Peptic ulcer

Peptic ulcer is usually a non-malignant ulcer of the stomach (called gastric ulcer) or duodenum (called duodenal ulcer). About 4 % of gastric ulcers are caused by malignant tumour, which is why ulcers of stomach are controlled. Duodenal ulcers are non-malignant. By far most instances are now known to be due to Helicobacter pylori, a spiral-shaped bacterium that lives in the acid environment of the stomach. These ulcers can also be caused or worsened by drugs such as Aspirin and other NSAIDs.

Signs and symptoms

Symptoms of a peptic ulcer can be:

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• Abdominal pain;
• Hematemesis (vomiting blood);
• Melena (tarry feces due to oxidised iron from hemoglobin);
• Weight loss;
• Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer are NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase 1, and most glucocorticoids (e.g. dexamethasone).

Related Topics:
Heartburn - Gastroesophageal reflux disease - NSAID - Cyclooxygenase - Glucocorticoid - Dexamethasone

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In patients over 45 with more than 2 weeks of the above symptoms the odds for peptic ulceration are high enough to warrant rapid investigation by EGD (see below).

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In earlier times it was thought that the timing of the symptoms in relation to the meal could differentiate between gastric and duodenal ulcers: a gastric ulcer would give pain during the meal, as gastric acid was secreted, while duodenal ulcers would only hurt after the meal — when acidic chyme was passed down to the duodenum. This theory has not been proved in practice.

Related Topics:
Gastric acid - Chyme - Duodenum

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