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Peptic ulcer disease: Difference between revisions

Peptic ulcer disease (view source)

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== Etiology ==
== Etiology ==
In addition to H. pylori and NSAIDs, there are multiple other “supportive” risk factors. These include smoking, alcohol, steroid use, and stress. Severe stress like trauma, burns and surgery may predispose to PUD. These ulcers sometimes have special names: ''Curling-ulcus'' after severe burn injury, and ''Cushing-ulcus'' after CNS injury.
In addition to H. pylori and NSAIDs, there are multiple other “supportive” risk factors. These include [[smoking]], [[alcohol]], [[Corticosteroid|steroid]] use, and stress. Severe stress like trauma, burns and surgery may predispose to PUD. These ulcers sometimes have special names: ''Curling-ulcus'' after severe burn injury, and ''Cushing-ulcus'' after CNS injury.


The most important risk factors for ulcer bleeding are:
The most important risk factors for ulcer bleeding are:


* NSAID and aspirin use
* [[NSAID]] and aspirin use
* H. pylori infection
* [[Helicobacter pylori gastritis|H. pylori infection]]
* Alcohol
* [[Alcohol]]
* Anticoagulants and antiplatelets
* [[Anticoagulant|Anticoagulants]] and [[Antiplatelet|antiplatelets]]
[[Zollinger-Ellison syndrome]] is a rare cause of PUD.


== Pathology ==
== Pathology ==
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Symptomatic peptic ulcers present with epigastric pain or discomfort, as well as other non-specific symptoms like bloating, abdominal fullness, and nausea. The symptoms of duodenal ulcers frequently improve with eating and worsen a few hours after meals and at night. The symptoms of gastric ulcers worsen with eating.
Symptomatic peptic ulcers present with epigastric pain or discomfort, as well as other non-specific symptoms like bloating, abdominal fullness, and nausea. The symptoms of duodenal ulcers frequently improve with eating and worsen a few hours after meals and at night. The symptoms of gastric ulcers worsen with eating.


Bleeding ulcer presents with features of upper <abbr>GI</abbr> bleeding, like haematemesis, melena, or anaemia. Perforated ulcers are the most common cause of GI perforation and cause peritonitis. Duodenal ulcers may penetrate through the wall into adjacent organs, forming fistulas.
Bleeding ulcer presents with features of [[Gastrointestinal bleeding|upper <abbr>GI</abbr> bleeding]], like haematemesis, melena, or anaemia.  


== Diagnosis and evaluation ==
== Diagnosis and evaluation ==
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== Complications ==
== Complications ==
Peptic ulcers may [[Gastrointestinal bleeding|bleed]], obstruct the gastric outlet, or perforate. Perforation may lead to [[peritonitis]].
Peptic ulcers may [[Gastrointestinal bleeding|bleed]], obstruct the gastric outlet, or perforate. Perforated ulcers are the most common cause of GI perforation and cause [[peritonitis]]. Duodenal ulcers may penetrate through the wall into adjacent organs, forming fistulas.


== Treatment ==
== Treatment ==
Treatment involves treating the underlying cause, removing risk factors, and giving PPIs.
Treatment involves treating the underlying cause, removing risk factors, and giving [[PPI|PPIs]].


Surgical treatment is necessary for the treatment of complications like perforation, bleeding (if endoscopic haemostasis fails), pyloric stenosis, cases which don’t respond to conservative therapy, or if malignancy is discovered.
Surgical treatment is necessary for the treatment of complications like perforation, bleeding (if endoscopic haemostasis fails), pyloric stenosis, cases which don’t respond to conservative therapy, or if malignancy is discovered.


Perforations and bleeding ulcers may be simply sutured or closed with a patch, or they may be treated with partial gastric resection and reconstruction surgeries like Billroth I, Billroth II, or Roux-en-Y. Many years ago, vagotomy was performed to reduce the production of stomach acid.
Perforations and bleeding ulcers may be simply sutured or closed with a patch, or they may be treated with partial gastric resection and reconstruction surgeries like Roux-en-Y (or, in the past, Billroth I or Billroth II). Many years ago, vagotomy was performed to reduce the production of stomach acid.


Many complications may occur after gastric resection:
Many complications may occur after gastric resection:
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* Dumping syndrome
* Dumping syndrome
* Maldigestion
* Maldigestion
* B12 deficiency
* [[Vitamin B12 deficiency|B12 deficiency]]
 
== Zollinger-Ellison syndrome ==
Zollinger-Ellison syndrome is a rare cause of PUD. It is characterized by multiple peptic ulcerations in the stomach, duodenum and even jejunum. It is caused by neuroendocrine tumors that produce gastrin, called gastrinomas, and they are often located in the pancreas, duodenum or the lymph nodes of the abdomen. Increased gastrin means increased stomach acid.
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Gastrointestinal surgery]]
[[Category:Gastrointestinal surgery]]