by Winaro Win,
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INDONESIA, Jul 10 — Peptic ulcers are a common health problem worldwide. Various factors affect this disease. Having known that Helicobacter pylori as a source of infection of the ulcer, antibiotic therapy becomes an option.
Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation
P
eptic ulcers are a common health problem worldwide. Various factors affect this disease. Having known that Helicobacter pylori as a source of infection of the ulcer, antibiotic therapy becomes an option. However, proton pump inhibitor type drugs such as esomeprazole (Nexium), omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (Aciphex) remains the main drug in the treatment of ulcers.
In the digestive system, an ulcer is an area where tissue has been destroyed by the gastric juices and stomach acid. Peptic ulcer disease is a general term for ulcers that occurs in the stomach or the duodenum, which is the upper part of the small intestine.
A peptic ulcer is an erosion or sore in the wall of the gastrointestinal tract. The mucus membrane lining the digestive tract erodes and causes a gradual breakdown of tissue. This breakdown causes a burning pain in the upper middle part of the belly (abdomen). Although, most peptic ulcers are small, they can cause a considerable amount of discomfort.
Signs and Symptoms
Ulcers do not always cause symptoms. Sometimes, a serious complication such as bleeding is the first sign of an ulcer. The most common symptom of peptic ulcer, by far, is abdominal pain. The pain can feel like burning and it may go to the back.
The pain often comes several hours after meal when the stomach is empty. The pain is often worse at night and early morning. It can last anywhere from a few minutes to several hours. The pain may be relieved by food, anti-acid, or vomiting. Other symptoms of peptic ulcer include nausea, vomiting, loss of appetite, or weight loss.
When the bleeding occurs, it can be fast or slow. Fast bleeding reveals itself in one of the following ways:
Vomiting of blood or dark material that looks something like a coffee ground. This is an emergency and warrants an immediate visit to the emergency department.
Blood in the stool or black, tarry, sticky looking stools.
Slow bleeding is often more difficult to detect because it has no dramatic symptoms.
Causes of Peptic Ulcer
For many years, excess acid secretion was believed to be the major cause of ulcers. Accordingly, emphasis was on neutralizing and inhibiting the secretion of acid or gastric juice in the stomach. While acid is still considered significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the stomach by a bacteria called Helicobacter pyloricus (H. pylori) a spiral-shaped bacterium that lives in the acidic environment of the stomach.
Ulcers can also be caused or worsened by drugs such as aspirin and other NSAIDs (Non Steroidal Anti Inflammatory Drugs) like Diclofenac or Ibuprofen especially when taken in empty stomach or on a low diet.
Some studies have found correlations between smoking and ulcer formation. Stress, alcohol, coffee, colas, spicy foods or caffeine by itself does not cause peptic ulcer but they do make it worse and prevent them from healing properly.
Options for Treatment
Younger patients with ulcer-like symptoms are often treated with antacids, H2 antagonists or Proton Pump Inhibitors (PPIs). Patients who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) may also be prescribed a prostaglandin analogue (Misoprostol) in order to help prevent peptic ulcers, which may be a side-effect of the NSAIDs in addition to Proton Pump Inhibitors (PPIs).
When H. pylori infection is present, the most effective treatments are combinations of 2 or 3 antibiotics and 1 proton pump inhibitor (PPI), sometimes together with a bismuth compound. In the absence of H. pylori, long-term higher doses of PPIs are often used.
Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics. Since the widespread use of PPI’s in the 1990s, surgical procedures (like "highly selective vagotomy") for uncomplicated peptic ulcers became obsolete.
Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery, injection, or clipping.
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