Peptic ulcer definition

The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). The test-and-treat strategy for detecting H. pylori is appropriate in situations where the risk of gastric cancer is low based on age younger than 55 years and the absence of alarm symptoms. Most other patients should undergo upper endoscopy to rule out malignancy and other serious causes of dyspepsia. Urea breath tests and stool antigen tests are most accurate for identifying H. pylori infection and can be used to confirm cure; serologic tests are a convenient but less accurate alternative and cannot be used to confirm cure. Treatment choices include standard triple therapy, sequential therapy, quadruple therapy, and levofloxacin-based triple therapy. Standard triple therapy is only recommended when resistance to clarithromycin is low. Chronic use of NSAIDs in patients with H. pylori infection increases the risk of PUD. Recommended therapies for preventing PUD in these patients include misoprostol and proton pump inhibitors. Complications of PUD include bleeding, perforation, gastric outlet obstruction, and gastric cancer. Older persons are at higher risk of PUD because of high-risk medication use, including antiplatelet drugs, warfarin, selective serotonin reuptake inhibitors, and bisphosphonates. Clinical recommendation Evidence rating References Use the test-and-treat strategy for patients with dyspepsia who are younger than 5...

Treatment for a bleeding ulcer can depend on its location, cause, and severity. It may involve medical procedures or medications. Some people aren’t even aware they have an ulcer. Others have symptoms like Keep reading to learn more about symptoms and treatment for ulcers, as well as to uncover a few ulcer myths. Ulcers don’t always cause symptoms. In fact, only about • abdominal pain • • • heartburn • • Symptoms may be a little different for each person. In some cases, eating a meal can ease the pain. In others, eating only makes things worse. An ulcer can bleed so slowly that you don’t notice it. The first signs of a slow-bleeding ulcer are symptoms of • • • lack of energy • • An ulcer that is bleeding heavily may cause: • • dark red or maroon colored blood in your stool • Rapid bleeding from an ulcer is a life-threatening event. If you have these symptoms, seek immediate medical attention. There’s a layer of mucus in your digestive tract that helps protect the gut lining. When there’s too much acid or not enough mucus, the acid erodes the surface of your stomach or small intestine. The result is an open sore that can bleed. Why this happens can’t always be determined. The two most common causes are Helicobacter pylori and nonsteroidal anti-inflammatory drugs. Helicobacter pylori ( H. pylori) H. pylori is a bacterium that lives within the mucus in the digestive tract. It can sometimes cause inflammation in the stomach lining, which leads to an ulcer. The risk may be grea...

Endoscopy An upper gastrointestinal endoscopy involves inserting a flexible, lighted tube called an endoscope down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine, called the duodenum. 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. For the breath test, you drink or eat something that contains radioactive carbon. H. pylori breaks down the substance in your stomach. Later, you blow into a bag, which is then sealed. If you're infected with H. pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide. If you are taking an antacid prior to the testing for H. pylori, make sure to let your doctor know. Depending on which test is used, you may need to discontinue the medication for a period of time because antacids can lead to false-negative results. • 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 int...

You have a You can have two types of peptic ulcer disease: • Gastric • Duodenal ulcer. This appears at the top end of the small intestine, an organ that digests and absorbs much of the food you eat. You can have ulcers at any age, but your chances go up as you get older. What Causes Peptic Ulcers? Ulcers form when digestive juices damage the walls of the • Bacteria. It’s called H. pylori), and as many as half of us carry it. Most people infected with H. pylori do not get ulcers. But in others, it can raise the amount of acid, break down the protective mucus layer, and irritate the digestive tract. Experts aren’t sure how H. pylori infection spreads. They think it may pass from person to person through close contact, like • Certain pain relievers. If you’ve been taking • What Are the Symptoms of a Peptic Ulcer? You’ll most likely feel a burning pain or discomfort between your belly button and breastbone. You might especially notice it on an empty stomach -- such as between meals or at night. The Other symptoms may include: • Bloated feeling • Burping • Lack of appetite or weight loss • • Bloody or dark • Small ulcers may not cause any symptoms. But if you notice any of these signs, talk to your doctor. How Is a Peptic Ulcer Diagnosed? Your doctor will ask about your symptoms, whether you take NSAIDs and other drugs, and medical history. They’ll also check you for The only way your doctor can tell for sure if you have an ulcer is to look. They may use a series of X-rays or a...

• Emma Sverdén , upper gastrointestinal surgeon 1 2, • Lars Agréus , general practitioner , professor 3 4, • Jason M Dunn , gastroenterologist 5, • Jesper Lagergren , upper gastrointestinal surgeon, professor 1 5 • 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden • 2Department of Upper Gastrointestinal Surgery, South Hospital, Stockholm, Sweden • 3Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden • 4The University of Newcastle, Australia • 5School of Cancer and Pharmaceutical Sciences, King’s College London, and Guy’s and St Thomas’ NHS Foundation Trust, UK • Correspondence to emma.s.eklundgmail.com What you need to know • More than 90% of duodenal ulcers are linked to H pylori infection; eradication therapy with antibiotics and proton pump inhibitors is the mainstay of treatment • A “test and treat” strategy for H pylori infection is appropriate in patients under 60 with suspected peptic ulcer disease who have no complications • Proton pump inhibitors are important in the prevention and treatment of peptic ulcer disease, but avoid their use without clear indications, and re-evaluate patients on long-term treatment • Gastric ulcers are followed up with endoscopy until healed to rule out malignancy • Urgently refer patients with complications such as ...