, the emphasis of treatment was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered necessary for the formation of ulcers and its suppression is still the primary treatment, the two most important initiating causes of ulcers are infection of the stomach by a bacterium named “Helicobacter pylori” (H. pylori) and chronic use of nonsteroidal anti-inflammatory medications or NSAIDs, including aspirin. Cigarette smoking also is an important cause of ulcers as well as failure of ulcer healing.

Infection with H. pylori is very common, affecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10% to 15% of those infected. In the past, H. pylori was found in more than 80% of patients with gastric and duodenal ulcers. With increasing appreciation, diagnosis and treatment of this infection, the prevalence of infection with H. pylori as well as the proportion of ulcers caused by the bacterium has decreased. It is estimated that currently only 20% of ulcers are associated with the bacterium. While the mechanism by which H. pylori causes ulcers is complex, elimination of the bacterium by antibiotics has clearly been shown to heal ulcers and prevent their recurrence.

NSAIDs are medications used for the treatment of arthritis and other painful inflammatory conditions in the body. Aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and etodolac (Lodine) are a few examples of this class of medications. Prostaglandins are substances produced by the body, which are important in helping the linings of the esophagus, stomach, and duodenum to resist damage by the acidic digestive juices of the stomach. NSAIDs cause ulcers by interfering with the production of prostaglandins in the stomach.

Cigarette smoking not only causes ulcers, but it also increases the risk of complications from ulcers such as bleeding, obstruction, and perforation. Cigarette smoking also is a leading cause of failure of treatment for ulcers.

Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation. Similarly, there is no conclusive evidence to suggest that life stresses or personality types contribute to ulcer disease.

How are peptic ulcers diagnosed?
The diagnosis of an ulcer is made by either a barium upper gastrointestinal X-ray (upper GI series) or an upper gastrointestinal endoscopy (EGD or esophagogastroduodenoscopy). The barium upper gastrointestinal (GI) X-ray is easy to perform and involves no risk (other than exposure to radiation) or discomfort. Barium is a chalky substance that is swallowed. It is visible on X- rays, and allows the outline of the stomach to be seen on X-rays; however, barium X-rays are less accurate and may miss ulcers up to 20% of the time.

An upper gastrointestinal endoscopy is more accurate than X-rays, but usually involves sedation of the patient and the insertion of a flexible tube through the mouth to inspect the esophagus, stomach, and duodenum. Upper endoscopy has the added advantage of having the capability of removing small tissue samples (biopsies) to test for H. pylori infection. Biopsies are also examined under a microscope to exclude a cancerous ulcer. While virtually all duodenal ulcers are benign, gastric ulcers can occasionally be cancerous. Therefore, biopsies often are performed on gastric ulcers to exclude cancer.

Is there a special diet for peptic ulcer disease? 
There is no conclusive evidence that dietary restrictions and bland diets play a role in ulcer healing. No proven relationship exists between peptic ulcer disease and the intake of coffee and alcohol. However, since coffee stimulates gastric acid secretion, and alcohol can cause gastritis, moderation in alcohol and coffee consumption is recommended.

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