Peptic ulcer disease

Peptic ulcer disease (PUD), also known as a peptic ulcer or stomach ulcer, is a break in the lining of the stomach, first part of the small intestine, or occasionally the lower esophagus.An ulcer in the stomach is known as a gastric ulcer while that in the first part of the intestines is known as a duodenal ulcer.
Peptic ulcers include:

Gastric ulcers that occur on the inside of the stomach
Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

Signs and symptoms

A gnawing or burning pain in the middle or upper stomach between meals or at night
Bloating or belching
Heartburn
Nausea or vomiting
Fatty food intolerance

Less often, ulcers may cause severe signs or symptoms such as:

Vomiting or vomiting blood — which may appear red or black
Dark blood in stools, or stools that are black or tarry
Trouble breathing
Feeling faint
Nausea or vomiting
Unexplained weight loss

Appetite changes

Causes
No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum

H. pylori
A major causative factor (60% of gastric and up to 50–75%[of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonizes the Gastric mucosa.The immune system is unable to clear the infection, despite the appearance of antibodies.
NSAIDs
Another major cause is the use of NSAIDs, such as ibuprofen and aspirin.The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins.
Other medicationsTaking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate and risedronate , can greatly increase the chance of developing ulcers.
Stress
Stress due to serious health problems such as those requiring treatment in an intensive care unit is well described as a cause of peptic ulcers, which are termed stress ulcers

Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output
Excessive drinking of alcohol
Smoking or chewing tobacco

Diagnosis
In order to detect an ulcer, your doctor may first take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as:

Laboratory tests for H. pylori. Your doctor may recommend tests to determine whether the bacterium H. pylori is present in your body. He or she may look for H. pylori using a blood, stool or breath test. The breath test is the most accurate. Blood tests are generally inaccurate and should not be routinely used.
Endoscopy
Your doctor may use a scope to examine your upper digestive system (endoscopy). During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers.
Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays of your upper digestive system creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.

Treatment

Anti H-pyroli Drugs

Antibiotics/Antibacterial:

  • amoxicillin

10-14 days of bismuth quadruple therapy (bismuth, proton pump inhibitor [PPI], tetracycline, and a nitroimidazole) (strong recommendation), particularly in those with previous macrolide exposure or are penicillin allergic
(Recommended option) 10-14 days of concomitant PPI, clarithromycin, amoxicillin, and a nitroimidazole (strong recommendation)
14 days of clarithromycin triple therapy (clarithromycin, a PPI, and amoxicillin or metronidazole) should be reserved for patients with no previous history of macrolide exposure who live in regions where clarithromycin resistance among H pylori isolates is known to be low (<15%) (conditional recommendation)

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